ability to experience vaginal penetration in any situation (e.g., intercourse, gynecological ex- aminations, tampon insertion) to the ability to easily experience penetration in one situation and but not in another. Although the most common clinical situation is when a woman is un- able to experience intercourse or penetration with a partner, difficulties in undergoing re- quired gynecological examinations may also be present. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts (Criterion A2) refers to pain occurring in differ- ent locations in the genito-pelvic area. Location of pain as well as intensity should be assessed.
Typically, pain can be characterized as superficial (vulvovaginal or occurring during penetra- tion) or deep (pelvic; i.e., not felt until deeper penetration). The intensity of the pain is often not linearly related to distress or interference with sexual intercourse or other sexual activities.
Some genito-pelvic pain only occurs when provoked (i.e., by intercourse or mechanical stim- ulation); other genito-pelvic pain may be spontaneous as well as provoked. Genito-pelvic pain can also be usefully characterized qualitatively (e.g., “burning," ”cutting,” ”shooting,” ”throb- bing”). The pain may persist for a period after intercourse is completed and may also occur during urination. Typically, the pain experienced during sexual intercourse can be reproduced during a gynecological examination.
Markedfear or anxiety about vulvovaginal or pelvic pain either in anticipation of, or during, or us a result of vaginal penetration (Criterion A3) is commonly reported by women who have regularly experienced pain during sexual intercourse. This "normal” reaction may lead to avoidance of sexual/intimate situations. In other cases, this marked fear does not appear to be closely related to the experience of pain but nonetheless leads to avoidance of inter- course and vaginal penetration situations. Some have described this as similar to a phobic reaction except that the phobic object may be vaginal penetration or the fear of pain.
Marked tensing or tightening of the pelvic ﬂoor muscles during attempted vaginal penetration (Criterion A4) can vary from reﬂexive-like spasm of the pelvic floor in response to at- tempted vaginal entry to ”normal/voluntary" muscle guarding in response to the antici- pated or the repeated experience of pain or to fear or anxiety. In the case of ”normal/ guarding” reactions, penetration may be possible under circumstances of relaxation. The characterization and assessment of pelvic ﬂoor dysfunction is often best undertaken by a specialist gynecologist or by a pelvic ﬂoor physical therapist.
Genito-pelvic pain/ penetration disorder is frequently associated with other sexual dysfunc- tions, particularly reduced sexual desire and interest (female sexual interest/arousal disor- der). Sometimes desire and interest are preserved in sexual situations that are not painful or do not require penetration. Even when individuals with genito—pelvic pain/penetration dis- order report sexual interest/motivation, there is often behavioral avoidance of sexual situ- ations and opportunities. Avoidance of gynecological examinations despite medical recommendations is also frequent. The pattern of avoidance is similar to that seen in phobic disorders. It is common for women who have not succeeded in having sexual intercourse to come for treatment only when they wish to conceive. Many women with genito-pelvic pain/ ten report that the symptoms significantly diminish their feelings of femininity.