In addition to the subtype “lifelong/acquired,” five factors should be considered dur- ing assessment and diagnosis of genito-pelvic pain/penetration disorder because they may be relevant to etiology and/ or treatment: 1) partner factors (e.g., partner’s sexual problems, partner’s health status); 2) relationship factors (e.g., poor communication, dis- crepancies in desire for sexual activity); 3) individual vulnerability factors (e.g., poor body image, history of sexual or emotional abuse), psychiatric comorbidity (e.g., depression, anxiety), or stressors (e.g., job loss, bereavement); 4) cultural/religious factors (e.g., inhi- bitions related to prohibitions against sexual activity; attitudes toward sexuality); and 5) medical factors relevant to prognosis, course, or treatment. Each of these factors may contribute differently to the presenting symptoms of different women with this disorder.
There are no valid physiological measures of any of the component symptom dimen- sions of genito-pelvic pain/penetration disorder. Validated psychometric inventories may be used to formally assess the pain and anxiety components related to genito-pelvic pain/ penetration disorder.
The prevalence of genito-pelvic pain/ penetration disorder is unknown. However, approx- imately 15% of women in North America report recurrent pain during intercourse. Diffi- culties having intercourse appear to be a frequent referral to sexual dysfunction clinics and to specialist clinicians.
The development and course of genito-pelvic pain/ penetration disorder is unclear. Because women generally do not seek treatment until they experience problems in sexual functioning, it can, in general, be difficult to characterize genito—pelvic pain/penetration disorder as life- long (primary) or acquired (secondary). Although women typically come to clinical atten- tion after the initiation of sexual activity, there are often earlier clinical signs. For example, difficulty with or the avoidance of use of tampons is an important predictor of later problems.
Difficulties with vaginal penetration (inability or fear or pain) may not be obvious until sex- ual intercourse is attempted. Even once intercourse is attempted, the frequency of attempts may not be significant or regular. In cases where it is difficult to establish whether symptom- atology is lifelong or acquired, it is useful to determine the presence of any consistent period of successful pain-, fear-, and tension—free intercourse. If the experience of such a period can be established, then genito-pelvic pain/penetration disorder can be characterized as ac- quired. Once symptomatology is well established for a period of approximately 6 months, the probability of spontaneous and significant symptomatic remission appears to diminish.
Complaints related to genito-pelvic pain peak during early adulthood and in the peri- and postmenopausal period. Women with complaints about difficulty having intercourse appear to be primarily premenopausal. There may also be an increase in genito-pelvic pain—related symptoms in the postpartum period.
Environmental. Sexual and / or physical abuse have often been cited as predictors of the
DSM-IV-defined sexual pain disorders dyspareunia and vaginismus. This is a matter of con- troversy in the current literature.
Genetic and physiological. Women experiencing superficial pain during sexual inter— course often report the onset of the pain after a history of vaginal infections. Even after the in- fections have resolved and there are no known residual physical findings, the pain persists.
Pain during tampon insertion or the inability to insert tampons before any sexual contact has been attempted is an important risk factor for genit0<pelvic pain/penetration disorder.
In the past, inadequate sexual education and religious orthodoxy have often been consid- ered to be culturally related predisposing factors to the DSM-IV diagnosis of vaginismus.
This perception appears to be confirmed by recent reports from Turkey, a primarily Mus- lim country, indicating a strikingly high prevalence for the disorder. However, most avail- able research, although limited in scope, does not support this notion (Lahaie et al. 2010).