Dyspareunia of vulvo-vaginal origin. Causes and management

Difficult or painful coitus is a symptom, not a pathologic entity. It may be caused by a congenital anomaly, an organic lesion, or a functional disorder of the vulva or vagina, or it may be psychic in origin. Although its cause can usually be determined relatively easily, a conditioned reflex created by a preexisting organic lesion, an anatomic malformation, or a deep-seated psychogenic problem producing fear of or aversion to sexual contact may tax the examiner's diagnostic ability. Reassurance, sexual counseling, deconditioning by vaginal dilation, and psychotherapy help most patients overcome dyspareunia. Surgery for the correction of congenital anomalies or the removal of organic lesions is sometimes required, but diligent evaluation to exclude a psychogenic factor for dyspareunia is first advisable.