Vaginismus and Dyspareunia: A Comparative Review of Female Sexual Pain Disorders

Melike Çarıkçı; Ayhan Çakıcı

doi:10.35365/cjhs.26.2.06

Authors

Melike Çarıkçı Kıbrıs Aydın Üniversitesi https://orcid.org/0009-0005-5717-8955
Ayhan Çakıcı Girne University https://orcid.org/0000-0002-5882-4892

DOI:

https://doi.org/10.35365/cjhs.26.2.06

Keywords:

genito-pelvic pain/penetration disorder, Vaginismus, dyspareunia, female sexual pain disorders, female sexual dysfunction, pelvic floor muscles

Abstract

Vaginismus and dyspareunia are among the most prevalent female sexual pain disorders and have a substantial impact on sexual functioning, psychological well-being, and intimate relationships. Although these disorders were historically classified as separate diagnostic entities, they were unified under the diagnosis of Genito-Pelvic Pain/Penetration Disorder (GPPPD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Nevertheless, this diagnostic integration has generated ongoing debate regarding whether clinically meaningful differences between the two conditions remain sufficiently recognized. Vaginismus is primarily characterized by involuntary pelvic floor muscle contraction, intense fear, anxiety, and avoidance of vaginal penetration, whereas dyspareunia is characterized predominantly by superficial or deep genital pain during sexual intercourse and is more frequently associated with identifiable organic conditions. This review comparatively examines the diagnostic characteristics, clinical manifestations, etiological mechanisms, psychosocial consequences, and current treatment approaches associated with vaginismus and dyspareunia. Recent national and international studies were systematically reviewed, with particular attention given to the biological, psychological, relational, and sociocultural factors contributing to the development and maintenance of these disorders. The reviewed evidence indicates that vaginismus is predominantly associated with psychogenic mechanisms involving fear, anxiety, and avoidance, whereas dyspareunia is more commonly related to biological conditions, including infections, hormonal changes, pelvic disorders, and neurophysiological mechanisms. Nevertheless, findings consistently demonstrate that both disorders develop through complex interactions among biological, psychological, and sociocultural factors. In conclusion, despite their classification under a single diagnostic category in DSM-5, distinguishing the predominant clinical features of vaginismus and dyspareunia remains essential for accurate differential diagnosis, individualized treatment planning, and improved clinical outcomes.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Publishing.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

https://doi.org/10.1176/appi.books.9780890425596.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

https://doi.org/10.117/appi.books.9780890425756.

Angel, K. (2010). The history of “female sexual dysfunction” as a mental disorder in the 20th century. Current Opinion in Psychiatry, 23(6), 536–541.

https://doi.org/10.1097/YCO.0b013e32833db7a1

Basson, R. (2000). The female sexual response: A different model. Journal of Sex & Marital Therapy, 26(1), 51–65. DOI: https://doi.org/10.1080/009262300278641

Berenguer-Soler, M., Navarro-Sánchez, A., Compañ-Rosique, A., Luri-Prieto, P., Navarro-Ortiz, R., Gómez-Pérez, L., Pérez-Tomás, C., Font-Juliá, E., Gil-Guillén, V. F., Cortés-Castell, E., Navarro-Cremades, F., Montejo, A. L., Arroyo-Sebastián, M. Á., & Pérez-Jover, V. (2022). Genito pelvic pain/penetration disorder (GPPPD) in Spanish women—Clinical approach in primary health care: Review and meta-analysis. Journal of Clinical Medicine, 11(9), 2340. https://doi.org/10.3390/jcm11092340

Bergeron, S., Charbonneau-Lefebvre, V., Rossi, M., & Rosen, N. O. (2021). Genito-pelvic pain/penetration disorder. In A. D. Lykins (Ed.), Encyclopedia of sexuality and gender. Springer. https://doi.org/10.1007/978-3-319-59531-3_39-1

Binik, Y. M. (2010). The DSM diagnostic criteria for dyspareunia. Archives of Sexual Behavior, 39(2), 292–303. https://doi.org/10.1007/s10508-009-9638-4.

Boardman, L. A., & Stockdale, C. K. (2009). Sexual pain. Clinical Obstetrics and Gynecology, 52(4), 682–690.

https://doi.org/10.1097/GRF.0b013e3181bf4a7e

Bogaert, E., & Roels, R. (2025). Sexual health in patient care: Shortcomings in medical training and experienced barriers in sexual history taking. BMC Medical Education, 25, Article 338. https://doi.org/10.1186/s12909-025-06850-3

Brauer, M., Lakeman, M., van Lunsen, R., & Laan, E. (2014). Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. The Journal of Sexual Medicine, 11(12), 3051–3063. https://doi.org/10.1111/jsm.12697

Brotto, L. A., Basson, R., & Gehring, D. (2010). Psychological profiles among women with vulvar vestibulitis syndrome. Journal of Psychosomatic Research, 69(3), 213–220.

https://doi.org/10.1016/j.jpsychores.2010.01.018.

Conforti, C. (2017). Genito-pelvic pain/penetration disorder (GPPPD): An overview of current terminology, etiology, and treatment. University of Ottawa Journal of Medicine, 7(2), 48–53. https://doi.org/10.18192/uojm.v7i2.2198

Cryle, P. (2012). Vaginismus: A Franco- American story. Journal of the History of Medicine and Allied Sciences, 67(1), 71-93. https://doi.org/10.1093/jhmas/jrq079.

Dewitte, M., Van Lankveld, J., & Crombez, G. (2011). Understanding sexual pain: A cognitive- motivational account. PAIN, 152(2), 251- 253.

https://doi.org/10.1016/j.pain.2010.10.051.

Dias-Amaral, A., & Marques-Pinto, A. (2018). Female genito-pelvic pain/penetration disorder: Review of the related factors and overall approach. Revista Brasileira de Ginecologia e Obstetrícia, 40(12), 787–793. https://doi.org/10.1055/s-0038-1675805

Doğan, S., Küçükgöncü, S., & Ertekin, S. (2008). Vaginismus: An overview from a sociocultural perspective. Sexual and Relationship Therapy, 23(3), 245-256.

https://doi.org/10.1080/14681990802167733.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. DOI: https://doi.org/10.1126/science.847460.

Eserdag, S., Sevinc, T., & Tarlaci, S. (2021). Do women with vaginismus have a lower threshold of pain? European Journal of Obstetrics & Gynecology and Reproductive Biology, 258, 189–192. https://doi.org/10.1016/j.ejogrb.2020.12.059

Heim, L. J. (2001). Evaluation and differential diagnosis of dyspareunia. American Family Physician, 63(8), 1535–1544.

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2019). Cochrane Handbook for Systematic Reviews of Interventions (2nd ed.). Wiley. https://doi.org/10.1002/9781119536604.

Ishak, W. W., Mikhail, A., Amiri, S. R., Berman, L. A. C., & Vasa, M. (2005). Sexual dysfunction. Focus, 3(4), 520–525. https://doi.org/10.1176/foc.3.4.520

Kaplan, H. S. (1979). The disorders of sexual desire and other new concepts and techniques in sex therapy. Disorders of sexual desire. Brunner/Mazel.

Lahaie, M.-A., Boyer, S. C., Amsel, R., Khalifé, S., & Binik, Y. M. (2010). Vaginismus: A review of the literature on the classification/diagnosis, etiology and treatment. Women’s Health, 6(5), 705–719. https://doi.org/10.2217/WHE.10.46

Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States. JAMA, 281(6), 537–544. DOI: https://doi.org/10.1001/jama.281.6.537.

Marshall, N., Levang, S. L., Liu, Y. D., Noga, H., Allaire, C., Altas, M., Correia, S., Driscoll, M., Merkt-Caprile, K., Nishikawara, R., Weaver, R., Howard, A. F., Sutherland, J., Brotto, L. A., Pukall, C. F., & Yong, P. J. (2025). Deep and superficial dyspareunia questionnaire: A patient-reported outcome measure for genito-pelvic dyspareunia. The Journal of Sexual Medicine, 22(5), 767–777. https://doi.org/10.1093/jsxmed/qdaf025

Mohammadzadeh, Z., Khakbazan, Z., Rad, M., & Farnam, F. (2023). Comparison of pain catastrophizing and anxiety in patients with dyspareunia and healthy women: A cross-sectional study. Journal of Medicine and Life, 16(2), 220–226. https://doi.org/10.25122/jml-2022-0234

Nasim, H., & Nashwan, A. J. (2025). The overlooked burden: Vaginismus and its greater prevalence in eastern women. Dialogues in Health, 6, Article 100205.

https://doi.org/10.1016/j.dialog.2025.100205

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. DOI: https://doi.org/10.1136/bmj.n71.

Pukall, C. F., Payne, K. A., Binik, Y. M., & Khalifé, S. (2005). Affective and sensory pain responses in women with vulvar vestibulitis syndrome. Pain, 113(1–2), 33–40.

https://doi.org/10.1016/j.pain.2004.10.003.

Rabinowitz, D., Lowenstein, L., & Gruenwald, I. (2017). Fear of vaginal penetration in the absence of pain as a separate category of female sexual dysfunction: A conceptual overview. Rambam Maimonides Medical Journal, 8(2), Article e0016.

https://doi.org/10.5041/RMMJ.10293

Raposo, C. F., Nobre, P. J., Manão, A. A., & Pascoal, P. M. (2024). Understanding sexual distress related to sexual function (SDRSF): A preliminary framework based on a qualitative study with clinical sexologists. International Journal of Clinical and Health Psychology, 24(3), Article 100473. https://doi.org/10.1016/j.ijchp.2024.100473

Raveendran, A. V., & Rajini, P. (2024). Vaginismus: Diagnostic challenges and proposed diagnostic criteria. Balkan Medical Journal, 41(1), 80–82.

https://doi.org/10.4274/balkanmedj.galenos.2023.2022-9-62

Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (2004). Vaginal spasm, pain, and behavior: An empirical investigation of the diagnosis of vaginismus. Archives of Sexual Behavior, 33(1), 5–17.

https://doi.org/10.1023/B:ASEB.0000007458.32852.c8

Ronghe, V., Pannase, K., Gomase, K. P., & Mahakalkar, M. G. (2023). Understanding hypoactive sexual desire disorder (HSDD) in women: Etiology, diagnosis, and treatment. Cureus, 15(11), Article e49690. https://doi.org/10.7759/cureus.49690

Rosen, N. O., & Bergeron, S. (2019). Genito-pelvic pain through a dyadic lens: Moving toward an interpersonal emotion regulation model of women’s sexual dysfunction. The Journal of Sex Research, 56(4–5), 440–461. https://doi.org/10.1080/00224499.2018.1513987

Sahoo, M. K., & Biswas, H. (2024). Unraveling the complexity of vaginismus in marital relationship: A case series. Cureus, 16(11), Article e73414. https://doi.org/10.7759/cureus.73414

Singh, S. (2025). Exploring Sexuality: Psychological, Social, and Biological Dimensions of Human Sexual Behaviour. IMRJR. 2(1), 30-36. https://doi.org/10.17148/IMRJR.2025.020104

Ter Kuile, M.M., Van Lankveld, J.J., De Groot, E., Melles, R., Neffs, J., & Zandbergen, H. (2001). Cognitive-behavioural therapy for non-coital vaginismus. Relevant variables and treatment outcome. Journal of Sex & Marital Therapy, 27(4), 357-374. https://doi.org/10.1080/009262301317081115

Ter Kuile et al., (2001). Dyspareunia, on the other hand, is often linked to organic and gynaecological causes (Seehusen, D. A., Baird, D. C., & Bode, D. V., 2014). Dyspareunia in women. American Family Physician, 90(7), 465-470.https://doi.org/10.1055/s-0038-1675805.