What Does the Term Dyspareunia Mean

In 1874, Barnes (1) coined the term dyspareunia. He felt that it would be a convenient way of summarizing the different conditions underlying painful intercourse: " ... just as 'dyspepsia' is used to signify difficult or painful digestion, we want a word to express the condition of difficult or painful performance of the sexual function" (p. 68). Although the usefulness of the term dyspepsia is a matter of some controversy (2), the diagnosis of dyspareunia has not been seriously challenged and is still used by all major classificatory systems, such as the DSM-IV-TR (3) and the ICD-10 (4). The lack of specificity of the word dyspareunia is evidenced by the growing number of overlapping terms (e.g., vul-vodynia, vulvar vestibulitis syndrome, dysesthetic vulvodynia, vestibulodynia) denoting presumed "disease entities." The majority of these terms originate from a recent renewed interest in painful vulvar conditions. Even prior to this increased interest, the term dyspareunia was often used interchangeably with the terms vaginismus or chronic pelvic pain. This unrestricted creation of diagnostic labels plagues many mental health and medical domains and often results in much confusion. In our view, the term dyspareunia has outlived its utility as a nosological entity. Although this suggestion might be considered radical, we believe that it is justifiable both on the basis of logical/theoretical considerations as well as on empirical data.

In this chapter, we will standardize our use of the terminology as follows: The term dyspareunia denotes any form of recurrent or chronic urogenital pain that interferes with sexual and nonsexual activities in women of any age, and which may be experienced in a variety of different locations (e.g., at the vaginal opening or deep inside the pelvic area) with various qualities and patterns (e.g., as an acute stabbing sensation on contact, or a chronic throbbing pain that waxes and wanes throughout the day). It is important to note that dyspareunia also occurs in men (5), but is relatively rare compared with its frequency in women. Why there is such a gender disparity remains unclear and is worthy of study; however, this chapter will focus on dyspareunia in women. Following the criteria outlined by Friedrich (6), vulvar vestibulitis syndrome refers to severe pain experienced in the vulvar vestibule upon contact. Unlike vestibulitis, vulvodynia denotes chronic vulvar pain or discomfort that can occur in the absence of overt stimulation.

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