Recurrent or persistent genital pain associated with sexual
intercourse in either a male or a female. (1). In women, it is generally defined as
genital pain occurring with penetration or during or after intercourse but not exclusively
vaginismus (a common type of insertional dyspareunia caused by intense involuntary
contraction of the perineal muscles surrounding the outer one third of the vagina) (2).
True dyspareunia is recurrent and associated with a disruption of normal functioning. The
disturbance causes marked distress or interpersonal difficulty. The disturbance is not
caused exclusively by Vaginismus or lack of lubrication. Diagnostic criteria is as
follows:
The patient often experiences
genital pain with sexual intercourse.
It
is due neither to Vaginismus nor inadequate lubrication.
Except for another Sexual Dysfunction, no other Axis I disorder explains it better.
It
is not directly caused by substance use (medication or drug of abuse) or by a general
medical
condition.
It
causes marked distress or interpersonal problems.
Vaginismus
Cause:
Dyspareunia is a symptom of multiple and varied disease
states and may have multiple causes with components of both organic and psychiatric
dysfunction.
Women with dyspareunia were found to have more physical
pathology and greater psychological symptoms. They reported more negative attitudes
toward sexuality, higher levels of sexual impairment, and lower levels of marital
adjustment, but they did not report more physical or sexual abuse, either past or present.
Subjects with the greatest psychological symptoms and marital maladjustment had no
discernible physical findings on examination, and their levels of sexual function were
similar to those of matched controls.
Treatment:
Depending on your history, the results of a medical exam and other diagnostic tests
treatment for dspareunia may include some of the following options:
Counseling and Psychotherapy [ See General Therapy
Section & Sex
Therapy ]:
Relaxation exercises may help a woman regain control over
vaginal muscles, reducing pain and making sexual intercourse more pleasurable.
Medical & Other:
* Position Change: In the case
of a tipped uterus, a change in position may allow the
uterus to move and result in more comfortable intercourse.
* Medications: In the case of an infection ,
treatment with medication often solves the
problem.
* Lubrication: Use of a cream or jelly can help make
sexual intercourse more comfortable
in cases when there is not enough natural lubrication.
Type Codes for the Sexual Dysfunctions
- Specify 1 of:
Due to Psychological Factors or
Due to Combined Psychological Factors and a General Medical Condition
- Specify 1 of:
Lifelong (it occurs throughout the patient's active sexual life) or
Acquired (there has been a time when the patient did not have this sexual dysfunction)
- Specify 1 of:
Generalized (the disorder occurs with all partners and in all situations) or
Situational
Coding Notes
Although I have picked Female Sexual Arousal Disorder as the
example, the following notes apply to many of the Sexual Disorders discussed below:
A patient who has a general medical condition (diabetes
mellitus) that partly, but not completely, accounts for a problem with arousal would be
diagnosed:
Axis I 302.72 Female Sexual Arousal
Disorder, Due to Combined Factors
Axis III 250.01 Insulin-dependent Diabetes Mellitus
A patient who uses drugs and who has arousal problems due
partly, but not solely, to the direct effects of drug use, would be diagnosed (other
specifiers would also apply):
Axis I 302.72 Female Sexual Arousal Disorder, Due to Combined
Factors
Patients whose arousal problems are due solely to a
combination of substance use (such as heroin intoxication) and a general medical condition
(such as diabetes mellitus) should be given two Axis I diagnoses:
625.8 Other Female Sexual Dysfunction Due to Diabetes
Mellitus
292.89 Heroin-Induced Sexual Dysfunction, With Impaired Arousal, With Onset
During Intoxication
Of course, you would have to supply the appropriate Axis I
and Axis III codes for each of the above examples.
Also See
Our Sexual Dysfunction Page for Links.
