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Diagnostic Criteria Section_Index.

Refer to conditions of use

Dyspareunia

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.


Related Features

Abuse (past or present)
Arousal disorders
Insufficient foreplay
Medications
Anxiety
Depression
Somatic or Sexual Dysfunction
Sexually Deviant Behavior

Differential Diagnosis 

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

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.