Why Deny Dyspareunia Its Sexual Meaning?

Dyspareunia, ie coital pain, is a sexual dysfunction with a multifactorial and multisystemic etiology. Predisposing, precipitating and maintaining factors, biological (muscular, endocrine, immunitary, neurologic, vascular, iatrogenic) and psychosexual, may variably interact in the individual woman. The natural history of dyspareunia is basic to understand the current controversy on its “real” nature as either a sexual or a pain disorder. At onset, dyspareunia is a sexual disorder, as pain (“nociceptive”) is usually triggered by coitus. Dyspareunia becomes increasingly a pain disorder (“neuropathic”) when the chronicity of unaddressed etiological factors of tissue damage may locally up-regulate the immunitary and pain nervous system. The expression “sexual pain disorders” (or urogenital sexual pain disorders) encompasses the continuum and respects both the key features. Deleting the sexual component would mean missing a fundamental aspect for understanding both pathophysiology and meaning of dyspareunia.

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