Dyspareunia

In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix.

Numerous physical, psychological, and social or relationship causes can contribute to pain during sexual encounters.

[7] Physical examination of the vulva (external genitalia) may reveal clear reasons for pain including lesions, thin skin, ulcerations or discharge associated with vulvovaginal infections or vaginal atrophy.

An internal pelvic exam may also reveal physical reasons for pain including lesions on the cervix or anatomic variation.

[8] When there are no visible findings on vulvar exam that would suggest a cause for superficial dyspareunia, a cotton-swab test may be performed.

[7] A cotton tip applicator is applied at several points around the opening of the vagina; the patient reports the resulting pain on a scale from 0–10.

[citation needed] The cause of the pain may be anatomic or physiologic, including but not limited to lesions of the vagina, retroversion of the uterus, urinary tract infection, lack of lubrication, scar tissue, abnormal growths, or tender pelvic sites.

Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation.

[22] During vigorous or deep or tight intercourse or masturbation, small tears may occur in the preputial frenulum and can bleed and be very painful and induce anxiety, which can become chronic if left unresolved.

If stretching fails to ease the condition, and uncomfortable levels of tension remain, a frenuloplasty procedure may be recommended.

Frenuloplasty is an effective procedure, with a high chance of avoiding circumcision, giving good functional results and patient satisfaction.

[13][29] The previous Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV,[30] stated that the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginal spasm (vaginismus).