The clinical evaluation of dyspareunia.

Strictly defined, dyspareunia means 'pain with intercourse'. The psychiatric DSM-IV subdivides and expands this definition and introduces psychogenic factors into the differential diagnosis. This allows development of a biogenic-psychogenic model, whereby organic or psychological factors can be present separately or in combination, within the disorder. Sexual dysfunctions are estimated to be present in 19-63% of women, with dyspareunia the primary complaint in 8-48%. The clinical evaluation of dyspareunia should include a thorough history and meticulous gynecologic examination. Laboratory or imaging studies should be ordered as warranted by suggestive history or exam findings. Identified causes should be treated and counseling considered. Three clinical dilemmas remain. Firstly, lack of standardization of exam findings; secondly discrepancy between objective physical findings and subjective patient complaints; and thirdly paucity of therapeutic options for patients, especially those with an unclear diagnosis. An integrated psychogenic-biogenic model should be developed and implemented for effective diagnosis and treatment of dyspareunia.