Abstract
A woman became unable to achieve penetration after repeated painful intercourse. This case illustrates the shortcomings of the present nomenclature and diagnostic criteria for the sexual pain disorders, dyspareunia and vaginismus. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, considers the sexual pain disorders as sexual dysfunctions, completely ignoring the pain component and leading to internally inconsistent descriptions of these conditions. The role of pain in dyspareunia and vaginismus and the implications of using a pain syndrome framework for diagnosis and research are discussed. Most important, pain syndrome framework focuses diagnosis on the presence or absence of pain and the history of the development of the pain. This approach does not deny a role for psychosocial factors, but rather considers them as critical components of the pain syndromes. From the pain syndrome perspective, preliminary data indicate that vulvar vestibulitis syndrome may be associated with nonpainful sensory abnormalities, and that women with vaginismus do not constitute a homogeneous group.
