The Biopsychosocial Puzzle of Painful Sex

Annu Rev Clin Psychol. 2022 May 9;18:471-495. doi: 10.1146/annurev-clinpsy-072720-014549. Epub 2022 Feb 25.


Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered.

Keywords: dyspareunia; genito-pelvic pain penetration disorder; provoked vestibulodynia; sex therapy; sexual pain disorders; vaginismus.

Publication types

  • Review

MeSH terms

  • Diagnostic and Statistical Manual of Mental Disorders
  • Dyspareunia* / diagnosis
  • Dyspareunia* / etiology
  • Dyspareunia* / psychology
  • Female
  • Humans
  • Male
  • Pain / complications
  • Vaginismus* / complications
  • Vaginismus* / diagnosis
  • Vaginismus* / psychology