Fast Five Quiz: Sexual Disorders

Steve Soreff, MD; Bradley Schwartz, DO; Michel E. Rivlin, MD


August 11, 2020

Dyspareunia is more commonly observed in women than in men, affecting as many as 20% of sexually active women. Anxiety, depression, fear of intimacy, and relationship problems can contribute to a low level of arousal and resulting discomfort or pain. Pelvic floor muscles also tend to tighten in response to stress, which can contribute to pain during intercourse.

Transvaginal ultrasonography may be helpful for patients with sexual pain who have cervical, bladder, uterine, or adnexal tenderness or masses on pelvic examination. In the absence of a palpable lesion, imaging is rarely useful.

According to the ACOG, the selective estrogen receptor modulator (SERM) ospemifene can be recommended as an alternative to vaginal estrogen for the management of dyspareunia caused by genitourinary syndrome of menopause. However, insufficient evidence is available to recommend the use of systemic estrogen or SERM therapies for nonatrophic causes of female sexual dysfunction or dyspareunia.

Conditions known to be associated with dyspareunia in men include:

  • Sexually transmitted infections

  • Testicular cancer

  • Tight foreskin (phimosis) or other foreskin problems

  • Prostatitis

  • Growths in or around the penis

  • Penile fracture or trauma

  • Peyronie disease

Another cause of dyspareunia in men is frenulum breve. Adult circumcision has been found to alleviate dyspareunia in men with a short frenulum, which should be investigated as a cause in men who do not have phimosis or other obvious underlying causes.

Read more about adult circumcision.