The clinical interview is uniquely equipped to cover multiple areas affected by dyspareunia and to elicit descriptions important to treatment planning. Although there is no standardized interview for the assessment of sexual pain disorders, the empirical literature has charted a clear path to relevant areas. Obtaining a psychosexual history is recommended [1]; it can provide invaluable information about predisposing factors such as family of origin and cultural schémas about sexuality, formative sexual experiences, and any history of sexual abuse/trauma. Of more proximal relevance is the assessment of pain properties, mediators, and interference, comorbid disorders, and self-reported effectiveness of past treatment attempts.

Pain Properties

The clinical interview starts with patients’ general descriptions of their difficulties and reasons for seeking treatment. This open-ended characterization is important as it can communicate much about the patient’s cognitive and emotional disposition toward the problem prior to treatment suggestion or intervention. It is followed by more specific questions about the properties of the pain. Of diagnostic importance are the lifetime onset of the pain, onset within an intercourse episode, duration of the pain, and its specific location (it is helpful to provide patients with a diagram/model of the genital and pelvic region), qualitative descriptions, and severity [2]. Open-ended characterizations of the pain should also be followed up with the administration of a pain descriptor list. Finally, the severity of pain can be elicited via visual analog or numerical rating scales.

Pain Mediators

Pain is a complex subjective experience that can be impacted by a variety of factors ranging from the mechanics of stimulation to emotional states [3]. Identifying factors that mediate pain is essential to diagnostic assessment and treatment interventions. It is important to elicit details regarding conditions that patients have identified as affecting their pain experience. For example, what tends to exacerbate or improve the pain? Some potential mediators include length of foreplay, intercourse positions, use of lubrication aids, level of desire/arousal, timing, fatigue, stress, mood, feelings toward the sexual partner, and overall relationship quality. Any one or combination of these factors may affect the pain experience and provide clues to its successful management.

Pain Interference and Comorbid Problems

Pain can also have a significant impact on other aspects of patients’ lives and interfere with their sexual function, psychological well-being, and relationships. The comor-bidity of other sexual dysfunctions, mood disturbances, and relationship difficulties are relatively well documented, although it can be difficult to separate cause and consequence. Regardless, comorbid disorders and/or problems require therapeutic attention and are thus important targets for assessment.

Women who experience pain with intercourse tend to report higher levels of difficulties with desire, arousal, and orgasm [4]. It is important to ask women about all aspects of their sexual function and satisfaction and to administer sexual function measures that allow for comparison to norms. Women with dyspareunia also report higher levels of mood disturbances, negative affect, somatization [4,5], and a hypervigilant and catastrophizing cognitive style [6, 7]. Inquiring about patients’ theories regarding their coital pain also can be fruitful, as these have been related to distress and relationship adjustment [8],

Relationship Adjustment

A disorder that interferes with sex is likely also to affect relationship dynamics. In turn, the quality of the relationship probably influences the experience of dyspareunia. It is thus ideal to involve the partner in the assessment process. Research on dyadic adjustment in the context of dyspareunia is scarce, but studies have shown an association between pain intensity and marital adjustment, partner solicitousness, and partner hostility [9, 10],

General relationship adjustment inquiries can be aided by self-administered measures. However, it is also crucial to ask specific questions about how the couple navigates the difficulties posed by intercourse pain. Examples of such questions are: How does each person react to difficult or aborted attempts at intercourse? What does the partner think the cause of the problem might be? What are fears about the possible impact of dyspareunia on the viability of their relationship? How does each person personalize the difficulty as a reflection of their desirability? What would happen if the pain went away? Comorbid sexual dysfunction in the partner is also important to assess as it can have a significant impact on the development of treatment strategies.

Previous Treatment Attempts

Finally, it is recommended that the patient be asked about the types and outcomes oftreatments she may have already engaged in, if any. It is important to respect these reports and preferences, but the clinician should keep in mind that not all treatments are delivered in the same fashion by all providers and that not all patients adhere to treatment regimens as recommended. Obtaining as many details as possible about prior treatment attempts can be useful in the determination of future steps.

Self-administered measures of pain, sexual function, and psychological and relationship adjustment complement the interview and are essential to implementing and monitoring treatment efficacy.

Pain

Dyspareunic pain has been measuredprimarily in terms of its intensity and qualitative description. Intensity is probably best captured via visual analog or numerical rating scales anchored at “no pain” and “extreme pain,” or variants thereof. These scales can be administered such that women rate the intensity of their pain retrospectively, or they can be part of a pain diary completed after every intercourse attempt. Descriptors of pain have been predictive of dyspareunia type [2] and thus constitute an important assessment tool.

The most widely used and validated pain measure with dyspareunic women is the McGill-Melzack Pain Questionnaire (MPQ) [ 11 ]. It consists of a list of pain descriptors about sensory, affective, and evaluative factors, while also providing an overall pain rating index. Because psychological reactions to pain can have as much of an impact on one’s life as the sensory aspect, it is useful to determine the level of distress incurred by attempted or penetrative intercourse especially in the formulation of cognitive treatment strategies. The Pain Catastrophizing Scale (PCS) [12] can be invaluable because it taps into emotions and cognitions that accompany the pain experience.

Sexual Function

Sexual function questionnaires can shed light on comorbid sexual dysfunctions and can be used to monitor treatment progress on multiple levels. There is no single standardized questionnaire designed exclusively for the assessment of sexual pain, but there are several appropriate sexual function and satisfaction measures.