Research suggests that dyspareunia exacts a high individual and societal cost. In addition to comorbid sexual difficulties [1–2], affected women also suffer from negative affect [2–4] and relationship concerns [5–7]. Dyspareunia is often experienced as one of the most disturbing symptoms of genital pain disorders.

In one study of interstitial cystitis (IC), a condition marked by intense bladder pain, painful intercourse and relationship strain were ranked as the most disturbing consequences of the condition [8]. Another study that compared women with dyspareunia to women with chronic pelvic pain (CPP) found that both groups reported similar impairments as a purported function of their pain [9].

Chronic pain disorders have long been associated with high healthcare expenditures, lower work productivity, and many other societal costs [10]. There are currently no reliable estimates of healthcare expenditures associated with dyspareunia. As an acute, recurrent pain disorder typically provoked by sexual intercourse, dyspareunia is unlikely to exact as high a cost as lower back pain or migraine. However, healthcare costs associated with dyspareunia may be high. First, it is highly comorbid with other treatment-resistant pain-related conditions with high associated costs such as IC [11], irritable bowel syndrome [12], pelvic inflammatory disease [13], CPP [14], and endometriosis [15]. Second, the heterogeneity of its etiology [16] indicates that appropriate treatments may not be immediately identifiable. Third, its interference with quality of life likely creates a charged emotional context which, coupled with the elusiveness of effective treatment, makes dyspareunia an ideal candidate for doctor-shopping, uncoordinated multiple treatment attempts, and low adherence to strategies that fail to demonstrate immediate effects. For instance, in one online study of 428 women with vulvar pain, close to half reported consulting 4–9 physicians [5]. Only 40% trusted their current physician to manage the pain, and 57% reported their pain had stayed the same or worsened since initiating treatment. The estimate of medical care expenses incurred ranged from under $500 to over $75,000.

An additional cost of dyspareunia stems from its potential impact on relationships. Although Davis and Reiss-ing [17] note that a number of studies fail to show relationship maladjustment in couples coping with dyspareunia, it is difficult to imagine that it would not affect the relationship dynamic. Extant studies of couple adjustment may fail to capture those couples who may not have survived the problems engendered by pain. In Gordon et al.’s vulvar pain study [5], 76% of respondents reported fearing that the pain would ruin their relationships. Although objective causes of relationship dissolution are difficult to ascertain, problems with sexual intimacy are often listed as one of most common reasons [18]. Infidelity has also been associated with divorce and linked to sexual dissatisfaction [19].

The study of dyspareunia has engaged the field in a fruitful debate about current conceptualizations of sexual dysfunction. It has also stimulated the realization that female and male sexual responses may diverge sufficiently to merit a gender-differentiated approach. The empirical investigation of pain characteristics coupled with the lack of validation for old notions of dyspareunia as a somatic manifestation of psychic conflict has led researchers to question whether dyspareunia is better characterized as a pain disorder rather than as a sexual dysfunction [16, 20]. The focus on its interference (with sexual intercourse) rather than on its presenting symptom (pain) has not led to advances in etiological theory or in treatment. In contrast, pain properties appear to directly indicate potential etiologies and treatment approaches.

The research shift from the sexual aspects of dyspareunia to its pain culminated in Binik’s appeal to eliminate the sexual pain disorders from the sexual dysfunction section of the DSM and have them subsumed under the pain disorders section [21]. This suggestion has its detractors, but the dilemma of classifying dyspareunia has forced the issue of nosological accuracy in sexual dysfunction and has made us consider the sociocultural forces that shape its development. This momentum has been concurrent with broader initiatives to reconceptualize female sexual dysfunction [22–23] in an attempt to untether ideas of sexual normalcy for women from those for men. One such argument posits that dyspareunia is the only true female sexual dysfunction [24] given that, unlike differing levels of arousal and desire, pain is unacceptable at any level. These theoretical and empirical forays make us examine presuppositions and correct damaging social constructions of pathology related to individuals’ sexual well-being.

Dyspareunia has also shone a spotlight on the futility of attempts to tease apart the psychological aspects from the physical aspects regarding sexuality. Sexual response is simultaneously a psychological and physiological process that defies attempts to situate problems in one domain or another, despite the DSM’s insistence on the identification of pure psychogenicity.

Dyspareunia is almost always a function of both factors. Furthermore, it introduces an acutely social dimension. The pain does not just occur in the presence of others; it is technically provoked by others (the sexual partner), creating a complex configuration of potential etiological factors that makes the search for a single causal pathway almost futile. Even when there is some certainty about an originating factor, the experience of pain during intercourse is likely to have engendered physical (e.g., nerve dysfunction), sexual (e.g., desire/arousal problems), emotional (e.g., anxiety/hypervigilance), and relational (e.g., guilt/anger) dynamics that threaten to perpetuate the pain long past the resolution of the original problem.