New Research Reframes Vaginal Pain Vaginal pain at intercourse has been eluding helpful diagnosis because the pain does not seem to have an observable cause. Depending upon the time at which and to who the sufferer presents, her diagnosis could vary from dyspareunia, vaginismus, female sexual arousal disorder, hypoactive sexual desire disorder, dysfunction related to anxiety, relationship difficulties, sexual aversion disorder of no diagnosis at all due to the absence of physical findings. The major reason for classifying dyspareunia and vaginismus as sexual dysfunctions has been the lack of a known basis for the pain. And it has been easy to explain it as sexually related. The problem is that by so classifying it, it has discouraged their study as pain syndromes. Conceptualizing a disorder as a pain syndrome does not deny that psychosocial factors play a role in both the pain and the disability resulting from the pain, nor does it argue that treatment be focused solely on physical and pharmacological methods. Rather, it places vaginal pain in the context of pain, thus setting the context for both treatment and research. Characterizing it as pain leads to an inquiry about the effects of the pain in the patient's functioning and on relationships, an approach very different from that of defining a problem as psychiatric. As a result, treatment is multimodal, including both physical and psychosocial interventions. Another important consequence of this approach is that it is easier for clinicians to help in psychosocial areas if the patient and partner consider their psychosocial problems as secondary to the physical pain. The research evidence points to the inadequacy of the classification of dyspareunia and vaginismus as separate sexual dysfunctions. According to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association): First, the major symptom of both is pain or fear of pain. It was found that the traditional quantitative and qualitative measures of pain and pain disorders are more useful in treatment than DSM-IV criteria. Second, the pain of intercourse or attempts at vaginal penetration can be elicited in non-sexual situations, and the disruptions in sexual behavior are usually the result of the pain rather than the cause. Finally, current treatments for dyspareunia and vaginismus based on sexual dysfunction have not been demonstrated effective. It would be useful to reclassify "sexual pain" as urogenital pain. Emphasizing the pain aspect of the sexual pain disorders will lead to improved empirical work and clinical understanding of two important and currently neglected women's health problems.