The criteria require persistence or recurrence of one or more of the following: Marked vulvovaginal or pelvic pain during intercourse or penetration attempts Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or because of vaginal penetration Marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration Symptoms must have been present for ≥ 6 months and must cause significant distress in the woman.