438 Sexual Dysfunctions
ulation); other genito-pelvic pa in may be spontaneous as well as provoked. Genito-pelvic pain
can also be usefully characterized qualitatively (e.g., “burning,” “cutting,” “shooting,” “throb-
bing”). The pain may persist for a period afte r intercourse is completed and may also occur
during urination. Typically, the pain experience d during sexual intercourse can be reproduced
during a gynecological examination.
Marked fear or anxiety about vulvov aginal or pelvic pain either in anticipation of, or during, or
as a result of vaginal penetration  (Criterion A3) is commonly reported by women who have
regularly experienced pain during sexual inte rcourse. This “normal” reaction may lead to
avoidance of sexual/intimate situations. In ot her cases, this marked fear does not appear
to be closely related to the experience of pa in but nonetheless leads to avoidance of inter-
course and vaginal penetration situations. Some have describe d this as similar to a phobic
reaction except that the phobic object may be vaginal penetration or the fear of pain.
Marked tensing or tightening of the pelvic floor  muscles during attempted vaginal penetration
(Criterion A4) can vary from reflexive-like spasm of the pelvic floor in response to at-
tempted vaginal entry to “normal/voluntary” muscle guarding in response to the antici-
pated or the repeated experience of pain or to fear or anxiety. In the case of “normal/
guarding” reactions, penetratio n may be possible under circumstances of relaxation. The
characterization and assessment of pelvic floo r dysfunction is often best undertaken by a
specialist gynecologist or by a pelvic floor physical therapist. 
Associated Features Supporting Diagnosis