mensions: 1) difficulty having in tercourse, 2) genito-pelvic pain , 3) fear of pain or vaginal
penetration, and 4) tension of the pelvic fl oor muscles (Criterion A). Because major diffi-
culty in any one of these symptom dimensions is often sufficient to cause clinically sig-
nificant distress, a diagnosis can be made on the basis of marked difficulty in only one
symptom dimension. However, a ll four symptom dimensions should be assessed even if a
diagnosis can be made on the basis of only one symptom dimension. 
Marked difficulty having vaginal intercourse/penetration  (Criterion A1) can vary from a total in-
ability to experience vaginal penetration in an y situation (e.g., interc ourse, gynecological ex-
aminations, tampon insertion) to the ability to easily experience penetration in one situation
and but not in another. Although the most comm on clinical situation is when a woman is un-
able to experience intercourse or penetration with a partner, difficult ies in undergoing re-
quired gynecological examinat ions may also be present. Marked vulvovaginal or pelvic pain
during vaginal intercourse  or penetration attempts  (Criterion A2) refers to pain occurring in differ-
ent locations in the genito-pelvic area. Location of pain as well as intensity should be assessed.
Typically, pain can be characterized as superf icial (vulvovaginal or occurring during penetra-
tion) or deep (pelvic; i.e., not felt until deeper penetrat ion). The intensity of the pain is often not
linearly related to distress or interference with  sexual intercourse or other sexual activities.
Some genito-pelvic pain only occurs when provoked (i.e., by intercourse or mechanical stim-