Genito-Pelvic Pain/Penetration Disorder 439
Development and Course 
The development and course of genito-pelvic pa in/penetration disorder  is unclear. Because
women generally do not seek treatment until they experience problems in sexual functioning,
it can, in general, be difficult to characterize genito-pelvic pain/penetration disorder as life-
long (primary) or acquired (secondary). Alth ough women typically come to clinical atten-
tion after the initiation of sexual activity, there are often earlier clinical signs. For example,
difficulty with or the avoidanc e of use of tampons is an important predictor of later problems.
Difficulties with vaginal penetration (inability or fear or pain) may not be obvious until sex-
ual intercourse is attempted. Ev en once intercourse is attemp ted, the frequency of attempts
may not be significant or regular. In cases where it is difficult to establish whether symptom-
atology is lifelong or acquired, it is useful to  determine the presence of any consistent period
of successful pain-, fear-, and tension-free intercourse. If the ex perience of such a period can
be established, then genito-pelvic pain/penet ration disorder can be characterized as ac-
quired. Once symptomatology is well establishe d for a period of approximately 6 months,
the probability of spontaneous and significan t symptomatic remission appears to diminish.
Complaints related to genito-pelvic pain pe ak during early adulthood and in the peri-
and postmenopausal period. Women with compla ints about difficulty having intercourse
appear to be primarily premenopausal. There may also be an increa se in genito-pelvic
pain–related symptoms in  the postpartum period.
Risk and Prognostic Factors