440 Sexual Dysfunctions
Differential Diagnosis
Another medical condition. In many instances, women with genito-pelvic pain/pene-
tration disorder will also be diagnosed with another medical condition (e.g., lichen scle-
rosus, endometriosis, pelvic inflammatory disease, vulvovaginal atrophy). In some cases,
treating the medical condition may alleviate the genito-pelvic pain/penetration disorder.
Much of the time, this is not the case. There are no reliable tools or diagnostic methods to
allow clinicians to know whether the medica l condition or genito-pelvic pain/penetration
disorder is primary. Often, the associated medi cal conditions are difficult to diagnose and
treat. For example, the increased incidence of postmenopausal pain during intercourse
may sometimes be attributable to vaginal dr yness or vulvova ginal atrophy as sociated with
declining estrogen levels. The relationship, however, between vulv ovaginal atrophy/dry-
ness, estrogen, and pain is not well understood. 
Somatic symptom and related disorders. Some women with genito-pelvic pain/pene-
tration disorder may also be  diagnosable with somatic symptom disorder. Since both
genito-pelvic pain/penetration  disorder and the somatic symptom and related disorders
are new diagnoses, it is not yet clear whet her they can be reliably differentiated. Some
women diagnosed with genito-pelvic pain/penetration disorder will also be diagnosed
with a specific phobia. 
Inadequate sexual stimuli. It is important that the clinician,  in considering differential diag-
noses, assess the adequacy of se xual stimuli within the woman’s sexual experience. Sexual sit-
uations in which there is inadequate foreplay or arousal may lead to difficulties in penetration,