Dyspareunia: persistent and recurrent genital pain associated with sexual intercourse. Although they occur mostly during intercourse, location, duration and pattern of pain may be quite variable.
Dyspareunia may occur in both men and women and, to be diagnosed, cause significant distress or interpersonal difficulties.

Dyspareunia may be:

• Superficial linked to a series of variable conditions that, in women, affecting the lips or the vestibule and man the glans.
• Deep: a lack of lubrication and atrophic changes can cause problems of friction with the movements of the penis, causing the sensation of deep pain experienced by women.

The pain most commonly associated with dyspareunia occurs during coitus, although some women report that they try it at a later time or in both cases.

CAUSES
Dyspareunia may be caused by several factors, but in most cases, is due to organic causes. It can occur due to the presence of:

• Infections and irritation of the external genitalia and / or vagina
• Urinary tract infections
• Inflammation of the cervix
• Pelvic inflammation
• Ovarian disease
• Endometriosis
• Uterine prolapse
• Postpartum
• Post surgical
• Other pathological conditions (atherosclerosis, diabetes, multiple sclerosis, etc.).

Factors Psychosexual

• Libido decreased
• Poor and inadequate vaginal lubrication and congestion
• Fear relationship
• Little or no sex education

These factors (associated or secondary to sexual pain) may frequently overlap each other contributing to the worsening of the perception of coital pain. Even the internal relationship issues the couple may contribute to the gradual intensification of dyspareunia.

TREATMENT
The clinical approach to dyspareunia should be multidisciplinary: neurologic, muscular, emotional and relational. The initial focus, however, is always centered on understanding the location, type and mode of pain. The presence of painful symptoms outside of sexual intercourse should move towards a possible organic etiology that requires submission to a specialist doctor.

The treatment of psycho-sexological components designed to teach relaxation techniques to deal with the sexual relationship with less anxiety and learn to manage the muscle tension in a genital level.

The presence or absence of a partner within the course of treatment should be carefully evaluated based on the quality of the report.