Which diagnosis best fits duration, episodicity, and exclusions?
A
Genito-pelvic pain/penetration disorder
Persistent or recurrent difficulties with ≥1 of: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during intercourse or penetration attempts; marked fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of pelvic floor muscles during vaginal penetration attempts
Absent/reduced sexual interest/arousal; ≥3 of: absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity and unreceptive to partner's attempts; absent/reduced sexual excitement/pleasure during sexual activity in ≥75–100% encounters; absent/reduced sexual interest/arousal in response to any internal/external erotic cues; absent/reduced genital or non-genital sensations during sexual activity in ≥75–100% encounters
AA. Persistent or recurrent difficulties with ≥1 of: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during intercourse or penetration attempts; marked fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of pelvic floor muscles during vaginal penetration attempts B. Symptoms persist ≥6 months C. Causes marked distress
BA. Absent/reduced sexual interest/arousal; ≥3 of: absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity and unreceptive to partner's attempts; absent/reduced sexual excitement/pleasure during sexual activity in ≥75–100% encounters; absent/reduced sexual interest/arousal in response to any internal/external erotic cues; absent/reduced genital or non-genital sensations during sexual activity in ≥75–100% encounters B. Symptoms persist ≥6 months C. Causes marked distress
Common specifiers
ALifelong; Acquired; Generalised; Situational
BLifelong; Acquired; Generalised; Situational
Differential flags
APrimary medical cause - endometriosis, vestibulodynia, pelvic inflammatory disease, lichen sclerosus (must exclude with examination); SSRI-induced vaginal dryness (medication history); Female sexual interest/arousal disorder (low arousal contributing to insufficient lubrication)
BFemale orgasmic disorder (arousal intact but orgasm impaired); Genito-pelvic pain disorder (pain limiting engagement rather than absent desire); Major depressive disorder (generalised anhedonia vs specific sexual domain)