Psychosomatic psychogenic dyspareunia is a nonspecific, symbolically meaningless response of the individual to a wide range of stressors. Accompanying stress “negative” emotions cause neurodynamic changes in the autonomic nervous system, in the subcortical structures of the brain. They can lead to changes in the conduct of sensitive information, dysfunction of the internal organs (microcirculation disorders, venous stasis, and even dystrophic processes in the genitals). The result may be pain during intercourse. The dynamics of the psychosomatic process ensures the stability of the pathological state and, in the absence of adequate therapy, can lead to a gradual transformation of reversible functional disorders in the genitals into persistent, difficultly reversible structural changes, which is postulated by the theory of pathological stable states and the long-term memory matrix. Thus, the possibility of developing structural changes distinguishes the psychosomatic form of dyspareunia from the conversion one. This possibility at a certain stage brings the clinical manifestations of psychosomatic dyspareunia to the manifestations of organic dyspareunia.

Both of these forms are associated with psycho-traumatic factors, but their content and the nature of the connection have certain differences. The development of conversion dyspareunia in 100% of cases is preceded by traumatic events, situations and conditions, united by a common inner meaning of non-acceptance of existing partner and sexual relations, or the female role with its sexual attributes. When psychosomatic dyspareunia prevail: a change in partnerships (22%), a general violation of the situation, changes in the life situation, increased stress (19.5%). In 31.7% of cases, the association of dyspareunia with any events or experiences was detected only in the process of psychotherapeutic work.

Dyspareunia is rare in men and usually has an organic basis. Thus, in case of Peyronie’s disease, fibrous plaques in the albumen and septum of the cavernous bodies of the penis often lead to its deformation during erection and painful sensations during coitus.

A very rare variant of inorganic dyspareunia in men is known – post-ejaculatory pain. This disorder is caused by involuntary contraction of the ejaculatory muscles and a number of other muscles associated with it, which can occur both during ejaculation and immediately after it. As a result, the man begins to experience acute pain after ejaculation. It usually passes within a few minutes, but may last longer. Men who experience post-ejaculatory pain often begin to avoid sexual contact. Since sexual activity brings them unpleasant, painful sensations, they may have problems with erection or orgasm (G. Kelly, 2000). Although the immediate cause of the pain is muscle spasm, this disorder appears to have deep psychological roots. Men who suffer from post-ejaculatory pain are considered to have a lurking feeling of guilt concerning sexual pleasure, ambivalent feelings about their relationship with their partner, and also tend to suppress feelings of anger and irritation. Such internal conflicts can exacerbate anxiety about painful sensations and lead to the fact that each ejaculation will be accompanied by pain (X. Kaplan, 1993). Post-ejaculatory pain should be distinguished from painful ejaculation due to inflammation of the seed tubercle located in the prostatic urethra (colliculitis).

Survey. In individuals of both sexes includes a standard sexological examination. When diagnosing dyspareunia in women, the following studies are necessary: ​​a thorough gynecological examination, ultrasound of the pelvic organs, determination of the patient’s hormonal profile (sex hormones) and bacteriological examination of the vaginal smear (to eliminate the organic basis of pain); urological and sexological examination of the patient’s permanent partner.

Additionally, an experimental psychological study is conducted for a comprehensive assessment of personal characteristics and the nature of interpersonal interaction with a partner.

The treatment aims to reduce or completely eliminate the painful sensation at Kbitus and increase satisfaction from sexual life. In identifying psychopathological symptoms, as well as in the presence of stable genitalia, pharmacotherapy is conducted using antidepressants, tranquilizers, and antipsychotics.

Psychotherapy: visualization techniques aimed at working with pain and discomfort; hypnosuggestive therapy and auto-training methods, matrimonial therapy to improve the relationship between partners; sex therapy, etc.
A scientist from the United States proposed a differentiated approach to the choice of psychotherapeutic treatment. In case of conversion disorder, she recommends integrative personality-oriented therapy, aiming at resolving key conflicts that underlie sexual dysfunction and sexual therapy. Since most of the conflicts encountered are the result of psychosexual developmental disorders, psychotherapeutic work involves their correction. It is conducted in the form of informational and explanatory and psychotherapeutic conversations, as well as through the formation of a positive experience in the simulated passage of the missed or distorted stages of psychosexual development, including during sex-therapeutic exercises. The often positive and controversial personal meaning of dyspareunia, which determines the low motivation for correcting painful sexual contacts due to their “secondary benefit”, should be taken into account.

The main goals of sexual therapy are: acquiring a positive experience of sexual contacts, developing an optimal stereotype of intimate relationships, bringing pleasure, training partners in expressing sexual feelings and desires, finding a compromise acceptable to both. In primary dyspareunia (from the very beginning of sexual activity) in young women with psychosexual developmental delays, sexual therapy should be as fully developed as possible, including activities aimed at familiarizing themselves with the function and structure of the genitalia, adaptation to vaginal penetration. In older women with dyspareunia, developed on the background of inadequate sexual technique, disorders of sexual desire, orgasmic dysfunction, standard methods of sensory focusing, genital delight, “non-binding” coitus are more often used. In cases of development of dyspareunia on the background of absolute anorgasmia and the associated unconscious rejection of sex, which does not cause pleasant sensations, vibrotherapy is used. She demonstrates their sexual potential to patients and creates motivation for therapy.

In psychosomatic dyspareunia, the leading role is played by integrative personality-oriented psychotherapy, aimed at identifying the connection between mental factors and dyspareunic pains, at strengthening self-confidence, replenishing female identity, obtaining emotional support and developing new ways of emotional manifestations, and also including as components body-oriented and sexual therapy. In case of detection of pathological changes in the genitals, treatment is carried out with the joint participation of a sexologist and a gynecologist. When conducting psychotherapy, emphasis is placed on the problems of early childhood, certain aspects of relationships with parents that have influenced the nature of psychosexual development, attitudes towards physicality, and the sexual aspects of life and communication with men. In the field of attention, they keep attitudes towards their own femininity, to receiving pleasure in general and in intimate contacts with a partner in particular, etc. The goal of this work is to ensure the completion of the development of female identity, the gradual acquisition of more constructive and flexible forms of treating with oneself and partner dyspareunic behavior will be deprived of its functional value. Effective ways of therapeutic support and restoration of contact of women suffering from psychosomatic dyspaurenia with their body, transformation of painful bodily patterns, acquaintance with new ways of emotional manifestations are body-oriented therapy and sex therapy.