How do healthcare providers evaluate women’s sexual pain?

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When doctors see patients, they need specific details about the pain a person is experiencing. Where does it hurt? When does it hurt? How much does it hurt? What does the pain feel like? The answers to these questions help healthcare providers assess what might be wrong and determine treatment options.

However, pain can be tricky to describe. What is painful to one person might be mere discomfort to another.

In 2019, a Journal of Sexual Medicine study reported on three ways to measure female sexual pain in the context of provoked vestibulodynia (pain at the entrance of the vagina):

Numeric rating scales. Women are asked to rate their pain on a scale of 0 to 10, with 0 representing no pain and 10 representing the worst possible pain.
Female Sexual Function Index (FSFI) Pain Subscale. The FSFI is a questionnaire that covers several domains of women’s sexuality, including pain. The pain subscale asks about the frequency of discomfort or pain during and following vaginal penetration. Women are also asked to rate their degree of discomfort or pain (very high to none at all).
Vulvalgesiometer. This device measures a woman’s pain threshold by applying fixed amounts of pressure to various genital areas. It is mainly used in research settings.

In clinical settings, doctors may use a cotton swab test. The cotton swab is gently pressed against different parts of the genitals, and the woman rates the degree of pain she feels.

If you’re experiencing sexual pain, give your doctor a call. Consider the following questions to describe the pain:

When did you start feeling pain?
Is it constant? Intermittent? When is it most bothersome?
Can you pinpoint the location? Is the pain in your vagina, vulva, or another area?
How would you describe the pain? Is it burning, throbbing, sharp, dull, or achy? Would another word or phrase describe it?
Does it worsen in certain circumstances? (When you’re stressed, during sex, etc.)
What remedies have you tried? Has any remedy worked better than another?
Do you have any other sex-related pain or symptoms, like sex headaches or post-orgasmic illness syndrome?