{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:24:05Z","timestamp":1789586645855,"version":"build-2803163510"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK100368"],"award-info":[{"award-number":["DK100368"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["HD081709"],"award-info":[{"award-number":["HD081709"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dyspareunia, defined as pain before, during or after intercourse, is a subset of female sexual dysfunction with overlapping gynecologic, urologic and psychosocial etiologies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This study aimed to evaluate the impact of menstrual pain and visceral hypersensitivity on sexual function and to identify risk factors for sexual pain in healthy reproductive-age females.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this prospective cohort study, we evaluated gynecologic and psychologic self-reported histories, validated sexual function questionnaires, and conducted a standardized gynecologic examination enhanced by quantitative sensory testing in reproductive-aged females with menstrual pain versus pain-free controls. Correlation analysis was conducted between the Female Sexual Function Index (FSFI) pain subdomain score and a priori hypothesized risk factors for dyspareunia: menstrual pain severity, experimentally provoked bladder sensitivity, anxiety, depression, pain catastrophizing, and vaginal pressure-pain sensitivity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>The primary outcome was severity of sexual pain as measured by the FSFI, comparing participants with moderate-to-severe dysmenorrhea (n\u2009=\u200999), dysmenorrhea with bladder hypersensitivity (n\u2009=\u200949) identified on non-invasive oral water challenge, and pain-free controls (n\u2009=\u200937).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In our young (median age 22 [IQR 19, 29]), nulliparous, predominantly heterosexual cohort (78.3%, 144\/185), 64.3% (119\/185) engaged in sexual intercourse within the four-week recall period. The median total FSFI score was 27.2 (22.0, 30.2). Across groups, only the dysmenorrhea with bladder hypersensitivity phenotype met the threshold for sexual dysfunction as measured by total FSFI score (24.6 [20.0, 28.1], p\u00a0=\u20090.008). Dysfunction was driven by difficulties with lubrication and higher pain levels during and after intercourse. On physical examination, those with and without dyspareunia were largely indistinguishable, with little to no tenderness of the pelvic floor, bladder, uterus and uterosacral ligaments. Amongst the six hypothesized risk factors for sexual pain, only experimentally provoked bladder pain was significantly associated with the severity of dyspareunia (r\u2009=\u20090.41, corrected p\u00a0&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>Young, otherwise healthy individuals with dysmenorrhea and occult visceral hypersensitivity exhibit signs of sexual dysfunction and significantly higher rates of dyspareunia in the absence of reliable clinical examination findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>Strengths include the use of a nonclinical sample of almost exclusively nulliparous females with no co-morbid pelvic pain diagnoses and prospective diary confirmation of dysmenorrhea severity. The study is limited by the narrow heteronormative, cisnormative sexual experience of penile-vaginal intercourse captured by the FSFI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Sexual pain is more prevalent in those with dysmenorrhea with bladder hypersensitivity than isolated dysmenorrhea, suggesting visceral hypersensitivity may be a non-structural mechanistic driver for dyspareunia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdae149","type":"journal-article","created":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T10:25:07Z","timestamp":1731666307000},"page":"98-106","source":"Crossref","is-referenced-by-count":3,"title":["Associations between menstrual pain and sexual function: the role of visceral hypersensitivity on developing sexual pain"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6448-282X","authenticated-orcid":false,"given":"Eva M","family":"Reina","sequence":"first","affiliation":[{"name":"Department of Obstetrics & Gynecology , Division of Gynecologic Pain and Minimally Invasive Surgery, , Evanston, IL 60201 ,","place":["United States"]},{"name":"NorthShore University HealthSystem\/University of Chicago , Division of Gynecologic Pain and Minimally Invasive Surgery, , Evanston, IL 60201 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M","family":"Hellman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, NorthShore University HealthSystem , Evanston, IL 60201 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Kmiecik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, NorthShore University HealthSystem , Evanston, IL 60201 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary F","family":"Terkildsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, NorthShore University HealthSystem , Evanston, IL 60201 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank F","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology , Division of Gynecologic Pain and Minimally Invasive Surgery, , Evanston, IL 60201 ,","place":["United States"]},{"name":"NorthShore University HealthSystem\/University of Chicago , Division of Gynecologic Pain and Minimally Invasive Surgery, , Evanston, IL 60201 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"issue":"4","key":"2025010313214227100_ref1","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/s0029-7844(98)80136-1","article-title":"Biopsychosocial profile of women with dyspareunia","volume":"90","author":"Meana","year":"1997","journal-title":"Obstet Gynecol"},{"issue":"2","key":"2025010313214227100_ref2","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/14034940210134040","article-title":"Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study","volume":"31","author":"Danielsson","year":"2003","journal-title":"Scand J Public Health"},{"issue":"02","key":"2025010313214227100_ref3","doi-asserted-by":"publisher","first-page":"090","DOI":"10.1363\/3609010","article-title":"Pelvic pain and associated characteristics among women in northern Mexico","volume":"36","author":"Garc\u00eda-P\u00e9rez","year":"2010","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"6","key":"2025010313214227100_ref4","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1001\/jama.281.6.537","article-title":"Sexual dysfunction in the United States: prevalence and predictors","volume":"281","author":"Laumann","year":"1999","journal-title":"JAMA"},{"issue":"3","key":"2025010313214227100_ref5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.sxmr.2016.03.002","article-title":"Prevalence of female sexual dysfunction among premenopausal women: a systematic review and meta-analysis of observational studies","volume":"4","author":"McCool","year":"2016","journal-title":"Sex Med Rev"},{"issue":"7","key":"2025010313214227100_ref6","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1111\/j.1743-6109.2008.00840.x","article-title":"The prevalence and risk factors of female sexual dysfunction in young korean women: an internet-based survey","volume":"5","author":"Song","year":"2008","journal-title":"J Sex Med"},{"issue":"1","key":"2025010313214227100_ref7","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s10508-005-0998-4","article-title":"Should dyspareunia be retained as a sexual dysfunction in DSM-V? 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