Although dyspareunia is a gender-neutral term, men experience dyspareunia much less often with vaginal-penile intercourse than women. Dyspareunia in men is often caused by concurrent medical illness, such as Peyronie's disease or neuropathy, although relationship dynamics and poor sexual technique may also cause sexual discomfort. Anal dyspareunia can occur with the anally receptive or insertive partner and is usually caused by insufficient lubrication or spasm of the anal musculature. Evaluation consists of the history and physical examination. As with most sexual dysfunctions, onset, context, patient perceptions regarding possible causes, and impact on the relationship(s) are important. Physical examination may reveal evidence of neuropathy, urethritis, epididymitis, Peyronie's disease, prostatitis, anal fissures, hemorrhoids, or other pertinent findings. Treatment of dys-pareunia involves correction of underlying physical pathology, counseling regarding sexual technique, and referral of complicated cases to a urologist or sex therapist, as indicated.

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