pathophysiology of genito-pelvic pain/ penetration disorder(GPPPD) can be considered as multifactorial, multisystemic, or complex.

Pathophysiology of sexual pain disorders in female can be considered as:^[1][2]

• Multifactorial
• Multisystemic
• Complex

Multifactorial:

• Biological, psychosexual, relational factors can coexist and interact to perpetuate and maintain a woman’s pain response in a woman complaining of coital pain. Over time, these different factors may act as predisposing, precipitating, or perpetuating sexual pain disorders.
  

Multisystemic: sexual function involves:

• Nervous system
• Endocrine system
• Vascular system
• Immunological systems
• Vaginal ecosystem: Vaginal receptiveness may be further modulated by; psychosexual, mental, interpersonal factors that may result in poor arousal with vaginal dryness. Fear of penetration, general muscular arousal secondary to anxiety, defensive contraction of the peri-vaginal muscles, leading to lifelong vaginismus.
  

Complex:Coital pain is greater than the simple peripheral tissue damage that may initially trigger the nociceptive component. When It becomes chronic, the pathophysiology of pain may gradually shift from nociceptive, a friend signal that should induce self-protection and defense, to neuropathic, with progressive involvement of the CNS.^[3]

• If pain is due to a physical cause, the pathophysiology of the underlying cause should be considered.

The pathophysiology of dyspareunia in males depends on the underlying cause, psychosexual and relational factors.