Introduction
The Deep and Superficial Dyspareunia Questionnaire (DSDQ) is a 45-item patient-reported outcome measure that assesses superficial and deep dyspareunia separately, together with their psychosocial effects. Nisha Marshall, Paul J. Yong, Caroline F. Pukall and colleagues published it in 2025 in The Journal of Sexual Medicine.
The DSDQ was co-developed with patient partners and clinicians. This guide explains its six subscales, scoring and early evidence.
Key Features of the Deep and Superficial Dyspareunia Questionnaire (DSDQ)
Purpose and Use
The DSDQ characterizes pain with sexual activity in detail. It supports diagnosis and treatment planning, and tracks changes in dyspareunia over time in clinical and research settings.
Target Population
The DSDQ is intended for adults with pain during sexual activity that involves vaginal insertion.
Structure
The DSDQ asks about the past four weeks. Its 45 items fall into six subscales:
Subscale
What it covers
Items
Vaginal Opening Pain
Pain at initial entry and during movement, how often it happens, distress, pain descriptors and fears about insertion
9
Deep Vaginal/Pelvic/Abdominal Pain
Pain at the deepest point and during movement, pain after insertion ends, distress and pain quality
6
Pain Interference
Effects on sleep, daily activities, standing, bending, walking, exercise, concentration and social life
8
Affect and Cognitions Related to Provoked Pain
Helplessness, hopelessness, anxiety, loss of control, exhaustion, stress and negative feelings about oneself
9
Sexual Distress Related to Sexual Well-being
Distress about sexual self-worth, relationships, desire, arousal, orgasm and pleasure
8
Pain Self-efficacy
Confidence in managing pain and continuing desired sexual activities
5
Visual diagrams help respondents identify pain locations and insertion depths.
Scoring Method
Pain intensity items use an 11-point scale (0 = no pain to 10 = worst pain imaginable). Other items use 4 to 6 options based on frequency, intensity or agreement.
Subscale scores: divide each item's score by its maximum possible score, sum these values, divide by the number of items with valid scores, multiply by 100 and round.Missing items: skipped items and "Not Scored" responses are excluded; if no items in a subscale are scored, that subscale is reported as indeterminate.Direction: each subscale runs from 0 to 100, where 100 is the worst pain, interference, distress or the lowest self-efficacy. In the Pain Self-efficacy subscale, stronger agreement receives a lower score.Cut-off scores have not been established.
Administration Format
The DSDQ is a self-report questionnaire that takes about 6–7 minutes, according to its authors.
Applications of the Deep and Superficial Dyspareunia Questionnaire (DSDQ)
The DSDQ supports several uses:
Diagnosis support: distinguishing deep from superficial pain.Treatment planning: capturing the broader impact of dyspareunia.Research: studying genito-pelvic pain and its psychosocial effects.Languages and availability
The DSDQ is available in English, its original language. The questionnaire and scoring instructions are in the supplementary material of the 2025 development article and the follow-up article in The Journal of Sexual Medicine.
Reliability and Validity
Initial testing reported:
Internal consistency: Cronbach's alpha 0.90 to 0.95 across the six subscales of the 103-item exploratory model; alpha was not reported for the final 45-item versionTest–retest reliability: Spearman ρ 0.67 to 0.89 over about one weekConvergent validity: ρ 0.65 to 0.83 for the first five factorsDiscriminant validity: weak or very weak correlations with unrelated constructs (maximum ρ 0.39)Content validity: established through an eDelphi panel, cognitive interviews, and patient and clinician focus groupsValidation studies:
Deep and Superficial Dyspareunia Questionnaire: a patient-reported outcome measure for genito-pelvic pain (2025): study linkFollow-up article in The Journal of Sexual Medicine: study linkLimitations and Considerations
Keep these points in mind:
Model fit: confirmatory factor analysis fit was fair (RMSEA 0.08, SRMR 0.08, TLI 0.81, CFI 0.83).Self-efficacy subscale: Factor 6 showed weak convergent validity (ρ 0.27).Not yet established: cut-offs and responsiveness to treatment over longer periods need further research.Samples: evidence comes mainly from specialized pelvic pain clinic samples.Other Versions And Related Questionnaires
There are no other versions of the DSDQ.
These questionnaires are related:
Female Sexual Function Index (FSFI); see the ResRef FSFI guidePROMIS Sexual Function and Satisfaction Measures (SexFS)Endometriosis Phenome and Biobanking Harmonization Project (EPHect) dyspareunia questionnaireVulvar Pain Assessment Questionnaire (VPAQ)Subjective Impact of Dyspareunia Inventory (SIDI)Additional Resources
The development article: linkFor inquiries, contact Paul J. Yong, Department of Obstetrics and Gynaecology, University of British Columbia, at paul.yong@vch.ca, or Caroline F. Pukall, Department of Psychology, Queen's University, at caroline.pukall@queensu.ca.Browse more obstetrics and gynecology questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Deep and Superficial Dyspareunia Questionnaire measure?The DSDQ measures superficial and deep pain with vaginal insertion over the past four weeks, plus pain interference, emotions and thoughts about pain, sexual distress and pain self-efficacy, across six subscales.
How is the DSDQ scored?Each item is divided by its maximum score, the values are averaged within each subscale and multiplied by 100. Each subscale runs from 0 to 100, where higher scores mean worse pain or impact.
How long does the DSDQ take?According to its authors, the final 45-item DSDQ takes about 6 to 7 minutes to complete.
Does the DSDQ have cut-off scores?No. Cut-off scores and responsiveness to treatment have not yet been established, so further research is needed before using fixed thresholds.
A Word from ResRef About the Deep and Superficial Dyspareunia Questionnaire (DSDQ)
The Deep and Superficial Dyspareunia Questionnaire (DSDQ) is a 45-item measure that assesses deep and superficial dyspareunia separately, together with their psychosocial correlates, across six subscales. It was co-developed with patient partners and clinicians, and initial testing supports its internal consistency, test–retest reliability, and convergent and discriminant validity. However, evidence comes mainly from specialized pelvic pain clinic samples, and score cut-offs and responsiveness to treatment are not yet established. The DSDQ may be particularly useful where distinguishing pain location and capturing the broader impact of dyspareunia are priorities.
References
Marshall, N., Levang, S. L., Liu, Y. D., Noga, H., Allaire, C., Altas, M., Correia, S., Driscoll, M., Merkt-Caprile, K., Nishikawara, R., Weaver, R., Howard, A. F., Sutherland, J., Brotto, L. A., Pukall, C. F., & Yong, P. J. (2025). Deep and Superficial Dyspareunia Questionnaire: a patient-reported outcome measure for genito-pelvic dyspareunia. The Journal of Sexual Medicine, 22(5), 767–777. https://doi.org/10.1093/jsxmed/qdaf025