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Pain Disorders: Pain During Intercourse


Pain disorders are characterized by the persistent pain or discomfort experienced while trying to have sex. Outside of certain kinks, sex should never be painful. However, many people, particularly women, experience pain during sexual activity during their lives, and this can cause severe emotional distress and a lack of interest in sex.

While men experience pain during sex, the prevalence is low compared to women and is under-researched. As such, only one pain disorder exists in the current edition of the Diagnostic and Statistical Manual of Mental Disorders: genito-pelvic pain/penetration disorder. This disorder only applies to people with a vagina and comprises two previously separate disorders, vaginismus and dyspareunia. Experts argued that these two disorders should be considered as one, as many of the symptoms overlap, with one study finding that approximately 47% of women diagnosed with dyspareunia had symptoms of vaginismus and approximately 74% of women diagnosed with vaginismus had symptoms of dyspareunia.

Genito-pelvic pain/penetration disorder

As stated above, genito-pelvic pain/penetration disorder is a sexual pain disorder that combines both dyspareunia and vaginismus. As the disorder is relatively new, prevalence rates are still to be determined. However, one study did find that the disorder affected approximately 10.5% of women. Other studies have found the prevalence rates to vary between 0.4% to 6.6% for vaginismus and 3% to 25% for dyspareunia. Additionally, postmenopausal women are at a higher risk of developing dyspareunia due to the change in flexibility and lubrication of the vaginal tissue.

Causes

As with many sexual disorders, there are many causes of genito-pelvic pain/penetration disorder. These include.

Mental health: Depression, trauma, fear of pain, shame, and guilt surrounding sex.

Relationship problems: Negative partner responses often reinforce or exasperate the pain.

Hormones: Reductions in estrogen from menopause, oral contraceptives.

Illness: Pelvic inflammatory disease, pelvic floor abnormalities, endometriosis, urinary tract infections, yeast infections.

Medication: Chemotherapy.

Cultural: Lack of sex education, religious beliefs.

Childbirth: Both with and without episiotomy.

Diagnostic criteria

To meet the diagnostic criteria for genito-pelvic pain/penetration disorder, a woman must experience difficulty in one of the following criteria for a period of over six months in almost all of their partnered sexual activity. These symptoms must cause the woman to experience significant distress to be diagnosed and can not be explained by another disease or disorder.

  • Difficulty with vaginal penetration.
  • Pain in the vulva, vagina, or pelvic area when attempting penetration or sexual activity.
  • Fear or anxiety about pain in the vulva, vagina, or pelvic area, in anticipation of, or during penetration or sexual activity.
  • The tightening of the pelvic floor muscles during penetration or attempted penetration

Genito-pelvic pain/penetration disorder can be either lifelong or acquired. For women with lifelong genito-pelvic pain/penetration disorder, the pain has been present since they became sexually active. For women with acquired genito-pelvic pain/penetration disorder, the pain has occurred after a period of normal sexual functioning.

Treatment

The treatment of genito-pelvic pain/penetration disorder is conducted by several health professionals who work collaboratively to develop a treatment plan suited to the individual’s needs. This is often done by a psychologist or sex therapist, gynecologist, and pelvic floor physiotherapist. The most common forms of treatment treat both the physiological and psychological causes.

Physical therapy

Women experiencing genito-pelvic pain/penetration disorder may work with a specialized pelvic floor physiotherapist to help train the pelvic floor muscles to relax. A woman may also be treated with dilation therapy, which involves the woman inserting various-sized dilators into the vagina to gently stretch the muscles over time.

Reframing sexual activity

A sex therapist or psychologist will work with women and their partners to help to deprioritize the role of penetration between the couple and prioritize affection and sensuality to help relieve the anxiety surrounding penetration.

Learning to build desire and arousal

Additionally, a therapist will work with the individual or couple to help build desire and arousal by creating mindfulness practices to help the woman to become more aware of periods of arousal or desire, establishing communication techniques between the couple, and working with the couple to enhance their quality time together.

A therapist may also recommend masturbation and genital exploration as a way for the woman to gain autonomy over her body, locate which areas are painful, and explore pleasure to build desire and arousal.

Addressing gynecological issues

A gynecologist will work with the women to treat any pelvic floor, urinary or vaginal infections, or issues from childbirth or menopause.

How to seek treatment?

It is important to remember that no one should experience pain while having sex. If you do experience pain or discomfort when engaging in any sexual activity, it is important that you seek help. Seeking treatment from a sex therapist, gynecologist, or general practitioner is a good place to start.

Conclusion

Although it is common for many women to experience pain during sexual activity, this isn’t normal sexual functioning and should be treated by a sexual health professional. As there are many different causes of genito-pelvic pain/penetration disorder, treatment is individualized to the women to treat their underlying psychological and physiological issues.

Key takeaways

Genito-pelvic pain/penetration disorder is a sexual pain disorder that combines both dyspareunia and vaginismus and affects around 10% of women.

Women with this disorder experience pain, discomfort, and anxiety during sexual activity or attempted sexual activity.

Although it is common, experiencing pain during sexual activity is not normal and should be treated by a sexual health professional, who will assess the woman for psychological and physiological causes.

Resources

Diagnostic and Statistical Manual of Mental Disorders - The American Psychiatric Association

Prevalence and sociodemographic predictors of sexual problems in Portugal: a population-based study with women aged 18 to 79 years - Journal of Sex and Marital Therapy

Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women - The Journal of Sexual Medicine

Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial - Frontiers Psychiatry

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