What is genito pelvic pain/penetration disorder and how it's different from dysparenia and vaginismus
Dr. Maria Castellas

Dr. Maria Castellas

Mar 01Vaginismus

What is genito pelvic pain/penetration disorder and how it's different from dysparenia and vaginismus

Genito pelvic pain/penetration disorder is referred to by many names like Genito pelvic penetration disorder or sexual pain disorder. It is characterized by having difficulty with intercourse and tremendous pain with penetration. The terms dyspareunia and vaginismus are both classified under this broader term  -  Genito Pelvic Pain/Penetration Disorder (GPPPD).

Certain criterias are laid out for diagnosing Genito pelvic pain/penetration disorders, and they are the following:

  • Having persistent or recurrent difficulty with vaginal penetration during intercourse
  • Reporting increased vulvovaginal or pelvic pain during vaginal intercourse or attempts at intercourse
  • Feeling enormous fear and anxiety about vulval, vaginal or pelvic pain in anticipation of or during penetration
  • Experiencing marked tension or spasm of the pelvic floor muscles with attempted vaginal penetration 
  • Symptoms are present for more than 6 months and are causing great distress

There has been research into increased pain sensitivity in these women that is due to hyperinnervation which could be from genetic,hormonal or inflammatory factors. 



Symptoms of Genito pelvic pain/penetration disorder include: 

  • Pain during intercourse
  • Avoiding sexual activity
  • Tightness in the pelvic floor muscles
  • Genital or vulval pain that is felt just at a single point or all around the vulva
  • Emotional and psychological agitation due to the impact of the pain

 

What could cause Genito pelvic pain/penetration disorder?

Genito Pelvic Pain/ Penetration Disorder might be caused by physical, psychological, or relationship challenges, all of which appear to be related. This simply indicates that Genito pelvic pain/penetration disorder might be caused by a variety of factors. Physical reasons include trauma to the vulva due to childbirth or surgery, infections such as UTIs or yeast infections, pelvic muscular spasms or chronic contraction of the pelvic floor muscles. Hypertonicity or increased tension in the muscles surrounding the vulva can also cause GPPPD, along with other anatomical or medical conditions such as pelvic organ prolapse, pudendal neuralgia, and dysfunction in the pelvic floor muscles. Hormonal conditions such as endometriosis and decreased estrogen in the tissues can also cause pain. 

Psychological variables such as stress, anxiety, and previous sexual trauma play a significant role in causing GPPPD. The pelvic floor muscles hold lots of emotion, meaning that traumatic situations that cause anxiety can produce a reflex contraction in the pelvic floor muscles. Over a period of time, this can become chronic, leaving the pelvic floor muscles with tension or trigger points. This can increase pain around the pelvis (with or without penetration), and is often accompanied with avoidance of penetration. The fear avoidance model talks about chronic pain and why there is a persistence of pain in Genito pelvic pain/penetration disorder.

 

The vicious cycle of female genital pain



 



When a person encounters their first unpleasant incident, they develop terrified and horrible thoughts about the pain and its meaning. These trigger a "flight or fright" reaction, which intensifies the unpleasant feelings and emotions linked with pain and the avoidance of sexual engagement. Pelvic floor hypertonicity exacerbates both the discomfort and the feeling. This discomfort reduces arousal, resulting in less lubrication and more painful penetration. Repeated sexual pain will cause dread and guarding, eventually leading to avoidance of vaginal penetration. Finally, the body and the mind get used to the idea of avoiding sexual activity.

 

Difference between vaginismus, dyspareunia, and Genito pelvic pain penetration disorder

Genito pelvic pain/penetration disorder is a female sexual dysfunction designated by the DSM-5, combining both the terms “vaginismus” and “dyspareunia”. The criteria for what is considered GPPPD is discussed in the beginning of this article, with the defining characteristic being that the person experiences pain or has a fear of pain with vaginal penetration or upon any sexual genital contact. 

Dyspareunia is persistent or recurring genital pain that occurs immediately before, during, or after sexual penetration. This discomfort can be felt in the genital area, including the vulva, vaginal opening, or deeper in the pelvis. If you have dyspareunia, you might be able to allow penetration, but it’ll be painful. 

Vaginismus is characterized by the spasm of the pelvic floor or vaginal muscles, which are strong enough to make insertion of tampons or sex toys, a gynecological exam and partner penetration very difficult or impossible. Vaginismus is categorized as primary and secondary.

The reason the conditions were combined under one sexual pain disorder is because researchers and practitioners felt that it would help to diagnose the condition better, especially because generally, treatment is also similar. However, there are some instances where treatment might differ, which is why it’s important to understand the difference.

 

Treatment

To diagnose Genito pelvic pain/penetration disorder, the doctor needs to complete an extensive evaluation to rule out any other medical conditions. It’s important to note that the cause for GPPPD can be “idiopathic” meaning “unknown”. The medical evaluation involves the person describing the pain/complaint and doctor looking into the person’s medical, surgical, sexual, gynecological, and medication history. 

Treatment for Genito pelvic pain/penetration disorder includes a multidisciplinary treatment approach because the cause of GPPPD has multiple factors and complexities. The goals of treatment should be 2 things: 

  1. To decrease sexual and genital pain
  2. To improve and restore sexual function

It’s essential that treatment is individualized and personal to each client. Generally, treatment involves the following components:

  1. Pelvic floor Physiotherapy to address any tension in the pelvic floor muscles that could be contributing to pain. Sessions start with education on anatomy and the pain response, which also helps bring awareness to the muscles so relaxation becomes easier. Guided breathing and stretches are provided to actively lengthen muscles, help the muscles relax, and decrease anxiety. Physiotherapists also guide people on how to use dilators. A study found that after an average of 7 sessions of physiotherapy, 51.4% patients with vaginal pain had either complete or significant improvement. 
  2. Psychological intervention which involves psychosexual therapy, education, and cognitive behavioral therapy. Negative beliefs and expectations surrounding sexual contact are addressed, along with a woman’s emotions and experience with pain. Relationship dynamics and anxiety and stress management are also discussed. 
  3. Sensate Focus and Gradual Exposure: Sensate focus exercises entail gradually reintroducing touch and closeness in a non-threatening manner, with an emphasis on pleasure rather than penetration. Gradual exposure strategies can help individuals get desensitized to the fear of pain during sexual engagement.
  4. Lifestyle changes: Includes getting any type of eating disorders checked and treated. Research suggests that there is a correlation between Genito pelvic pain disorder and eating disorders.

 

Conclusion

Genito pelvic pain/penetration disorder can be treated and if any of the above information is relevant and if you feel this is what you could have, please feel free to call the clinic and enquire about this and the “Online Vaginismus Program” at Proactive for Her. The online program offers an extensive consultation with expert gynecologists who are trauma informed and well aware of what Genito pelvic pain disorder includes. You can rely on a team of experienced mental health therapists, pelvic health therapists, and pleasure coaches. Proactive for Her has a comprehensive way of treating you.