Do you have a vagina and have suffered from pain during sex? Did you think you were the only one and were afraid to talk about it? It’s time to get quick and dirty tips about vaginal pain.
Today we are going to discuss Genito-Pelvic Pain/Penetration Disorder, or GPPPD. It's a relatively new diagnostic category of female sexual dysfunction, first introduced in 2013.
GPPPD reflects the combination of two older categories of female sexual dysfunction, dyspareunia and vaginismus, into one entity. Dyspareunia is pelvic pain during or after sexual intercourse and vaginismus is an involuntary spasm of the musculature surrounding the vagina causing it to close, resulting in penetration being difficult, painful, or impossible.
It’s estimated that the prevalence of GPPPD is around 15% in North America, but some research supports higher estimates. It should be noted that many people don’t report their vaginal pain during intercourse. In fact, one study found that only about 51% told their partners about vaginal pain and that mild to moderate pain was unlikely to be enough to get them to speak up to their partners. However, even mild pain can disrupt sexual satisfaction and pleasure.
What are the symptoms of GPPPD?
The diagnostic criteria for GPPPD include persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse.
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
Keep in mind that penetration can be sexual penetration like intercourse or finger stimulation or non-sexual like gynecological examinations or tampon insertion. A person may struggle in all situations or may notice difficulty in one area and not another. The pain can be more superficial (closer to the opening of the vagina) or deeper in the pelvic region. Some may find that the pain lingers after sexual intercourse is over. The pain in GPPPD can be described as “burning,” “shooting,” “cutting,” or “throbbing.” Some may note a sense of heat or irritation. These issues persist for 6 months or more.
For those who have deal with this situation persistently, it can lead to avoidance of and anxiety about sexual interactions. In terms of criteria 4, the tensing and tightening during attempted vaginal penetration can be involuntary spasms or “normal/voluntary” guarding due to anticipated or repeated pain or the anxiety and fear regarding pain.
Even when sexual desire and interest is preserved, many find that they still avoid sexual opportunities, and as a result may experience relational issues.
How can GPPPD be treated?
The etiology of GPPPD is not well known and it remains under-researched. However, if you choose to be evaluated, several factors will be considered to explore the etiology and possible treatment avenues. This will include your relationship, partner, individual vulnerability, mental health and stressors, as well as cultural, religious, and medical factors.
This is because of the wide range of elements that can affect your experience of sex. These are factors like poor communication or sexual desire mismatch in your relationship, your partner’s sexual issues or health status, poor body image, a history of emotional or sexual abuse, depression, anxiety, grief, losing a job, or cultural or religious messaging that leads to negative ideas or attitudes regarding sex and medical conditions.
There are also many medical conditions that lead to vaginal pain. This is not an exhaustive list, but some of those medical conditions may be: allergic reactions (e.g. latex), infections (e.g. herpes, HPV, vaginitis), inadequate lubrication, Crohn's disease, IBS, interstitial cystitis, endometriosis, vaginitis, neuropathies, and hemorrhoids.
There are some who would like to separate sexual health from mental or physical health, but I’m a sex positive psychologist!
It’s also very clear from the research that these things are interconnected. For instance, those with GPPPD are more likely to have experiences of sexual, physical, or emotional abuse. It is also more common in those with anxiety and depression disorders.
We’ve talked a bit about cognitive or early maladaptive schemas on this podcast and they show up in GPPPD as well. Those who have GPPPD often have schemas associated with incompetence, rejection, and vulnerability to danger. There are often negative beliefs or cognitive distortions associated with pain and sex (e.g. “the pain will be unbearable”). These are all elements that can be helped with proper treatment.
Here are some quick tips for treatment that you can get started on today:
- See a sex therapist! There are various mental health therapists that also perform sex therapy. I’m one of them! In this form of therapy, the provider will explore your mental health history and factors (e.g. history of abuse or history of depression and anxiety) and help you work through those issues and how they may contribute to your GPPPD. It can feel weird at first to talk to someone about sex, but we aren’t bothered. I’ve helped folks of all genders explore their sexuality and work through hangups or problems they’ve had sexually. There are many CBT, mindfulness, and other techniques that are beneficial!
- Lube. It’s fantastic! A water-based lube can go a long way to reduce vaginal pain. Don’t hestitate to add this into your sexual play.
- In terms of sexual play—don’t be afraid to have it. If you deal with GPPPD, don’t be afraid to take your time and really ensure that you are turned on for sex. Feeling tense will only exacerbate the situation.
- Urinate after sexual intercourse
- Avoid scented vaginal products.
- Get your partner(s) involved. If communication or partner issues are leading to increased vaginal pain, work on those issues!
There is help for this disorder and treatment is more likely to be effective if it’s tailored to you. Don’t be silent. Reach out to a professional that can aid you in having the healthiest and most pleasurable sex life you can have!
Did you know about GPPPD prior to this episode? What kind of questions do you have about the connection between sexual and mental health? Let me know on Instagram @kindmindpsych. You can also reach out to me via my email at email@example.com, or leave a voicemail at (929) 256-2191.