Genito-Pelvic Pain or Penetration Disorder (Sexual Pain Disorder)

Definition

Genito-pelvic pain/penetration disorder refers to a condition in which people experience difficulty having intercourse, and feel significant pain upon penetration. The severity of the condition ranges from a total inability to experience vaginal penetration in any situation to the ability to easily experience penetration in one situation but not in another. For example, a women might not feel pain when inserting a tampon but might experience intense discomfort when attempting to have vaginal intercourse.

Genito-pelvic pain/penetration disorder is a new diagnosis in the DSM-V. It was previously referred to as a sexual pain disorder consisting of dyspareunia, which refers to pain in the pelvic area during or after sexual intercourse, or vaginismus, referring to an involuntary spasm of the musculature surrounding the vagina causing it to close, resulting in penetration being difficult, painful, or impossible.

The number of women with genito-pelvic pain/penetration disorder is not known, but it is estimated that 15 percent of women in North America experience recurrent pain during intercourse. The disorder is associated with other sexual challenges, such as reduced sexual desire and avoidance of any genital contact that might cause pain. As a result, many women with genito-pelvic pain/penetration disorder often have problems in their relationships around sex and many report that their symptoms make them feel less feminine.  

Symptoms

Genito-pelvis pain/penetration disorder commonly involves the following symptoms:

  • Persistent difficulty having intercourse.
  • Pain in the genital or pelvic area during vaginal intercourse or attempts at penetration.
  • Significant fear or anxiety associated with the pain of intercourse. This fear may be present before, during, or after vaginal penetration.
  • Tensing or tightening of the pelvic floor muscles when attempting vaginal intercourse.

To be diagnosed with genito-pelvic pain/penetration disorder, symptoms must be present for at least six months. Genito-pelvic pain is most commonly reported during early adulthood and in the peri- and postmenopausal period.

Causes

Genito-pelvic pain/penetration disorder can be characterized as being lifelong or acquired. Specifics around the development of the disorder are unknown, but the following factors may be relevant to the cause and treatment of genito-pelvic pain:

1) Partner factors, such as their health status or challenges with sexual intercourse

2) Relationship factors, such as differences in sexual desire and lack of communication

3) Individual vulnerability factors, such as history of abuse or poor body image

4) Cultural and religious factors, such as attitudes toward sexuality

5) Medical factors, such as infections and other conditions that cause pain in the genito-pelvic region

An important risk factor for the development of genito-pelvic pain/penetration disorder is pain during tampon insertion. Additionally, many women have an increase in genito-pelvic pain-related symptoms in the postpartum period or after a history of vaginal infections.

Treatments

The nature of treatment and outcome of genito-pelvic pain/penetration disorder depends on the cause of the pain. Sharing symptoms of pain with a clinician can help to develop a diagnosis and decide on the appropriate treatment.

  • For painful intercourse in women after pregnancy, gentleness and patience should be exercised.
  • For painful intercourse in menopausal women, use lubricants and estrogen-containing creams or medications as prescribed.
  • For painful intercourse caused by endometriosis, medications can be obtained. Surgery, which might give total relief, may also be an option.
  • For painful intercourse due to other complications, disease, or psychological factors, see your health care provider.

What To Expect Your medical history will be obtained and a physical examination performed. Detailed medical history questions documenting difficulty with intercourse may include:

  • When did the pain first develop?
  • Is intercourse painful every time that it is attempted?
  • Has it always been painful?
  • Is it painful for your spouse, also?
  • Where is the pain? (Labia, vagina, entire pelvic area?)
  • Does the pain occur during entry?
  • Has there been a significant traumatic event in the past (rape, child abuse, or similar)?
  • What illnesses, diseases, and disorders are currently being treated?
  • What medications are being taken?
  • Has there been a significant emotional event recently?
  • What have you done to try to make intercourse less painful?
  • How well has it worked?
  • What other symptoms are present?

Unless the problem is clearly caused by one person's physical issues, the couple involved should see the doctor together. If a physical problem is suspected, tests will be ordered.

Prevention Good hygiene and routine medical care will help to some extent. Adequate foreplay and stimulation will aid in ensuring proper lubrication of the vagina. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not water-soluble and may encourage vaginal infections.

Treatment of Vaginismus Dyspareunia inhibits sexual interest as well as responsiveness. In some situations vaginismus may occur, causing the vaginal muscles to involuntarily contract and clamp down as a self-protective way of avoiding the anticipated discomfort.

The treatment of choice with vaginismus is an extensive therapy program combining education and counseling with behavioral exercises. Exercises include pelvic floor muscle contraction and relaxation (Kegel exercises) to improve voluntary control. Vaginal dilation exercises are recommended using plastic dilators, and should be done under the direction of a therapist or other health care provider. Treatment should involve the partner. This should include gradually more intimate contact culminating in intercourse.

Educational treatment should provide information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.

Sources

  • Diagnostic and Statistical Manual of Mental Disorders
  • Dyspareunia Fact Page
  • National Institutes of Health - National Library of Medicine. Medical management of endometriosis-associated pain
Last reviewed 01/23/2017