Genito Pelvic Pain / Penetration Disorder (AKA Vaginismus) – How can a sexologist help?
A common sexual dysfunction disorder that can cause significant health concerns for women or those with vulvas is Genito pelvic pain/penetration disorder (GPPPD) (formally known as vaginismus). Within the diagnostic and statistical manual of mental health disorders 5th edition (APA, 2022), Vaginismus is now classed as GPPPD (APA, 2022). GPDD is defined as the involuntary spasm of the pelvic muscles surrounding the outer third of the vagina (Jeng et al., 2006). The reflex contraction of these muscles within the vaginal canal are the result of direct penetration, imagined penetration or attempted penetration, and often associated with anxiety and distress (Jeng et al., 2006; Rosenbaum, 2011). GPPPD therefore can cause significant distress for an individual’s sexual, psychological, physical, and emotional health, and impact greatly upon intimacy within a relationship (Jeng et al., 2006).
What causes GPPPD?
GPPPD can affect women/vulva owners of all ages, and there are various factors that can contribute to the development of GPPPD. Women/vulva owners with comorbid psychiatric conditions such as anxiety, depressive or mood disorders are 4 times more likely to develop GPPPD (APA, 2022). Other psychosocial factors and interpersonal difficulties such as environmental stressors, relationship difficulties and cultural background are likely to perpetuate ongoing symptoms of GPPPD (APA, 2022). Other significant factors such as history of sexual abuse or assault can increase the likelihood of developing GPPPD (APA, 2022). Genetic and biological factors such as history of vaginal infection, early puberty, poor pelvic floor muscle control and pain during tampon insertion are all factors that can increase the risk for developing this disorder. There is no specific reason for developing GPPPD, and sadly, there is a lot of shame, guilt, and embarrassment that women / vulva owners may feel for experiencing GPPPD. It is not something to be ashamed of and is very effectively treated with the right support and psychosexual treatment approach. Through psychosexual counselling, many women / vulva owners often learn there are many other ways of being intimate, and the expectations on penetrative sex alone do not have to be so high.
How can a sexologist help with GPPPD?
The literature indicates that the most effective treatment approach for women/vulva owners experiencing GPPPD is multidisciplinary in nature, and usually includes therapeutic support from a sexologist, pelvic-floor physiotherapist, gynaecologist, and your regular GP. Due to the biological, psychological, social, and environmental factors that can play a role in GPPPD, it is vital to ensure your treatment approach is multidisciplinary, and your sexologist will often refer you to both a gynaecologist and/or pelvic floor physiotherapist for best practice. An effective treatment plan for GPPPD is different for each person, but will likely include various intervention strategies, including psychoeducation, cognitive behavioural therapy for associated anxiety, desensitization, relaxation strategies, exercises for vaginal dilation, use of dilator therapy (in conjunction with pelvic floor physio), physiotherapy Kegel exercises, progressive muscle relaxation, sexual counselling, and couples therapy engagement (Jeng et al., 2006). Your GP may also recommend Xylocaine jelly or oral analgesics in cases of severe GPPPD (Jeng et al., 2006).
Author: Abbey Sawyer Sexologist, MAAPi, PostGradDipPsych, BPsychSci, BCrim.
Abbey is a Sexologist who is near completion of her Master of Science in Medicine degree, specialising in psychosexual therapy. Abbey is passionate about the interlink between psychological health and sexuality, and enjoys supporting people of all ages, genders, and cultural backgrounds to enrich their sexual lives and improve their mental health.
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American Psychiatric Association. (2022). Genito-Pelvic Pain/Penetration Disorder. In Diagnostic and statistical manual of mental disorders: DSM-5-TR. essay, American Psychiatric Association Publishing.
Jeng, C.-J., Wang, L.-R., Chou, C.-S., Shen, J., & Tzeng, C.-R. (2006). Management and outcome of Primary Vaginismus. Journal of Sex & Marital Therapy, 32(5), 379–387. https://doi.org/10.1080/00926230600835189
Rosenbaum, T. (2011). Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: A clinical approach. Journal of Sex & Marital Therapy, 37(2), 89–93. https://doi.org/10.1080/0092623x.2011.547340