A lot of times, women experience pain during penetrative sexual intercourse. In severe cases, penetrative sex seems extremely painful and sometimes impossible due to muscle contraction. As couples might not comprehend why sex is so uncomfortable and challenging, their relationships may begin to deteriorate. Some women worry about upsetting their partners and anticipate that they could lose them, which leads to significant psychological and emotional distress.
Genito−pelvic pain/penetration disorder (GPPPD) is a sexual dysfunction disorder characterized by persistent, severe discomfort and difficulties having penetrative intercourse. The diagnosis for GPPPD is made when the symptoms last for at least six months. The term "GPPPD" is an umbrella term referring to two sexual pain conditions: dyspareunia (painful intercourse) and vaginismus (a situation in which the muscles in the vagina contract to the point that penetration is difficult and, in extreme cases, impossible).
For women with GPPPD, penetration can be uncomfortable at entry (pain is felt upon first or attempted penetration of the vagina) or during deep penetration. Some people become anxious and fearful when they anticipate experiencing pain, and their pelvic floor muscles tighten involuntarily, which adds to the discomfort. Consequently, women with GPPPD cannot engage in sexual intercourse with their partners. Unsurprisingly, some GPPPD−affected women may lose their desire for sex, and others may avoid having sex.
GPPPD can be either lifelong or acquired. Lifelong GPPPD is defined as GPPPD that starts with the first attempt at penetration and lasts throughout all subsequent sexual encounters. After a time of regular sexual activity, acquired GPPPD typically occurs. Any age can experience GPPPD. However, menopausal women and young people are at a higher risk than others. In some cases, women develop GPPPD right after childbirth.
The underlying causal factors of GPPPD are still unknown to a great extent, but several factors seem plausible. Gynecological conditions such as endometriosis and vaginal infections can contribute to GPPPD. Vaginal atrophy or experiencing dryness after menopause also be a contributing factor. Apart from medical issues, impaired social functioning, frequent relationship conflict with the partner, and communication gap between the two can be distressing. Psychological factors like negative body image, history of trauma like sexual abuse, and maladaptive thoughts on sex, such as perceiving it to be something that is "wrong" or "bad," can also predispose an individual to develop GPPPD. Fear of pain during first-time sexual intercourse, lack of sexual education, and other sociocultural factors are common etiological factors.
To begin with the treatment, firstly, any sexual discomfort in women should be discussed with a gynecologist. Treating the underlying medical issue may be sufficient if GPPPD is brought on by it. For instance, lubricants can aid with dryness in the vagina. Women may benefit from certain medications or hormone therapy after menopause. Treatment includes psycho-educating the patient about the condition and its implications, CBT−focused training for restructuring maladaptive cognition, and medical and surgical interventions that may be optimized through a multidisciplinary approach.
Women with pelvic pain/penetration disorders frequently benefit from pelvic floor physical therapy. It teaches women how to relax their pelvic muscles by including pelvic floor muscle exercise and is often accompanied by biofeedback. Women learn to contract their pelvic muscles and relax through these activities. Physical therapists may also employ other methods to loosen and stretch constrained pelvic muscles. A few methods include myofascial release and soft tissue mobilization, applying pressure to very sensitive areas of the affected muscles, which may be where the pain begins (trigger points), stretching the affected muscles or the tissues that cover them (myofascial), and occasionally applying a gentle electric current through a device positioned at the opening of the vagina. Additionally, bladder training and bowel retraining are carried out. The women are required to urinate on a prescribed schedule and are given exercises to strengthen the muscles surrounding their urethra and anus, often in conjunction with biofeedback.
Another treatment approach for GPPPD is sex therapy, with or without a partner. Women might benefit from learning more about their anatomy and sexual cycle from a sex therapist. Additionally, women can find ways to unwind and interact with their partners. Some women "practice" penetration and get more accustomed to it by using vaginal dilators, plastic tubes that progressively and gently stretch" the vagina, gradually reducing the pain experienced in GPPPD.
It is advised that women with GPPPD seek medical advice from a doctor before trying any self-help methods, especially if they need support with medication. Since it involves a sensitive area, using the incorrect method might have several unfavorable effects and aggravate pain and distress in patients.
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