What is Dyspareunia and the Underlying Diagnoses of Sexual Pain

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Addressing unwanted sexual pain is a key component of sexual health. The presence of unwanted sexual pain, also known as dyspareunia, can make engaging in sex become quite stressful. Dyspareunia can vary based on the person, and can occur before, during, or after sexual intercourse. It can sometimes even happen while using female hygiene products—such as tampons or menstrual cups—or when engaging in gynecological exams. While anyone may experience it at some point in their life, dyspareunia is more common in women than men.

Genito Pelvic Pain/Penetration Disorder (GPPPD)

Sexual pain can be stressful and overwhelming, but it may come as a relief to know that in some cases there may be a potential diagnosis lurking underneath the pain. Genito Pelvic Pain/Penetration Disorder (GPPPD) is a medical diagnosis and condition where there is significant pelvic pain, and the pelvic floor muscles contract involuntarily, which prevents penetration during sex as well as from objects such as tampon and medical equipment used during gynecological tests. For people with GPPPD, any attempt to engage in penetration during the muscle contractions will result in pain and discomfort. Current estimates are that GPPPD impacts about 15% of women in North America.

It is important to note, however, that not all instances of sexual pain or dyspareunia qualify as Genito Pelvic Pain/Penetration Disorder, as GPPPD necessitates both symptoms of dyspareunia (pelvic pain), and involuntary contractions of the pelvic floor muscles when penetration is attempted. It may be helpful to think of dyspareunia as a broader, more umbrella term encompassing pelvic-sexual pain, and GPPPD being a more specific diagnosis within dyspareunia.

Underlying Diagnoses of Dyspareunia

List of 11 potential contributors to pelvic pain, blue text on light blue background. Text reads: childbirth, breastfeeding, skin disorders, infections such as STIs or UTIs, injury or trauma from childbirth, changes in the vagina due to menopause, vulvodynia, endometriosis, vestibulodynia, history of sexual abuse or trauma, interstitial cystitis.When thinking about dyspareunia it is important to note that many things may contribute to or cause pelvic pain in women including childbirth, breastfeeding, skin disorders, infections such a STIs or UTIs, injury or trauma from childbirth, changes in the vagina due to menopause, vulvodynia, endometriosis, vestibulodynia, history of sexual abuse or trauma, interstitial cystitis, and more. Dyspareunia is exceedingly common, with the American College of Obstrecticans and Gynecologists noting that nearly 3 out of 4 women have experienced painful sex at some point in their lives. For some women, the pain may be temporary, and for others the pain may be more longstanding and necessitate more significant intervention.

Dyspareunia in Men

In men, dyspareunia may be present due to sexually transmitted infections, physical trauma to the penis or foreskin, Peyronie’s disease, or painful erections.  Research indicates that anywhere between 2-10% of men may experience pelvic pain, however, it’s possible these estimates are not comprehensive due to limited reporting and studies on the occurrence of dyspareunia in men. With any instances of painful sexual encounters, it is recommended to discuss these concerns with your medical doctor. You don’t need to suffer in silence!

Treating Dyspareunia

Pelvic pain can create a feedback loop of stress, anxiety, and feeling overwhelmed where people often worry about the impacts on their romantic relationships, physical health, and overall prognosis or hope for the future. And, while it can quite literally be a pain, it can be treated! Often times when embarking on a course of treatment for dyspareunia, the first stop will be a thorough assessment of the patient’s medical history and physical exam with a health care provider who is skilled and trained at fully assessing the scope of the sexual pain.

While the thought of a physical exam may fill some with fear and trepidation, it is important to discuss these fears and concerns with your provider so that you may work collaboratively to address them in a way that feels accessible and realistic to you.  These exams may help determine what may be contributing to the dyspareunia and possible interventions that may be helpful.

Most often, a skilled pelvic floor physical therapist will be a crucial part of the treatment team to help identify and oversee various skills and interventions that may be helpful in addressing and relieving dyspareunia. At times, a recommendation might be made to seek out sex therapy to integrate a variety of skills, such as:

These are just a few of the skills that may help support and solidfy the work of alleviating dyspareunia in addressing the mind/body connection of pain and sexual intimacy. A sex therapist can also help you explore and examine how to navigate the impact of dyspareunia within your romantic relationships, as well as explore and create space to alleviate feelings of shame, anxiety, stress, and being overwhelmed that may be secondary to the pain.

When examining all of these pieces, one of the key take aways is that sex with unwanted pain does not have to be a part of your sexual life. A sex therapist can help support you along your journey towards sexual health and fullfillment.

Wildflower Center for Emotional Health is a therapy practice with offices in Chicago (River North) and Oak Park, IL. We offer in-person services at each of our locations as well as online therapy to anyone in Illinois. We specialize in perinatal and reproductive health, trauma and PTSD, anxiety and depression, relationships, sex and intimacy concerns, and more.Learn More