ICD-10 Code: F52.6
Female genito-pelvic pain/penetration disorder (GPPPD) is part of a cluster of diagnoses called the sexual dysfunctions. Sexual dysfunctions are a group of psychiatric conditions that include:
Sexual dysfunctions are characterized by a significant impairment in a person's ability to respond sexually or to experience sexual pleasure. This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest. An individual may have several sexual dysfunctions at the same time.
Biology, Psychology, and Sexual Function
Several factors can disrupt sexual functioning. Medical conditions such as multiple sclerosis, spinal cord injury or other nerve damage, diabetes, endocrine (hormonal) disorders, and menopausal status can all lead to problems of sexual interest or sexual capacity. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), may have sexual side effects. Some age-related vascular, nerve-related, and hormonal changes can also adversely affect sexual functioning. It is important to note that when sexual dysfunctions can be primarily attributed to one or more of these biological factors, it should not be diagnosed as a psychiatric disorder, and treatment should target the underlying medical problem. However, in many cases, medical concerns can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a psychiatric diagnosis may be appropriate.
Other psychiatric disorders can adversely affect sexual function. As one example, Major Depressive Disorder may be characterized by decreased interest in all or almost all of one’s usual activities. Sexual interest, therefore, may be diminished. In such cases, a separate diagnosis of a sexual dysfunction is not warranted. However, as was the case with medical conditions, other psychiatric disorders can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
Several psychological issues, even in the absence of a diagnosable psychiatric disorder, can contribute to sexual dysfunction. Negative body image may lead to feelings of anxiety around sexuality, inhibiting desire or capacity. Performance anxiety may similarly lead to problems of sexual function. Stressors, such as work or family concerns, may preoccupy the individual, affecting sexual interest or performance. A history of sexual trauma or other negative historical events may create negative associations with sexuality, thus undermining function. In such cases, a diagnosis of a sexual dysfunction is usually warranted.
Relationship factors can also contribute to problems of sexual functioning. At a purely physical level, often an individual’s sexual concerns stem not from a problem within the individual, but from a lack of appropriate sexual stimulation from his or her partner. At an interpersonal level, some couples suffer from poor sexual communication, have poor understanding of sexuality, have different desires or preferences for sexual activity, or feel negatively about each other. All of these factors have the potential to adversely affect sexual arousal or performance. Such cases should not be diagnosed as a psychiatric disorder. Again, however, relationship problems can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
The etiology of a sexual dysfunction is frequently unclear, and clinical judgment is needed. Often, multiple possible explanations need to be explored, using both medical and psychiatric examination procedures.
Given the fact that GPPPD is a newly documented diagnosis, its prevalence is still to be ascertained. However, approximately 15% of women report recurrent genital pain during intercourse. The disorder is characterized by the following symptoms:
GPPPD is a new diagnosis that subsumes a number of diagnoses, including vulvodynia, vaginismus, and non-coital sexual pain disorder. During any attempt to penetrate, a reflex action triggers tension in the muscles, resulting in pain. It is an involuntary reflex, wherein the female has no control over the contraction of the muscles, and experiences pain that may vary from mild to intense.
The tightening of the muscles can cause difficulties with the use of tampons, instruments used for gynecological examinations, and the penis or other sexual objects. The disorder is commonly associated with a reduced sexual desire and interest. Even when individuals with the disorder report interest or motivation in sex, they may avoid sexual activity for fear of pain. Individuals with this disorder may also avoid gynecological examinations despite medical recommendations.
There are five factors that should be taken into consideration during the assessment and diagnosis of genito/pelvic pain/penetration disorder:
Recent studies have shown at least four possible pathways that may modify risk of developing this disorder. These include hormonal changes, neurological changes, inflammation, and hypertonic pelvic floor muscles. Early psychological stressors such as sexual abuse, physical abuse, and anxiety may play a role in the development of GPPPD.
However, this is a matter of controversy in the literature and the psychological predictors of the disorder are still unknown. In studies of couples with GPPPD, those with greater affection and encouragement of adaptive coping were associated with lower levels of intercourse pain and better sexual functioning. Conversely, couples with negative interaction styles were associated with greater pain and lower sexual functioning.
Women with GPPPD report disruptions to every aspect of their sexuality compared to women without these conditions, including lower desire, arousal, sexual satisfaction, and frequency of orgasm and intercourse. Women may report feelings of guilt, shame, and inadequacy as a sexual partner, as well as fears of losing or disappointing their partner because of the pain.
Published treatment recommendations for female genito-pelvic pain/penetration disorder include those from the Dehli Psychiatry Journal, Advances in Psychosomatic Medicine and American Family Physician.
Clinical research suggests that the following treatments are indicated for the treatment of adults with GPPPD: