Genito-pelvic pain is a health issue that affects women around the world, and it can have a negative impact on their sexual functioning. Experts in the field of female sexual dysfunction may characterize genito-pelvic pain in women as dyspareunia (i.e., painful sex, including superficial and deep dyspareunia), or as vaginismus (i.e., muscle spasms around the vagina caused by a hypertonic pelvic floor).
Dyspareunia is a term for pain with penetration during sexual activity, whether it be by a toy, finger, or penis. This condition has traditionally been divided into two types: superficial dyspareunia and deep dyspareunia. As the name suggests, superficial dyspareunia is pain that is felt during initial penetration. It is often caused by infection, lack of lubrication (potentially related to hormonal factors), or injury.
Deep dyspareunia, on the other hand, is pain that is felt during deep penetration. It generally occurs when an individual has an existing condition or another health problem that affects an area of the body adjacent to the deeper parts of the vagina. Some causes of deep dyspareunia include endometriosis, ovarian cysts, uterine fibroids, tumors in one of the reproductive organs, pelvic inflammatory disease (often caused by an untreated sexually transmitted disease), or scarring from an abdominal surgery or one of these conditions.
Vaginismus is characterized by painful spasms or contractions of the muscles around the vagina in response attempted vaginal penetration. While this condition may be particularly distressing for individuals during sexual intercourse, the involuntary contraction of muscles can also happen in nonsexual situations such as when putting in a tampon or getting a gynecological examination.
Although the muscle spasms around the vagina are thought to be caused by an overly tense pelvic floor that makes penetration painful or impossible, the reason why vaginismus occurs is still unclear. That being said, multiple studies have shown associations between vaginismus and anxiety and/or sex-related distress.
There are several ways in which genito-pelvic pain syndromes can negatively affect a woman’s sexual functioning. The following are just a few examples:
- Pain during intercourse: The most common and defining feature of genito-pelvic pain syndromes is pain during intercourse. This can range from mild discomfort to severe pain, making sex unpleasant or unbearable and possibly leading to avoidance of sexual activity altogether.
- Fear and anxiety: Experiencing pain during sexual activity can lead to fear and anxiety about engaging in future sexual encounters. Anticipation of pain can create a sense of dread and lead to a cycle of avoidance behavior.
- Diminished sexual desire: Chronic pain and the associated negative emotions can contribute to a decrease in sexual desire.
- Negative body image: Women with chronic genito-pelvic pain may develop feelings of inadequacy, shame, or embarrassment about their bodies, which can negatively affect their self-esteem and confidence.
- Relationship strain: Sexual pain disorders can strain intimate relationships. Communication difficulties can arise as couples struggle to understand and address the physical and emotional aspects of the condition. Partners may feel frustrated, rejected, or helpless, which can lead to emotional distance and relationship dissatisfaction.
Given the complexity of genito-pelvic pain syndromes and their far-reaching effects, it is important for women who are experiencing pain during sex to seek medical help and support. A healthcare provider with experience in sexual medicine can offer diagnosis, treatment options, and strategies to manage the physical and emotional aspects of these conditions.
References:
Kumar, K., & Robertson, D. (2017). Superficial dyspareunia. CMAJ : Canadian Medical Association journal, 189(24), E836. https://doi.org/10.1503/cmaj.161337
Maseroli, E., Scavello, I., Cipriani, S., Palma, M., Fambrini, M., Corona, G., Mannucci, E., Maggi, M., & Vignozzi, L. (2017). Psychobiological Correlates of Vaginismus: An Exploratory Analysis. The journal of sexual medicine, 14(11), 1392–1402. https://doi.org/10.1016/j.jsxm.2017.09.015
Orr, N., Wahl, K., Joannou, A., Hartmann, D., Valle, L., Yong, P., & International Society for the Study of Women’s Sexual Health’s (ISSWSH) Special Interest Group on Sexual Pain (2020). Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sexual medicine reviews, 8(1), 3–17. https://doi.org/10.1016/j.sxmr.2018.12.007
