Sexual pain disorder

   Sexual pain disorder, combining the terms dyspareunia, vaginismus, genitopelvic pain, and penetration disorder, is common in women of reproductive and postmenopausal age worldwide (up to 34-45%) and is more often manifested as recurrent acute pain. A diagnosis of genitopelvic pain/penetration disorder (GPPD) is made when at least one of the following symptoms is present: persistent or recurrent difficulty with vaginal penetration; marked vulvovaginal or pelvic pain during vaginal intercourse and attempts of vaginal penetration; marked fear or anxiety about vulvovaginal or pelvic pain in anticipation, during or as a result of vaginal penetration; marked tension of the pelvic floor muscles during attempts of vaginal penetration. Additional criteria include the presence of the listed symptoms for at least 6 months, resulting in significant sexual distress that causes serious problems in the relationship and is not related to the effects of any substance or any other medical condition. The mechanisms of sexual pain are determined by a wide range of biological, psychiatric and social factors, which explains the difficulty in diagnosing and treating it, as well as the negative impact on sexual functioning in the couple. Timely multidisciplinary care for women suffering from a sexual pain disorder can effectively alleviate the condition and ensure marital sexual harmony in the couple. The modern range of treatment options includes both conservative and surgical treatment methods, the rational choice of which can significantly improve patients’ quality of life.

1. Meana M., Fertel E., Maykut C. Treating genital pain associated with sexual intercourse. In: Peterson Z. D. (ed.). The Wiley Handbook of Sex Therapy. Chichester: Wiley Blackwell; 2017: 98–114. Available at: https://doi.org/10.1002/9781118510384.ch7.

2. Weijenborg P. T., Ter Kuile M. M., Stones W. A cognitive behavioural based assessment of women with chronic pelvic pain. J Psychosom Obstet Gynaecol. 2009; 30 (04): 262–268 https://doi.org/10.3109/01674820903378742.

3. Nobre P. J., Pinto-Gouveia J., Gomes F. A. Prevalence and comorbidity of sexual dysfunctions in a Portuguese clinical sample. J Sex Marital Ther. 2006; 32 (02): 173–182 https://doi.org/10.1080/00926230500442334.

4. Dias-Amaral A., Marques-Pinto A. Female Genito-Pelvic Pain / Penetration Disorder: Review of the Related Factors and Overall Approach. Rev Bras Ginecol Obstet. 2018; 40 (12): 787–793. https://doi.org/10.1055/s-0038-1675805.

5. Bornstein J., Goldstein T., Stockdale C. K., Bergeron S., Pukall C., Zolnoun D., Coady D. 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Obstet Ginecol. 2016; 127 (4): 745–751. https://doi.org/10.1097/AOG.0000000000001359.

6. Both S., van Lunsen R., Weijenborg P., Laan E. A new device for sflow: a test in a nonclinical sample. J Sex Med. 2012; 9 (11): 2888–2902. https://doi.org/10.1111/j.1743-6109.2012.02910.x.

7. Pukall C. F., Goldstein A. T., Bergeron S. et al. Vulvodynia: definition, prevalence, impact, and pathophysiological factors. J Sex Med. 2016; 13 (03): 291–304. https://doi.org/10.1016/j.jsxm.2015.12.021.

8. Conforti C. Genito-pelvic pain / penetration disorder (GPPPD): An Overview of current terminology, etiology, and treatment. Women, s health. 2017; 7 (2): 48. https://doi.org/10.18192/uojm.v7i2.2198.

9. Nobre P. J., Pinto-Gouveia J. Cognitive and emotional predictors of female sexual dysfunctions: preliminary findings. J Sex Marital Ther. 2008; 34 (04): 325–342. https://doi.org/10.1080/00926230802096358.

10. Nobre P. J., Pinto-Gouveia J. Cognitive schemas associated with negative sexual events: a comparison of men and women with and without sexual dysfunction. Arch Sex Behav. 2009; 38 (05): 842–851. https://doi.org/10.1007/s10508-008-9450-x.

11. Oliveira C., Nobre P. J. Cognitive structures in women with sexual dysfunction: the role ofearlymaladaptive schemas. J Sex Med. 2013; 10 (07): 1755–1763. https://doi.org/10.1111/j.1743-6109.2012.02737.x.

12. Anderson A. B., Rosen N. O., Price L., Bergeron S. Associations between penetration cognitions, genital pain, and sexual well-being in women with provoked vestibulodynia. J Sex Med. 2016; 13 (03): 444–452. https://doi.org/10.1016/j.jsxm.2015.12.024.

13. Bergeron S., Likes W. M., Steben M. Psychosexual aspects of vulvovaginal pain. Best Pract Res Clin Obstet Gynaecol. 2014; 28 (07): 991–999. https://doi.org/10.1016/j.bpobgyn.2014.07.007.

14. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. J Sex Med. 2012; 9 (08): 2077–2092. https://doi.org/10.1111/j.1743-6109.2012.02803.x.

15. ter Kuile M. M., van Lankveld J. J., de Groot E., Melles R., Neffs J., Zandbergen M. Cognitive- behavioral therapy for women with lifelong vaginismus: process and prognostic factors. Behav Res Ther. 2007; 45 (02): 359–373. https://doi.org/10.1016/j.brat.2006.03.013.

16. Rosen N. O., Bergeron S., Sadikaj G., Glowacka M., Delisle I., Baxter M. L. Impact of male partner responses on sexual function in women with vulvodynia and their partners: a dyadic daily experience study. Health Psychol. 2014; 33 (08): 823–831. https://doi.org/10.1037/a0034550.

17. Davis S. N., Bergeron S., Sadikaj G., Corsini-Munt S., Steben M. Partner behavioral responses to pain mediate the relationship between partner pain cognitions and pain outcomes in women with provoked vestibulodynia. J Pain. 2015; 16 (06): 549–557. https://doi.org/10.1016/j.jpain.2015.03.002.

18. Bergeron S., Binik Y. M., Khalifé S., Pagidas K., Glazer H. I., Meana M., Amsel R. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting fromvulvar vestibulitis. Pain. 2001; 91 (03): 297–306. https://doi.org/10.1016/S0304-3959(00)00449-8.

19. Desrochers G., Bergeron S., Khalifé S., Dupuis M. J., Jodoin M. Provoked vestibulodynia: psychological predictors of topical and cognitive-behavioral treatment outcome. Behav Res Ther. 2010; 48 (02): 106–115. https://doi.org/10.1016/j.brat.2009.09.014.

20. Goldstein A. T., Pukall C. F., Brown C., Bergeron S., Stein A., Kellogg-Spadt S. Vulvodynia: Assessment and Treatment. J Sex Med. 2016; 13 (04): 572–590. https://doi.org/10.1016/j.jsxm.2016.01.020.

21. Backman H., Widenbrant M., Bohm-Starke N., Dahlof L. G. Combined physical and psychosexual therapy for provoked vestibulodyniaan evaluation of a multidisciplinary treatment model. J Sex Res. 2008; 45 (04): 378–385. https://doi.org/10.1080/00224490802398365.

22. Brotto L. A., Yong P., Smith K. B.., Sadownik L. A. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015; 12 (01): 238–247. https://doi.org/10.1111/jsm.12718.

23. Bergeron S., Khalifé S., Glazer H. I., Binik Y. M. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome. Obstet Gynecol. 2008; 111 (01): 159–166. https://doi.org/10.1097/01.AOG.0000295864.76032.a7.

24. Goldfinger C., Pukall C. F., Thibault-Gagnon S., McLean L., Chamberlain S. Effectiveness of cognitive-behavioral therapy and physical therapy for provoked vestibulodynia: a randomized pilot study. J Sex Med. 2016; 13 (01): 88–94. https://doi.org/10.1016/j.jsxm.2015.12.003.

25. Dunkley C. R., Brotto L. A. Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness-Based and Cognitive Behavioral Therapies. J Clin Psychol. 2016; 72 (07): 637–650. https://doi.org/10.1002/jclp.22286.

26. Engman M., Wijma K., Wijma B. Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus. Cogn Behav Ther. 2010; 39 (03): 193–202. https://doi.org/10.1080/16506070903571014.

27. Lee Y., Chung H., Kim J., Park N. H., Song Y. S., Kang S. B. Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial. Obstet Gynecol. 2011; (117): 922–927. URL: https://pubmed.ncbi.nlm.nih.gov/21422866/

28. Kabakçi E., Batur S. Who benefits from cognitive behavioral therapy for vaginismus? J Sex Marital Ther. 2003; 29 (04): 277–288. https://doi.org/10.1080/00926230390195515.