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Genito-Pelvic Pain or Penetration Disorder DSM-5 302.76 (F52.6)

DSM-5 Category: Sexual Dysfunctions

Introduction

Genito-Pelvic Pain or Penetration Disorder is a condition in which the pelvic floor muscles around the vagina contract or tighten whenever an attempt is made to penetrate. This is an involuntary action, wherein, the partner has no control over the muscle contraction. The tightening of the muscles prevents any possible penetration of foreign object such as tampons, instruments used for gynecological tests, and the phallus. During any attempt to penetrate, a reflex action triggers tension in the muscles, resulting in pain. It is a state where the woman has no control over the contraction of the muscles, and experiences pain that may vary from mild to intense. This involuntary tightening is similar to the act of quickly pulling back a finger that is exposed to heat. This disorder also varies in degree from person to person. While some women cannot have anything penetrate the vagina, some can have a tampon inserted but not have intercourse. An attempt to have an intercourse, therefore, usually results in pain. This disorder was earlier referred to as Vaginismus, and is now called Genito-Pelvic Pain/Penetration Disorder by DSM5 in its latest edition (American Psychiatric Association, 2013). It is essential that people know the significant change in nomenclature.

Symptoms of Genito-Pelvic Pain/Penetration Disorder

There is no evidence to show that every woman suffering from this disorder should experience the same symptoms. The DSM-5 criteria for Genito-Pelvic Pain/Penetration Disorder include one or more symptoms of this condition (Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds, 2012):

• Tightening of the vaginal muscle resulting in the inability to penetrate
• A feel of tension, pain or a burning sensation felt when penetration is attempted
• A decrease in or no desire to have intercourse
• Voluntary avoidance of sexual activity
• An intense phobia or fear of pain

Causes

Though it is difficult to state and point out the exact causes for Genito-Pelvic Pain, it has been suggested that inflammation in the vaginal muscles or an injury in the vulva could be causal factors. While this may be the technical cause for the disorder, psychologically, Penetration Disorder may be a result of a traumatic past experience. That experience may well be intense pain during childbirth. Victims of child abuse or women whose experience with intercourse has always been painful are both ideal candidates. In some cases, nerves becoming over-sensitive may also trigger the disorder, preventing the person from having intercourse. According to the National Health Services (2013), even the fear of getting pregnant or being told in childhood that “sexual desire is wrong or sex is painful” could be factors that result in this condition.

Subtypes

Genito-Pelvic Pain/Penetration Disorder can be classified into early-onset, late-onset and situational (University of British Columbia, 2013).

Early-Onset

This is a case in which the pain in the pelvic muscles has persisted and continues to do so. This may be a natural disorder, where the first attempt at penetration led to pain, and each time thereafter the pain continued to manifest.

Late-Onset

In this classification, the pain is usually experienced after vigorous physical activity of any sort. The pain may also be triggered after penetration is attempted with a penis, tampon or other objects.

Situational

In this condition, the intensity of pain varies by situation – hence the name: it may be felt under certain conditions or with some particular objects. For instance, a woman may not able to feel the pain when inserting a tampon, but may experience an intense and shooting pain when attempting penetration during intercourse. Strangely, the pain may occur only during intercourse with one person and not another.

Genito-Pelvic Pain and Personal life

This disorder has a tremendous impact on personal life. Women with this disorder often have strained relationships because of the inability to have sexual intercourse, and because it prevents them from having a child and raising a family. As psychological stress builds up over time, it may even lead to depression. The inability to get penetrated is likely to cause a deep psychological influence in a person's mind. The person may begin to feel ashamed, shocked, embarrassed or even inferior. The chances of this person coming to a conclusion of being “defective” are also high after repeated failures and unbearable pain. Unless the condition is examined and treated, and proper counseling done, it may lead to further strains in the relationship that might even end in separation and prolonged mental agony.

Treatment

While there is no guarantee that penetration disorder may be cured, it can still be dealt with. After an examination, if the actual cause has been discovered, it can be treated accordingly (The Society of Obstetricians and Gynaecologists of Canada [SOGC], 2013). In general, treatments for Genito-Pelvic Pain include the following:

If the person has had a physical injury or inflammation in the pelvic muscles, and that is causing the pain, it can be treated with proper medication.

There are also exercises that should be done after proper consultation with a doctor. However, one limitation is that exercises cannot help cure the disorder overnight. It requires continuous practice and execution, and dedication from the person suffering this condition. If the recommended regime is followed properly, the pain can effectively be treated and the condition may even be cured. It is important that the patient does not attempt intercourse during this period.

Women suffering from penetration disorder may even be counseled for their emotional and psychological well-being. Counseling may help a person overcome fear of pain and penetration and, over a period of time, help them be prepared to respond to anxiety in a more appropriate way.

Depending on the intensity of the pain, there are chances that the person may actually need to undergo surgery to rid themselves of the problem

It is generally advised that women experiencing this disorder resort to consulting a doctor for any assistance with medication rather than try any self-help techniques. Since it deals with a region that is sensitive, a wrong technique may trigger a series of undesirable consequences, resulting in the person experiencing pain greater than when penetration is attempted.

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Reference

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