My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
There are a number of reasons why a female might experience painful intercourse. Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a category in the DSM-V that encompasses a range of conditions relating to difficulties with vaginal penetration, including vaginismus, dyspareunia and provoked vestibulodynia (PVD) (American Psychiatric Association, 2013).
Vaginismus is characterized by involuntary spasms of the pelvic floor muscles, making penetration difficult or even impossible, while dyspareunia and PVD are marked by pain during or after penetration. Although the two conditions are distinct in their presentations, they generally share the common element of a fear-pain-tension cycle that comes into play.
A 2015 study exploring the relationship between these conditions found that fear and vaginal muscle tension were significantly greater in individuals with vaginismus compared to those with dyspareunia/PVD and no-pain controls (Lahaie et al., 2015). Behavioral measures of fear and muscle tension distinguished vaginismus from dyspareunia/PVD, with considerable overlap between these conditions. Interestingly, the study found no significant difference in genital pain levels between the vaginismus and dyspareunia/PVD groups, which could suggest that although the degree of fear and muscle tension may vary, the experience of pain is a common thread linking the two.
In both vaginismus and dyspareunia/PVD, the fear of pain leads to increased muscle tension, which in turn exacerbates the experience of pain during penetration. This further reinforces the fear of pain, creating a vicious cycle that can be difficult to break without intervention.
A multidisciplinary approach can be greatly beneficial to individuals seeking effective treatment. This may involve gynecological care to address any underlying physical conditions, pelvic floor physiotherapy to reduce muscle tension, psychological support to manage the emotional and cognitive aspects of fear, and in some cases, neurological intervention if nerve pain is suspected. Addressing each of these dimensions is crucial in overcoming the fear-pain-tension cycle and improving sexual well-being.
Mind-body approaches can also play an important role in easing the Fear-Pain-Tension cycle with techniques such as mindfulness, hypnotherapy, and breathwork, all of which have been shown to reduce anxiety and promote relaxation, making them valuable tools in the management of vaginismus and dyspareunia/PVD.
Through the practice of cultivating a non-judgmental awareness of the present moment, mindfulness can help reduce the fear, and resulting tension, associated with penetration. This is backed by research such as a study by Lori Brotto and colleagues that demonstrated the effectiveness of mindfulness in improving symptoms such as pain and sex-related stress in individuals with PVD (Brotto et al., 2020).
If you’re new to mindfulness, a great way to get started with a regular mindfulness practice is with a simple body-scan exercise. You might enjoy this guided body scan audio at this link. When doing this exercise, you may like to keep a journal of your observations as to the sensations within your body and your emotions before and after each practice.
Hypnotherapy sessions can be particularly effective in addressing and reframing the subconscious fears and anxieties that contribute to vaginismus and dyspareunia/PVD, as well as promoting a state of deep relaxation that is beneficial in reducing muscle tension. Self-hypnosis exercises can provide tools to anchor to a state of relaxation and focus on positive sensations when engaging in sexual activity.
Controlled breathing techniques can help manage the physiological response to fear, reducing muscle tension and promoting a sense of calm during penetration attempts.
Ultimately, breaking the Fear-Pain-Tension cycle is not solely about alleviating physical symptoms but also fostering a sense of empowerment and well-being. With a holistic combination of interventions, it is possible to overcome this cycle and enjoy a fulfilling, pain-free sex life.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Brotto, L. A., Bergeron, S., Zdaniuk, B., & Basson, R. (2015). Mindfulness and cognitive behavior therapy for provoked vestibulodynia: Mediators of treatment outcome and long-term effects. Journal of Consulting and Clinical Psychology, 83(4), 929–935. doi.org/10.1037/ccp0000042
Lahaie, M. A., Amsel, R., Khalifé, S., Boyer, S., Faaborg-Andersen, M., & Binik, Y. M. (2015). Can fear, pain, and muscle tension discriminatevaginismus from dyspareunia/provoked vestibulodynia? Implications for the new DSM-5 diagnosis of genito-pelvic pain/penetration disorder. Archives of Sexual Behavior, 44(6), 1537–1550. doi.org/10.1007/s10508-014-0434-8
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