Genito-pelvic pain/penetration disorder (GPPPD) refers to significant pain and difficulty with penetrative vaginal sex that lasts for at least six months.

GPPPD is actually an umbrella term for two sexual pain disorders: dyspareunia (painful intercourse) and vaginismus (a situation in which the muscles in the vagina contract to the point that penetration is difficult, and sometimes impossible).

For women with GPPPD, penetration can be painful at entry (pain is experienced with initial or attempted penetration of the vagina) or with deep penetration. For some, the anticipation of pain fills them with fear and anxiety. Their pelvic floor muscles contract in a nonvoluntary way, which contributes to the pain. Some women are unable to have intercourse at all.

As a result, women with GPPPD may lose their desire for sex and some  avoid sexual situations. Their relationships may suffer, as partners may not understand why sex is so difficult. Some women worry about disappointing their partner and fear that their partner may leave them.

When GPPPD starts from the first penetration attempt and continues for all sexual experiences, it is called lifelong GPPPD.

Acquired GPPPD occurs after a period of normal sexual function.

GPPPD can happen at any age, but it is especially common in young adults and menopausal women. Some women have GPPPD after having a baby.

Scientists aren’t sure what causes GPPPD, but they have found some associated factors:

• Vaginal infections or other gynecological conditions, such as endometriosis.
• Vaginal atrophy or dryness after menopause.
• Relationship conflict.
• Poor communication with partner.
• Poor body image.
• Past sexual abuse.
• Feelings that sex is “bad” or “wrong.”
• Virginity myths
• Fear of pain
• Lack of sexual education and other sociocultural factors

Women who have any type of sexual pain are encouraged to talk to their gynecologist. If GPPPD is caused by a medical condition, addressing that situation may be all that is needed. For example, lubricants can help with vaginal dryness. After menopause, women may benefit from certain medications or hormone therapy.

Sex therapy, with or without a partner, is another option. A sex therapist can help women learn more about their own anatomy and sexual response cycle. Women can also learn relaxation techniques and strategies for communicating with their partner. Some women use vaginal dilators  – plastic tubes designed to gently and gradually “stretch” the vagina – as a way to “practice” penetration and become more comfortable with it.

Resources

• The Journal of Sexual Medicine
  Alizadeh, Ameneh, MS, et al.
  “Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women”
  (Full-text. May 30, 2019)
  https://www.jsm.jsexmed.org/article/S1743-6095(19)31163-4/fulltext

• PsychCentral.com
  Medina, Johnna, PhD
  “Genito-Pelvic Pain/Penetration Disorder”
  (Last updated: September 8, 2018)
  https://psychcentral.com/disorders/genito-pelvic-painpenetration-disorder/

• Psychology Today
  “Genito-Pelvic Pain or Penetration Disorder (Sexual Pain Disorder)”
  (Last reviewed: February 21, 2019)
  https://www.psychologytoday.com/us/conditions/genito-pelvic-pain-or-penetration-disorder-sexual-pain-disorder