Genito-Pelvic Pain/Penetration Disorder (GPPPD): An Overview of Current Terminology, Etiology, and Treatment

Abstract

Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a relatively new diagnostic category of female sexual dysfunction, which was introduced during the release of the DSM-5 in 2013. GPPPD reflects the combination of two previous categories of female sexual dysfunction, dyspareunia and vaginismus, into one entity. As such, there is confusion surrounding the proper terminology and diagnostic criteria used when evaluating female sexual or genital pain. This review article attempts to clarify the terminologies used within the medical and scientific community, and provides an overview of current views on etiology and treatment. The likely biological antecedents to genital pain are an exaggerated and prolonged inflammatory response in the vestibular mucosa causing neuroproliferation, and leading to eventual hyperalgesia, allodynia, and pelvic muscle tension in the genital region. These processes interact with psychosocial factors to produce chronic pain. Treatment includes education, CBT, pelvic floor physiotherapy, medical interventions, and surgical interventions, though sexual function may be optimized through a multifaceted approach. RésuméLa GPPPD est une catégorie diagnostique relativement récente de la dysfonction sexuelle féminine, qui a été introduite dans le DSM-5 en 2013. La GPPPD reflète la combinaison de deux catégories précédentes de dysfonctionnement sexuel féminin, la dyspareunie et le vaginisme, en une entité. En tant que tel, il existe une confusion entourant la terminologie appropriée et les critères de diagnostique utilisés lors de l’évaluation de la douleur sexuelle ou génitale féminine. Cet article de revue tente de clarifier les terminologies utilisées dans la communauté médicale et scientifique et donne un aperçu des points de vue actuels sur l’étiologie et le traitement. Les antécédents biologiques probables à la douleur génitale sont une réponse inflammatoire exagérée et prolongée dans la muqueuse vestibulaire entraînant une neuroprolifération, et conduisant à une éventuelle hyperalgésie, allodynie et tension musculaire pelvienne dans la région génitale. Ces processus interagissent avec des facteurs psychosociaux pour produire une dou- leur chronique. Le traitement comprend l’éducation, la TCC, la physiothérapie du plancher pelvien, les interventions médicales et les interventions chirurgicales, bien que la fonction sexuelle puisse être optimisée par une approche multidimensionnelle.

An Adaptive Computational Fear-Avoidance Model Applied to Genito-Pelvic Pain/Penetration Disorder

“…Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a prevalent sexual dysfunction affecting approximately 20% of heterosexual women [18], but underlying mechanisms are still poorly understood. Studies suggest that treatment should be based on multidisciplinary interventions that take into account individual differences [8,10,21]. Thomtén and Linton [27] approached GPPPD as a pain disorder by applying the Fear Avoidance Model of Vlaeyen and Linton [30] to the disorder.…”

“…GPPPD is a relatively new diagnostic category of female sexual dysfunction, introduced in the DSM-5 [2]. It reflects the combination of two previous categories, dyspareunia and vaginismus, in one entity [10]. One of the following criteria have to be met for diagnosis, with at least six months duration and presence of clinically significant distress: difficulties during vaginal penetration during intercourse, marked culcovaginal or pelvic pain during vaginal intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration, and marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration [2].…”

“…Interventions. The etiology of GPPPD is multi-factorial and complex, which means that biological, psychological and relational factors interact to perpetuate and maintain a women's pain response [10]. GPPPD should thus never be viewed as a purely medical or psychogenic problem but always be evaluated and treated from a biopsychosocial perspective [14,21].…”

Efficacy of internet-based treatment for genito-pelvic pain/penetration disorder: Results of a randomized controlled trial.

“…In addition, treatments for dyspareunia include pelvic floor exercises, pain management, awareness training, mindfulness, vaginal training, and communication skills training (Bergeron et al, 2001; Brotto et al, 2015). Treatments for dyspareunia also target vulvodynia, a closely related chronic pain conditions in the vulvar region, and its common subtype provoked vestibulodynia (former vulvar vestibulitis), characterized by localized provoked pain at the vaginal entry (Conforti, 2017). For vaginismus, gradual exposure with vaginal inserts in combination with relaxation exercises is the most frequently used treatment method often supplemented by sensate focus exercises (ter Kuile et al, 2013; van Lankveld et al, 2006).…”

Vulvodynia: a modern perspective on the problem

“…Этот диагноз объединил два прежде выделяемых отдельно нарушения -диспареунию и вагинизм [5]. Вульводиния сама по себе не классифицируется как женская сексуальная дисфункция, однако может вызывать ее [6].…”