Management of Female Sexual Pain Disorders

Abstract

Our understanding of the sexual pain disorders vaginismus and dyspareunia has been fundamentally altered over the past two decades due to increased attention and empirically sound research in this domain. This increased knowledge base has included a shift from a dualistic view of the etiology of painful and/or difficult vaginal penetration being due to either psychological or physiological causes, to a multifactorial perspective. The present chapter reviews current classification and prevalence rates, including ongoing definitional debates. Research regarding the etiology, assessment and management of sexual pain disorders is discussed from a biopsychosocial perspective. Cyclical theories of the development and maintenance of sexual pain disorders, which highlight the complex interplay among physiological, psychological and social factors, are described. Medical/surgical treatment options, pelvic floor rehabilitation and psychological approaches are reviewed, as well as future directions in treatment research.

The Medicalization of Women's Sexual Pain

“…However, there has been much less commentary on the medicalization of sexual pain-currently a subset of an official FSD diagnosis (American Psychiatric Association [APA], 2000). Practitioners and critics alike recognize that sexual pain is a unique case among a multitude of sexual problems (Boyer, Goldfinger, Thibault-Gagnon, & Pukall, 2011). Whereas a concept such as (dys)functional sexual desire lends itself to debate as to whether it is an objectively measurable phenomenon relevant to the domain of health (Meana, 2010), sexual pain has a more obvious relationship to biomedicine's expertise in pain pathways and pain reduction.…”

“…Most recently, biopsychosocial frameworks have been favored in lieu of or in addition to strictly biomedical factors, with the intention of moving beyond reductionist perspectives (Boyer et al, 2011). Yet, research aimed to illuminate social, relational, and psychological aspects of women's sexual pain experience is often framed in a reductive way, resulting in the presentation of sexual pain and related phenomena as fractured statistical constructs.…”

“…As Boyer et al (2011) pointed out, this pervasive mind=body split is a vestige of using strictly biomedical and positivist frameworks in health-related research. This is often assumed to be eliminated by researchers employing a biospychosocial framework.…”

“…Hence, there are also many non-sexual reasons women seek treatment to minimize genital pain (e.g., conceiving and giving birth to a child, wearing a tampon, or riding a bike). Professionals who specialize in treating sexual pain tend to agree that multifactorial, multidisciplinary approaches to treatment are necessary for this extremely complex, heterogeneous problem (Boyer et al, 2011;Graziottin & Brotto, 2004;Landry et al, 2008). Some argue that, historically, this has taken the form of medical, followed by mental health, interventions when and if medical intervention fails (Payne, Bergeron, Khalifé, & Binik, 2006).…”

“…To this end, vaginal dilation is often prescribed for managing sexual pain and restoring intercourse (Backman, Widebrant, Bohm-Starke, & Dahlof, 2008;Graziottin & Brotto, 2004). 3 Pelvic physiotherapy with biofeedback is another treatment for sexual pain involving cognitive behavioral elements and little risk (Boyer et al, 2011;Landry et al, 2008). Physiotherapists have adapted common physiotherapy techniques to reduce involuntary muscle tension and target pain pathophysiology for women with sexual pain.…”