Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women

Abstract

Introduction To date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD). Aim To evaluate the prevalence of GPPPD and its associated factors. Methods This was a population-based, cross-sectional study of 590 healthy married women age 18–70 years conducted between May and October 2017 in Tehran, Iran. Main Outcome Measures Research tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik’s guideline for the diagnosis of GPPPD. Results 196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik’s guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik’s guideline was lowered to also include those reporting “somewhat” pain in addition to the group reporting “moderate” and “quite a bit or always,” then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD. Clinical Implications Reliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians’ judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain. Strengths & Limitations The present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik’s guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias. Conclusion Further research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures.

Sexual Behaviors and Vulnerability to Sexually Transmitted Infections in Transgender Women

“…Another reason for low sexual satisfaction in transgender women is the signi cant prevalence of dyspareunia in them. The frequency of dyspareunia in transgender women was 42.5% which is signi cant compared to the prevalence of severe (10.5%) and moderate dyspareunia (25.8%) in Iranian women [34]. At the same time, due to the absence of vaginoplasty in 74% of participants, they had to have anal sex which was described as painful and unpleasant.…”

Mediators of Sexual Distress in Women with Dyspareunia: A Population-based Cross-sectional Study

“…With regard to need of survey based on the new concept of GPPPD and importance of standard study in society with different culture from western countries, our research team designed a population-based study in 2017-2018. The results related to the prevalence of GPPPD, risk factors and protective factors of GPPPD explicitly discussed in other article (8). In the present paper, we explained about the characteristics of sexual pain such as the pain location, time and nature of pain.…”

Coping with dyspareunia, the importance of inter and intrapersonal context on women’s sexual distress: a population-based study

“…Although sexual pain can happen in women of all ages and rarely in men, this study focuses on married women. The results concerning the prevalence of the GPPPD, risk factors, and protective factors of the GPPPD are discussed explicitly in another paper [9]. The present paper addresses the characteristics of sexual pain, such as the location, time, and nature of pain.…”