Actually, I hate sex.
You don’t often hear people saying that sex is painful or that penetration itself is impossible, but 1 out of 9 vulva owners will have pain with sexual intercourse at some point in their lives.
Thankfully, due to progressive TV shows (I’m looking at you Sex Education), social media and hardworking health professionals, there is much more awareness and education about pelvic pain and painful intercourse, but we still have a long way to go. So, let’s talk about pelvic pain, pain with intercourse, and all the different words and terms we medical professionals use to describe them.
There are a few descriptive terms for painful intercourse or pain in/around the vulva
- Vulvodynia
- Vaginismus
- Dyspareunia
- Gentiopelvic pain disorder (GPPD)
Vulvodynia is used to describe pain around the vulva, generally without an identifiable cause. This diagnosis will usually be given when the pain is mostly on the outside of the genitals. The location, consistency and severity of the pain vary among individuals. Some individuals experience pain in only one area of the vulva, while others experience pain in multiple areas (1). Individuals with this presentation will often describe the pain as a burning, itching, rawness, or stinging, particularly during urination or sexual intercourse (2) (3).
Vaginismus can be described as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. This can occur in response to physical contact or pressure, especially during sexual intercourse. (4) (5). It may limit your ability to insert things into your vagina like tampons, fingers, vibrators/toys or a penis. It may also cause painful gynaecological examinations. Something like vaginismus can occur alongside other chronic pelvic pain conditions like endometriosis or as an isolated condition without a co-morbidity. If you have ever struggled, or are currently struggling with painful sex, tampon usage or any other vagina/vulva/pelvic floor concerns, see a pelvic floor physiotherapist! Help is available!
Dyspareunia is essentially a work used to describe difficult or painful sexual intercourse. Dyspareunia is a close relative of vaginismus and vulvodynia but is a more global term to define pain with sex from any number of causes. It is not a diagnosis, but rather a descriptive term for "painful sex".
Genito-pelvic pain/penetration disorder or GPPPD: The most recent suggestion by the DSM (Diagnostic and Statistical Manual of Mental Disorders) is to use the term GPPPD to encompass vaginismus and dyspareunia in a single diagnostic entity. This term is essentially an umbrella term that globally describes pain in the pelvis, during penetration or otherwise.
A diagnosis of Gentio-pelvic pain/penetration disorder (GPPPD) is made when a patient with clinically significant distress has had persistent difficulty with vaginal penetration during intercourse, marked vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration. A Diagnosis of GPPPD may also be made if there is a marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration, with vaginal penetration referring also to instances such as tampon insertion or gynaecological pelvic examinations (1,2).
No matter which category you may fit into, if you are experiencing pain in your pelvis with sex or otherwise, then there is help and treatment available. If you have any of the following symptoms, know that they are not normal and that there is help available:
- Pain or inability to use tampons
- Painful intercourse often with tightness, burning or stinging
- Pain or inability to use a vibrator/dildo internally
- Penetration being generally difficult or impossible
- Pain during gynaecological exams
- Pain of unknown origin with touching of the vulva
- Incomplete bladder emptying
- Incomplete bowel emptying
- Leaking with exercise, coughing or sneezing
References:
- Diet LO. What is Vulvodynia. Sexual Health. 2018.
- Keyword B, Date T. What is vulvodynia? 2018.
- Arnold LD, Bachmann GA. Idiopathic vulvodynia. The Vulva: CRC Press; 2016. p. 105-20.
- Crowley T, Goldmeier D, Hiller J. Diagnosing and managing vaginismus. Bmj. 2009;338.
- Binik YM. The DSM diagnostic criteria for vaginismus. Archives of sexual behavior. 2010;39(2):278-91.
- Binik YM. The DSM diagnostic criteria for dyspareunia. Archives of Sexual Behavior. 2010;39(2):292-303.
