Are Sexual Pain Disorders Linked to Trauma?

Female sexual pain disorders are complex with its etiology being multifactorial. The most effective treatments are utilizing a multidisciplinary approach (Fugl-Meyer et al., 2013; Al-Abbadey, Liossi, Curran, Schoth, & Graham, 2016). Sexual Pain Disorders present with complaints of penetrative discomfort with concerns and/or anxiety in anticipation of vulvovaginal penetration.  Genito-pelvic pain/penetration disorder is characterized as marked difficulty having intercourse and may be caused by various changes within the body such as vestibulitis, interstitial cystitis, atrophic changes with dryness and thinning of the vaginal tissues. These conditions can be accompanied with tensing of the pelvic floor muscles which makes any penetrative sex more difficult and painful. Sexual pain disorders are commonly reported in 10-28% of females in the USA (Diagnostic and Statistical Manual of Mental disorders Fifth Edition, DSM-5-TR TM, American Psychiatric Association,2022). Research on the psychological and sexual functioning aspects of women with sexual pain disorders  report higher levels of psychological distress with higher anxiety, lower levels of sexual satisfaction, sexual desire, arousal, genital self-image (Desrochers, Bergeron, Landry & Jodoin, 2008; Pazmany, Bergeron, Van Oudenhove, Vergaeghe & Enzlin, 2013; Al-Abbadey et al. 2016) and hypervigilant to possible discomfort with penetration (Payne, Binik, Amsel & Khalife, 2005; Al-Abbadey et al.2016). A common experience of women with a history of sexual pain is to experience feelings of a lack of worthiness, shame and avoidance of interactive penetrative experiences and report negative effect on quality of life (Xie et al., 2012; Al-Abbadey et al., 2016). In general, there are limitations on the current research done in this area. Research is needed on LBTQ+ individuals and pain disorders. There needs to be clear definitions of the type of vaginal pain being treated, a need for control groups in treatment outcome studies, description of the questionnaires used as outcome measurements, establishment of what criteria meets clinical significance and ample sample sizes to test the hypothesis in question.

Avoidance of sexual interactions are common and are associated with fear and anxiety (Brauer, Lakeman, Rik van lunsen, Laan 2014). In addition, posttraumatic stress disorder can occur with sexual difficulties (Bird, Piccirillo, Garcia, Blais, Campbell 2021). Trauma may be related to the experience of sexual or emotional abuse related to intimate and sexual encounters and result in either complete avoidance, disconnection during sexual encounter and/ or painful sexual penetrative encounters. It is not uncommon for sexual desire; arousal and orgasmic functioning to be compromised if a pain disorder is existing.

The good news is that with gynecological, urological, and psychotherapeutic treatments these conditions can be treated. An integration of different treatment modalities is supported in the research (Bergeron et al., 2015). Use of physical therapy, use of dilators, electrical stimulation, EMG biofeedback and psychological therapies support the biopsychosocial approach to treating sexual pain disorders and improving sexual functioning, psychological well-being and sexual satisfaction. (Bergeron et al., 2001; Danielsson et al., 2006; Bergeron et al., 2008; Goldfinger et al., 2009). Some invite yoga or acupuncture into the treatment as well. (Brotto, Krychman, & Jacobson, 2008; Khamba et al., 2013).   For women with pelvic floor pathologies, physical therapy maybe recommended (Goldstein & Komisaruk, 2017; Fontaine et al., 2018).  A meta-analysis on pelvic floor training on women with sexual disorders concluded the effectiveness of this strategy (Tennfjord, Engh, & Bø, 2017).

        There are several treatment approaches of sexual pain which include medical pharmacological treatments, surgical interventions, physical therapies such as biofeedback, dilators, pelvic floor exercises, electrical stimulation, psychological therapies such as cognitive behavioral therapy (CBT), and hypnotherapy and eye-movement desensitization reprocessing (EMDR). Research on these different modalities vary in results.

Things that you can engage in:

  • Dialogue with your clinician about your sexual functioning and intimate relationships
  • Acknowledge and embrace your concerns and goals
  • Consider possible etiologies: hormonal/endocrine; urological; history of trauma and its relation to intimacy and sexuality; psychological status; medications and medical difficulties that may impact sexual and emotional intimacy
  • Consider treatment options by consulting with clinicians that work with sexual health, specifically with sexual penetrative difficulties
  • Bring in balance and wellness into your life experience by sharing your experiences with others; developing a meditative practice to bring calmness into yourself and into your interactions with others; create a group of clinicians that support your situation and lean into your friends and family for comfort