Genito-Pelvic Pain/Penetration Disorder

GPPPD occurs when penetrative sex or other vaginal penetration cannot be experienced without pain. As GPPPD can encompass a variety of physical and psychological manifestations, the signs and symptoms of the disorder can vary from person to person. 

Below are some of the common signs and symptoms of genito-pelvic pain disorder, or GPPPD:

GPPPD often involves an intense fear of and anxiety about pain while experiencing vaginal penetration. Here is a list of psychological and emotional symptoms related to this disorder:

• Persistent or recurrent pain during attempted vaginal penetration, which may include sexual intercourse, gynecological examinations, or insertion of tampons
• Tightening or involuntary contraction of the pelvic floor muscles (vaginismus), making penetration difficult or impossible
• Burning or stinging sensations in the genital area during or after penetration
• Discomfort or pain in the lower abdomen or pelvic region

GPPPD often involves an intense fear of and anxiety about pain while experiencing vaginal penetration. Here is a list of psychological and emotional symptoms related to this disorder:

• Fear or anxiety about sexual activity or penetration attempts
• Anticipation of pain or discomfort during sexual encounters, leading to avoidance of sexual intimacy
• Negative emotional reactions, such as shame, guilt, or low self-esteem, related to the inability to engage in penetrative sexual activities
• Disturbance in overall emotional well-being and mental health due to chronic² pain and sexual difficulties
• Reduced sexual desire or interest due to the association of sex with pain or fear

• Avoidance of sexual activities or situations that involve vaginal penetration
• Reluctance or refusal to undergo gynecological examinations or medical procedures that require vaginal penetration
• Difficulties in maintaining intimate relationships due to the impact of the disorder on sexual functioning

Diagnosis of GPPPD requires the individual to experience symptoms related to significant pain and difficulty with penetrative vaginal sex that lasts for at least six months.

While the exact cause of genito-pelvic pain penetration disorder, or GPPPD may vary from person to person, the following are some common factors that can contribute to the development of the disorder:

Physical causes

In some cases, GPPPD may be characterized by the combination of painful sex (dyspareunia) and involuntary vaginal muscle spasms. Here are some of the physical causes:

• Pelvic floor muscle dysfunction, such as involuntary tightening or spasms of the pelvic floor muscles, can lead to pain and difficulty with vaginal penetration.
• Infections or medical conditions affecting the genital region, such as yeast infections, urinary tract infections, or endometriosis, can cause pain during intercourse.
• Anatomical irregularities, such as certain structural concerns in the pelvic area, may lead to discomfort or pain during penetration.

Psychological and emotional causes

• Past traumatic experiences: A history of sexual abuse* or trauma can result in fear, anxiety, or aversion to sexual activities, including vaginal penetration.
• Anxiety and stress: Anxiety may lead to muscle tension and hypersensitivity in the genital area, which can exacerbate pain during penetration.
• Negative sexual beliefs: Cultural or religious beliefs that promote guilt or shame around sexuality may contribute to sexual pain disorders.

Pain triggers related to trauma

For individuals who have experienced past traumatic events, certain triggers may intensify their symptoms or bring about distressing memories. These triggers can include:

• Certain sexual acts or positions that resemble past traumatic experiences
• Specific environments or situations that remind the individual of the traumatic event
• Lack of emotional safety or trust in the current intimate relationship

Interpersonal and relationship factors in penetration disorder

• Lack of communication: Difficulties in expressing sexual needs and concerns with a partner can lead to misunderstandings and further anxiety during sexual encounters.
• Relationship conflicts: Unresolved conflicts or dissatisfaction within the relationship can impact sexual intimacy and contribute to the development of the disorder.

Due to the variety of underlying causes and risk factors related to GPPPD, a multifaceted approach involving medical professionals, psychologists, and sex therapists can be helpful in understanding and addressing the condition.

GPPPD causes difficulties with attempted or completed vaginal penetration during sexual intercourse. This can be an extremely bothersome condition for patients. The treatment of genito-pelvic pain/penetration disorder typically aims to alleviate pain, improve sexual functioning, and enhance overall well-being. Effective management of GPPPD combines medical, psychological, and in some cases, relational interventions.  

• Topical anesthetics: In some cases, topical anesthetics may be prescribed to reduce localized pain during penetration. These numbing agents may provide temporary relief and make sexual activities more comfortable.
• Antidepressants: Certain types of antidepressant medication may help regulate pain perception and improve mood, contributing to pain reduction.
• Do not start, stop, or change medications without consulting with your healthcare professional.

Other genito-pelvic pain treatment options

• Vaginal dilators: GPPPD involves pain and tightening during attempted penetration. With genito-pelvic pain/penetration disorder, sexual intercourse can be painful, but vaginal dilators may help. Vaginal dilators are graduated cylinders or cones that are used to gradually stretch and desensitize the vaginal canal. 
• Botulinum toxin injections: In severe cases of pelvic floor muscle spasm, botulinum toxin injections, or botox injections, may be considered to relax the muscles and reduce pain.

• Pelvic relaxation exercises: Practicing deep-breathing exercises and relaxation techniques may help reduce muscle tension in the pelvic area and promote a sense of calm during sexual activities.
• Communication and education: Learning about sexual health and pain disorders can empower individuals to seek appropriate care and advocate for their needs.
• Patience and self-compassion: Practicing patience and self-compassion throughout the treatment journey is often essential for healing and progress.

With the right support, treatment, and intervention, many individuals can overcome the challenges of genito-pelvic pain/penetration disorder and regain a fulfilling and satisfying sexual life.

For individuals experiencing genito-pelvic pain/penetration disorder, cognitive behavioral therapy (CBT) is a commonly used treatment method. Due to the sensitive and personal nature of this disorder, online therapy may provide patients with a more comfortable environment to discuss symptoms.

The following are some additional resources that may be helpful for this disorder:

• The American College Of Obstetricians and Gynecologists
• American Association Of Sexuality Educators, Counselors And Therapists
• Planned Parenthood

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

A study published in 2019 that aimed to evaluate the prevalence of GPPPD, or genito-pelvic penetration disorder, and its associated factors found that risk factors for GPPPD included a strong aversion to genitalia, low sexual satisfaction, and severe depression, while secure financial status and high marital satisfaction were protective factors.

Another study published in 2023 found that a therapeutic education program reduced pain in individuals who experience GPPPD. The study found that the program was effective when delivered both in person and online.

Here are some key statistics on genito-pelvic pain/penetration disorder:

1. Painful sex (as dyspareunia) is prevalent in about 3% to 18% of individuals worldwide.
2. A meta-analysis from 2021 states that a “significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14-2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24-2.88; 3 studies) and the diagnosis of vaginismus.”
3. Research published in 2018 found that women who received cognitive behavioral group consultations experienced “a significant increase in all behavioral domains and total sexual function as compared to the control group.”
4. A study published in the Journal of Consulting and Clinical Psychology concluded that internet-based treatment “has been shown to be effective for GPPPD symptoms and could therefore be a promising treatment modality.” The study states, “Genital pain, painful and noncoital penetration behavior, and negative penetration-related cognitions significantly improved with medium to large effects…”