Chapter 17 – Female Sexual Interest and Arousal Disorder (FSIAD)

Issues with pain: Genito-pelvic pain/ penetration disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) has merged dyspareunia and vaginismus into a new category of genito-pelvic pain/penetration disorder.

To qualify, one of the following should be persistent or recurrent:

difficulty in vaginal penetration marked vulvovaginal or pelvic pain during penetration, or attempt at penetration fear or anxiety about pain in anticipation of, during, or after penetration tensing or tightening of pelvic floor muscles during attempted penetration

This represents a spectrum from dyspareunia to vaginismus. The patient’s history may include a range of penetration difficulties including inability to use tampons, inability to achieve finger penetration of the vagina, difficulty with gynaecological examinations, difficulty with intercourse and inability to achieve penetration.

It is important to exclude underlying physical causes, including:

pelvic floor muscle dysfunction vulvodynia (mostly chronic pain and does not usually lead to pain with penetration) vestibulodynia imperforate hymen infection such as Candida, chronic Group B streptococcal infection (not colonisation) pelvic infection (usually deep dyspareunia not superficial penetration) trauma (sexual assault, rough sex, dermatological conditions) menopausal atrophy endometriosis (usually deep pain not superficial entry pain)

For more information also see Chapter 4: The Vagina and Vulva.

Genito-pelvic pain disorders usually benefit from a multidisciplinary team approach. Women’s health physiotherapists are very skilled in the measurement and management of increased pelvic tension ... Buy now