Estimating the prevalence of genito-pelvic pain/penetration disorder (GPPPD) can be complicated, experts report in a recent Journal of Sexual Medicine study.
Vaginal penetration and intercourse are painful and problematic for women with GPPPD. As a result, women may become anxious and fearful of intercourse, and their pelvic floor muscles might tense to the point that penetration is extremely difficult or impossible.
The term genito-pelvic pain/penetration disorder was developed in 2013, when the categories of dyspareunia and vaginismus were combined for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
However, the prevalence of GPPPD is unclear. The present study sought to determine the prevalence and identify risk factors for GPPPD in married women.
Five hundred ninety Iranian women from the Tehran area participated in the study. Their average age was 36 years and their average length of marriage was 14 years. Most were housewives, and most had agreed to their marriages and obtained family consent.
The women completed a self-report checklist and two questionnaires, one of which was developed by Yitzchak M. Binik and considered “one of the first questionnaires recommended for the merged diagnosis of vaginismus and dyspareunia.” Binik’s assessment tool includes questions on pain, fear, and pelvic muscle dysfunction associated with vaginal penetration. It also asks women how many successful penetration attempts they have had during the previous six months.
Researchers used the Patient Health Questionnaire to evaluate symptoms of depression.
GPPPD prevalence rates varied depending on the assessment used. When women were asked to self-report their experiences, one-third of them said they felt pain during intercourse or felt fearful of intercourse.
However, Binik’s guideline for a GPPPD diagnosis calls for women to feel pain, fear, or muscle dysfunction “moderately” or “quite a bit or always.” When these criteria were followed, the GPPPD prevalence rate was 16%. When distress was considered, the rate fell to 10.5%.
“Overly strict criteria and a high threshold for diagnosis may result in the exclusion of a considerable number of women suffering from pain and fear,” the authors wrote, noting that when Binik’s threshold was lowered to include women who answered “somewhat” to describe their pain or fear, the GPPPD prevalence rate rose to 25.8%.
They added that “cultural and religious differences can be so influential in this regard that the threshold may be affected, in at least some communities.”
Depression was a serious risk factor for GPPPD for the women in this study. About 31% of the women diagnosed with GPPPD had “severe” depression, and the researchers found that the risk of GPPPD was about 7 times higher in women who were severely depressed. GPPD was also more common in women with low sexual satisfaction and those who had a “strong aversion” to touching or looking at genitalia.
Marital satisfaction and financial stability were other important factors. Women who were highly satisfied with their marriages were less likely to have GPPPD, as were women who were financially stable.
The authors recommended further research concerning the GPPPD diagnostic threshold.
“We suggest that if a woman is experiencing sexual distress with even mild to moderate levels of pain, she should be diagnosed with GPPPD,” they wrote.
Archives of Sexual Behavior
Binik, Yitzchak M.
“The DSM Diagnostic Criteria for Vaginismus”
(First online: October 23, 2009)
The Journal of Sexual Medicine
Alizadeh, Ameneh, MS, et al.
“Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women”
(Full-text. Published online: May 30, 2019)
“Genito-Pelvic Pain or Penetration Disorder (Sexual Pain Disorder)”
(Last reviewed: February 21, 2019)