Could Explicit Motor Imagery Help Women With Genito-Pelvic Pain?

Could Explicit Motor Imagery Help Women With Genito-Pelvic Pain?

Explicit motor imagery (EMI) is the technique of thinking about moving without actually moving. It is a method that is sometimes used for chronic pain management to help individuals gradually alter their brain’s response to pain.

About a quarter of the brain’s neurons are “mirror neurons,” which means that they begin to fire when a person simply thinks about moving or sees another person move. Therefore, repeated exposure to images of individuals performing potentially painful actions may eventually help moderate the response of these neurons, improving pain and functionality.

EMI has been used to treat patients who have shoulder, hand, foot, knee, or back pain. Now, researchers are exploring extending EMI therapy to treat women experiencing genito-pelvic pain/penetration disorder (GPPPD), which is a condition characterized by pain or difficulties during vaginal penetration as well as heightened pelvic floor muscle tension.

To do this, the first necessary step is to determine whether imagery that depicts potential genital pain elicits anxiety or anticipation of pain in women with GPPPD. A total of 113 women participated in an online study to test this: 62 women with self-reported genito-pelvic pain and 51 women who were pain-free.

The participants viewed 33 images of women doing activities that may cause genito-pelvic pain for women with GPPPD including:

  • Sitting
  • Walking
  • Running
  • Lifting heavy objects
  • Putting in a tampon
  • Implied penetrative sex
  • Actual penetrative sex
  • Implied gynecological exam
  • Actual gynecological exam

For each image, the women were asked to rank their viewing anxiety, their anticipated anxiety, and their anticipated pain on a scale from 0 (not anxious/no pain) to 9 (extremely anxious/extremely painful) using these three questions:

  1. How anxious do you feel looking at this image? (viewing anxiety)
  2. Imagine you are the woman in this image, how anxious would you feel performing this activity? (anticipated anxiety)
  3. Imagine you are the woman in this image, what would you rate your perceived pain in this situation? (anticipated pain)

Across the board, the women in the genito-pelvic pain group reported significantly higher levels of viewing anxiety, anticipated anxiety, and anticipated pain than the women in the control group with only a few exceptions. For example, both groups reported similar levels of viewing anxiety in the image categories of implied and actual penetrative sex. Similarly, both groups reported similar levels of anticipated anxiety and anticipated pain for the lifting category.

This research confirms that images that portray potentially painful actions for women with genito-pelvic pain prompt an elevated response from these individuals. Importantly, this finding indicates that EMI therapy may be useful for women with GPPPD.


  • Kelly, K.J., Fisher, B.L., Rosen, N.O., & Hamilton, L.D. (2022). Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images. The Journal of Sexual Medicine19(8), 1281-1289. DOI:

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