What’s Going On?

In 2013, a diagnosis of “genito-pelvic pain/penetration disorder” (GPPD) was created to encompass the previously separate “vaginismus” and “dyspareunia.” The term GPPD is relatively new, so it’s still more common to get a diagnosis of vaginismus or dyspareunia. GPPD involves having one or more of the following symptoms, for at least six months:1

• It’s hard to have penetrative sex.
• Vaginal intercourse or attempts at penetration hurt your pussy*.
• The pain of having penetrative sex starts to cause you significant fear or anxiety before, during, or after vaginal penetration.
• Your pussy*—its pelvic floor muscles—tense up when you’re trying to have penetrative sex.

“Vaginismus” has been defined as recurring involuntary spasms in the vagina that interfere with intercourse2 or as frequently having trouble letting anything inside your vagina whether it’s a penis, finger, or dildo, even if you want to.3,4

“Primary vaginismus” refers to vaginismus that happens at your first attempt at vaginal penetration during sex or with tampons or for a gynecological exam.5

“Secondary vaginismus” refers to vaginismus that happens after a period of pain-free vaginal penetration.5

“Dyspareunia” is a more broad term, meaning persistent or recurring pain in your pussy* that occurs before, during, or after vaginal penetration.6

It is difficult to know causes surrounding GPPD because no large-scale study has been conducted and cases are very different for individuals. It's hard to parse out what is mental-emotional and what is a physical problem. The two are often tied. Causes could be anything from childhood trauma to muscular tension.7,8  Because most people globally don’t have access to treatment for GPPD whether pelvic-floor physical therapy or psychotherapy, there is not much solid data on their experiences.9

How Common Is This?

Estimates of the prevalence of dyspareunia range from 1 to 61% of people with pussies* so it’s hard to know how common it really is.10 Part of this wide range is because researchers are using different questionnaires that could be measuring different experiences. It is also difficult to know the prevalence of vaginismus. Estimates range significantly from lower than 1% in community samples to 1-25% in clinical studies.11,12

The American College of Obstetricians and Gynecologists says that 75% of women experience pain with intercourse at some point in their lives.13 But that statistic could contain both short-term and long-term pain, with causes as diverse as not enough lube to GPPD.

How Can I Take Care of My Pussy*?

Multidisciplinary treatment of vaginismus and dyspareunia aims at retraining a person’s habitual physical and emotional responses.

Pelvic floor physical therapy can help with pelvic floor muscle awareness and retrain overactivity of pelvic floor muscles (make them tense up less easily). Pelvic floor physical therapists can also perform something called internal and external soft tissue mobilization and myofascial release to muscles in spasm.14,7 (Ie- to help you relax your pussy*!)

Sometimes therapists use objects that increase slowly in size that you put into your vagina. This is called "graded exposure with vaginal dilators of increasing diameter" and is part of a process of muscle relaxation and desensitization.15,16

Sex therapy, couples counseling, and psychotherapy can also be helpful.14,7

Author’s Dedication: To Liz Miracle, who helped me find passion and purpose in my career and showed me what true empathy and dedication to patients can look like.