Pelvic pain, painful sex and intimacy challenges are more common than many people realise. GPPPD is a broad umbrella diagnosis used to describe painful intimacy. Experienced by up to 20% of women, this diagnosis can be overwhelming and validating, and can often leave you with more questions than answers. Today we are going to explain the basics and provide you with some insight into how this diagnosis can impact sex, intimacy & relationships. Whether this blog is for you, your lover or even a friend, chances are you will learn something new today!
DYSPAREUNIA & VAGINISMUS
Dyspareunia is the clinical term for pain during sexual intercourse or genital sexual activity.
The pain can occur before, during, or after penetration and may be felt in the vulva, vagina, pelvis, or deeper inside the abdomen.
Vaginismus can be defined as a persistent or recurrent difficulty allowing vaginal penetration of a penis, finger, or object, despite the individual’s expressed wish to do so, due to involuntary tightening or tensing of the pelvic floor muscles. This accompanies increased feelings of fear, anxiety and stress surrounding penetration and intimacy and is not explained by another medical condition.
Before GPPPD existed, people could be diagnosed with either dyspareunia or vaginismus. In 2013, these two were combined and Genito Pelvic Pain Penetration Disorder became a new medical category.
Genito Pelvic Pain Penetration Disorder
GPPPD can be defined with the following 4 criteria:
- Difficulty with vaginal penetration (attempted or complete)
- Genito-pelvic pain during penetration
- Fear or anxiety about the pain
- Involuntary pelvic floor muscle tensing/tightening
Symptoms lasting for at least 6 months cause significant distress and are not explained by a separate medical condition.
For many, the experience is broad and inconsistent. Pain may not always be present; it can occur unexpectedly and leave individuals feeling frustrated or overwhelmed. Others experience consistent pain or involuntary vaginal tension whenever they attempt physical intimacy with a partner, even if they genuinely want to engage.
Some people have previously enjoyed pleasurable sexual intimacy and penetration, only to suddenly develop pain later in life. Others report pain or vaginal tension from their very first sexual experiences.
As you can see, the range of experiences is extremely broad. While up to 20% of women are estimated to experience this at some point in their lives, the true number may be higher due to under-reporting.
DOES GETTING A DIAGNOSIS HELP?
Seeking a diagnosis can be beneficial, it can support you in finding the right treatment and guidance. It helps women recognise the pain as legitimate and deserving of investigation, financial support and professional care.
Some women worry that they must experience “significant” distress to qualify for a diagnosis. This can feel overwhelming and invalidating. While some people do experience severe distress, others may have pain without high distress levels. Everyone’s experience is different, and there is no perfect way to measure distress, which can make diagnosis tricky
For many women, having a diagnosis can feel incredibly validating. It acknowledges that their experience is complex and requires attention and an empathetic approach to treatment.
For others, a diagnosis is not helpful, as it can be more damaging to be labelled as having a ‘disorder’ when perhaps they are actually experiencing a very natural reaction to external factors influencing their sexual health.
IS A DIAGNOSIS SEX POSITIVE?
Some professionals argue that this diagnosis unnecessarily centres penetrative sex, overlooking the role of poor sex education and cultural messaging around what “real sex” is. Critiques highlight that GPPPD often emphasises penetration—often penis-vagina penetration, as the main marker of “successful” sex.
While painless penetration is a valid goal, an intense focus on penetration as the most legitimate form of sex is limiting. Sex positivity celebrates sex as a beautiful emotional, sensual, and physical experience that encompasses many forms of pleasure. Social conditioning that prioritises penetration can diminish people’s ability to enjoy a wide variety of pleasurable experiences, and it invalidates many queer and LGBTQIA+ sexual experiences
A HOLISTIC APPROACH TO TREATMENT IS ESSENTIAL
Taking a holistic approach is essential and usually requires input from a few different health professionals. Starting with a GP, having input from more than one professional is important to ensure that not only your physical health is considered. Research clearly shows that emotional and mental wellbeing play a major role in reducing pain and anxiety.
Health professionals such as gynaecologists, GP’s, pelvic floor physiotherapists and pain specialists often deal with the medical and physical aspect of GPPPD. They can assess physical causes and offer medical or physical treatments if needed.
When pain is involved, this can cause an increased fear and avoidance of sex or physical intimacy. To disrupt this cycle, it is essential to work with a therapist, sexologist or somatic therapist. Working with a sex positive therapist encourages individuals to explore their relationship with sex and intimacy, giving clients a space to explore how pleasure and play can reduce pain.
When seeking support surrounding pain, sex and intimacy, it is essential to work with a practitioner that is sex positive and comfortable with diving into the deeper details.
When given a safe space to speak openly about their experiences, individuals often feel more supported and validated. Research actually shows up to a 40% pain reduction in individuals who worked 1:1 with a sex therapist.
TIPS FOR PRIORITISING PLEASURE IF YOU ARE EXPERIENCING PAIN
Explore Touch Without Pressure To Penetrate
Pleasure is a broad experience. So much pleasure can be experienced without penetration. Even if pain is present, pleasure does not disappear. Slow down your approach. Explore your body slowly, it is not a race. I invite you to explore gentle body massage, slowly moving towards gentle, external vulva massage. Remove the idea that you need to insert or explore penetration. Slowly explore what it is like to bring intentional, loving touch to your vulva, stomach and surrounding areas. And remember, adding a yummy, nourishing lubricant or body oil is an amazing way to create a delicious sensory experience.
My personal favourite is the Yinn Body Oil.
Slow It Down
Pleasure is about presence. Pleasure is about patience. How can you tune in to the micro sensations of your body? Does it feel soft, does it tickle, can you run your finger tips slowly over your body ever so lightly? It is in slowness that you can develop an intentional, loving and patient relationship with your body. Maybe your body is experiencing a challenge right now, you get to be it’s biggest supporter! Your body is your home and right now it needs you to have patience.
Get Your Lover/Partner On Board!
It can be really confusing trying to communicate the experience of pain to a lover. Especially if you don’t understand it completely yourself. Chances are, if they've never experienced this, they are confused too. The right partners/lovers are curious, supportive and open. Maybe intimacy needs a super slow approach for now. Can sexual and physical intimacy look beautiful and fulfilling without penetration? Yes, absolutely! This doesn’t mean we are giving up on penetration, it just means that right now, penetration isn’t the focus. You want your lover/partner to be someone who respects and honours you. Read about GPPPD together, maybe share what you learn from your GP, sexologist or somatic coach. A great lover is someone who wants to learn about your experience.
Consider Purchasing A Glass Or Crystal Wand
Here at Yinn, our pleasure wands are either glass or crystal. This is because we believe in creating a slow and intentional pleasure practice. Glass or Crystal is a beautiful way to practice this. Smooth, sleek and they warm to the touch, this is a perfect place to start if you want to slowly introduce gentle penetration or external massage. I highly recommend exploring dearmouring and using this technique to gently release tension. My personal recommendation for this would be The Luna.
I WANT YOU TO REPEAT AFTER ME
‘My pain does not define my experience of pleasure’
‘My body is capable of experiencing SO much pleasure’
‘There is no “right” way to experience sex & intimacy. I get to decide what fulfilling sex & intimacy look like for me right now’
‘I know that I can experience deeply fulfilling relationships and that with the right support, my experience of pain will be reduced.’
Whether you, or someone you know is experiencing GPPPD, I want you to remember that pain can be reduced, sex & intimacy are not defined by penetration and you deserve to experience deeply fulfilling sex, intimacy & relationships.
With love,
Your In House Sexologist
Annalise Webster