Pain is both a physical and emotional experience.
Women who experience pain in the most intimate location, the vulva and vagina, lack outward signs related to chronic pain or disability. They often experience visits to multiple practitioners before receiving an adequate diagnosis and this can contribute to psychological distress.
During sexual activity, pain or discomfort can coincide with arousal, touch, penetration and orgasm. This experience can subsequently affect the desire to engage in sexual activity, the ability to become or remain aroused, and the capacity to consciously relax the pelvic floor sufficiently to allow comfortable penetration. Vulvodynia, which causes discomfort and pain with sexual activity affects sexual functioning due to conditioned responses to pain, and reactive high-tone pelvic floor activity perpetuating the cycle of pain.
These factors can result in and be perpetuated by depression, anxiety, and sleep disturbances. In fact, women with the highly prevalent condition of provoked vestibulodynia (PVD) are reported to experience psychological hyper-vigilance, catastrophization, perfectionism, and decreased self-efficacy.
Vulvodynia contributes to individual and relational distress. Although the causes are physical, and medical and physical therapy are important components to treatment, psychological therapy, which includes couples and sex therapy, is an important part of treatment. Therapy addresses the negative thoughts associated with chronic pain, the feelings of anxiety, guilt and injury to one’s sexual self esteem. Psychodynamic therapy, cognitive and behavioral interventions and mindfulness are tools that may be offered in a therapeutic setting. Therapy also helps couples navigate out of power struggles around sex and learn better communication skills that include reflective listening and empathy.
If your health care practitioner suggests sex or couples therapy, this is not because the pain is “in your head.” The physical pain is real, however, the emotional injury to both the woman and her partner is real as well.
Read this recent article in PAINweek for more information.