Sexual dysfunctions in women with chronic pelvic pain. A modified sex-therapeutic model

Abstract

Pelvic pain in women is frequently associated with sexual disturbances: inhibited sexual desire, excitement disorders (dyspareunia) and orgasmic dysfunctions. Women with chronic pelvic pain have a disturbed relationship with their own body. They lost the ability of living the body as a place of sensual joy and mutual communication. The goal of therapy is not only relieving from pain, but also that the women should learn (again) to enjoy life as much as the capacities allow this. Therapeutic measures include guidance and appropriate treatment: a biopsychosocially oriented approach. Formal psychotherapy, implying the working trough of deep, unconscious conflicts, anxieties, and angers from childhood, is not necessary and mostly not possible. Also formal sextherapy or psychosexual therapy (Kaplan) is not indicated. This paper describes the different steps of an appropriate and modified sextherapy on psychosomatic and psychodynamic lines. Difficulties, risks and chances of each step are demonstrated; a careful physical examination, information, counselling and emotional support, physical and psychological rest, drug therapy, the way of individual counselling and sexual enrichment program, couple sexual counselling and sextherapeutical sessions. Through these steps the woman can be accompanied to a new life style. The participation in a self-help group for women with emancipatoric goals opens some women's eyes for yet unused capacities and talents. Through these sessions both partners can learn how to live up a new partnership.