When the "Oohs" are Painful, Not Pleasurable: An Investigation of Anodyspareunia Among Gay, Bisexual, and Queer Men

Abstract

Recurrent and severe pain during receptive anal penetration, also known as anodyspareunia, is common among gay and bisexual men with prevalence rates ranging from 12.5% to 18%. Despite high prevalence, this is the first study to assess diagnostic criteria for Genito-Pelvic Pain/Penetration Disorder (GPPPD) among gay, bisexual, and queer (GBQ) men, and the first to systematically explore symptom and biopsychosocial profiles, test a cognitive-behavioural (CBT) model of maintaining factors, and explore the treatment barriers among GBM with anodyspaurenia. Overall, 369 Canadian GBM (Mage = 31.26, SDage = 10.85) with and without recurrent and severe pain during receptive anal penetration completed an online self-report questionnaire package. Study hypotheses were examined using descriptive statistics, Kruskal-Wallis H tests, analyses of variances, latent class analyses, structural equation modelling, and chi goodness of fit tests. Almost half of the sample (47.2%) met full criteria for GPPPD, 31.0% met no criteria, and 21.8% met criteria, but reported no distress or interference. Pain at the entrance of the anus, experienced at the moment of penetration, and persisting for five minutes or less was common across groups, whereas pain located inside the anal canal and rectum, experiencing pain during thrusting, and pain persisting for more than five minutes differentiated between GBM with and without a GPPPD diagnosis. GBM with GPPPD reported significantly greater pain catastrophizing, pain-related cognitive and somatic anxiety, pain-related fear, prostate and rectal conditions, and heterosexist harassment, rejection, and discrimination than the other two groups. The fear-avoidance model of sexual pain was partially among GBM with GPPPD. Commonly reported barriers by GBM with GPPPD who did not consult with a health care professional included unhelpful beliefs, shame, and embarrassment. GBM with GPPPD who sought treatment most often reported consulting with a general practitioner. The high proportion of GBM who met full criteria for GPPPD highlights the need for effective interventions and further research regarding anodyspareunia among this population. Implications of the study findings for assessment, diagnosis, treatment, and knowledge transfer and exchange are discussed.