Genito-pelvic Pain/penetration Disorder Research Articles

(350) Assessment of Fundamental Knowledge and Comfortability of Medical Trainees in the Diagnosis and Treatment of Genito-pelvic Pain Penetration Disorder

Abstract Introduction Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a common condition affecting up to 25% of the US population. Despite its prevalence, significant barriers exist for patients to obtain appropriate diagnosis and treatment. Lack of uniform education in vulvar anatomy, physiology, and vulvar pain conditions in medical schools for trainees may be a contributing factor in the delay to diagnosis for patients. The vulvar examination is pivotal in diagnosing GPPPD but is often omitted, despite its importance, due to shortcomings in medical education. The lack of formal education may leave many healthcare workers feeling unprepared to care for their patients' sexual health. Objective Our study aims to assess the fundamental knowledge of medical trainees who treat vulvar health in the diagnosis and treatment of GPPPD. We also aim to assess the knowledge and confidence of physician residents on how to conduct a comprehensive vulvar examination. Methods This cross-sectional analytical survey study uses Qualtrics to administer the survey after obtaining IRB approval. The target audience includes urology residents, obstetrics and gynecology residents, dermatology residents, internal medicine residents, family medicine residents, emergency medicine residents, and medical students. The survey link and a brief description of the project were emailed to all residency program directors in these specialties who had valid email addresses provided in the FREIDA American Medical Association Residency Database. Program directors were instructed to share the link to the anonymous online survey with their current resident cohorts. Results Survey collection is currently ongoing and formal results are forthcoming. We hypothesize that the results will demonstrate that resident physicians in urology, obstetrics and gynecology, dermatology, internal medicine, family medicine, and emergency medicine as well as medical students are not receiving instruction or counseling on vulvar anatomy, how to diagnose common vulvar conditions, or how to treat common vulvar conditions. Each of these shortcomings significantly contributes to the lack of access and misdiagnosis that patients with GPPPD experience which leads to overutilization of the healthcare system and significant disruption in patient’s quality of life. We aim to show the disparities that exist in order to affect a systematic change and standardization in how we teach vulvar sexual health curriculum nationwide. Conclusions It is crucial to assess these knowledge gaps in training to create educational tools to alleviate these medical education shortcomings. We believe that our findings will provide evidence that will warrant targeted interventions, such as the creation of a nationwide standardized curriculum of medical school training in vulvar anatomy and physiology. Furthermore, we hope this work serves as a catalyst for increased cultural competency training for medical trainees to better address structural barriers for patients with GPPPD to obtain health care with the goal of effectively increasing equity, diversity, and inclusion in the healthcare landscape. Disclosure No.

Assessing Sexual Functioning with the Female Sexual Function Index in Women Suffering from Genito-Pelvic Pain Penetration Disorder Undergoing a Therapeutic Educational Program

Genito-Pelvic Pain/Penetration Disorder is a common sexual disorder that affects an individual’s sexual health and overall well-being. Education is a therapeutic resource that presents several advantages, and it can potentially generate improvements both in pain and sexual functioning-related outcomes in patients suffering from this affliction. The objective of this study was to assess if a therapeutic educational program produced improvements in the different domains of the Female Sexual Function Index in participants suffering from Genito-Pelvic Pain Penetration Disorder. Participants were randomized into a group that received a face-to-face therapeutic educational program, a group that received the same program but online, or a control group. The Female Sexual Function Index was assessed, and analysis of the change in the domains for every group was performed using multiple t-tests. Improvements were found in the face-to-face intervention group, but only the “Pain” domain showed significant improvements (−1.1 points, p < 0.05). Improvements were also found in the online group, but they were only significant in the “Pain” and “Satisfaction” domains (−0.8 points, p < 0.05 for both). A therapeutic educational program improves pain-related outcomes, and it shows a positive tendency to also improve sexual functioning-related outcomes in patients suffering from Genito-Pelvic Pain/Penetration Disorder. Registration: Clinical Trials (NCT05114473).

Sexual Dysfunctions in Women with Posttraumatic Stress Disorder Following Childhood Sexual Abuse: Prevalence Rates According to DSM-5 and Clinical Correlates

Many women with posttraumatic stress disorder (PTSD) after child sexual abuse (CSA) suffer from sexual problems. However, little is known about the frequency of female sexual dysfunctions (FSD) as defined by DSM-5 among women with PTSD due to CSA. Furthermore, factors related to FSD in this patient population are understudied. To assess prevalence rates and clinical correlates of FSD according to DSM-5 criteria in women with PTSD after CSA, a structured clinical interview for sexual dysfunctions according to DSM-5 criteria was administered in a sample of 137 women with PTSD after CSA. Participants also completed measures for PTSD, depression symptoms, and borderline personality disorder symptoms. The association between FSD, severity of abuse, PTSD-, depression-, borderline symptom severity, and age was examined. In a second step, the association between FSD and PTSD-clusters was assessed. Diagnostic criteria of female sexual interest/arousal disorder (FSIAD) were met by 2.6% of women in our sample. 5.2% met criteria of female orgasmic disorder (FOD), and 11.8% those of genito-pelvic pain/penetration disorder (GPPPD). PTSD symptom severity predicted number of fulfilled criteria of FSIAD and FOD, the cluster “negative alterations in cognition and mood,” was associated with more fulfilled criteria in FSIAD and FOD. The majority of women reported sexual problems, but diagnostic criteria of FSD were met by only a small number of participants. PTSD symptoms, especially the cluster “negative alterations in cognition and mood,” seem to be related to female sexual functioning after CSA.

Applications of botulinum toxin to the female pelvic floor: Botulinum toxin for genito-pelvic pain penetration disorder and chronic pelvic pain in women

Chronic pain conditions like genito-pelvic pain penetration disorder and chronic pelvic pain cause significant morbidity in women worldwide and yet are underdiagnosed and undertreated. While the use of botulinum toxin for pain conditions has expanded, there are few randomized controlled studies of botulinum toxin for pelvic pain conditions in women. This paper provides an update on the current status and context for considering botulinum toxin treatment for these conditions to complement and expand currently available approaches. High quality clinical trials to evaluate safety and efficacy and to determine optimal doses and approaches to injection are urgently needed.

Association Levels Between Results from a Therapeutic Educational Program on Women Suffering from Genito-pelvic Pain Penetration Disorder and Their Socioeconomic Status

IntroductionSexual health is fundamental in an individual’s well-being. Genito-pelvic pain/penetration disorder, also known as dyspareunia, is one of the most common sexual disorders, and approaches from physiotherapy include multimodal options, being education, a recent resource often used. Social and economic factors might influence the effectiveness of educational therapies in patients suffering this affliction. The objective of this study was to determine if there is an existing correlation between the participant’s socioeconomic status and the results of a therapeutic educational program.MethodsA randomized controlled trial was performed using therapeutic education as intervention in a sample of 69 women suffering from genito-pelvic pain/penetration disorder. Results over time were assessed regarding pain intensity, pain-related outcomes, and sexual functioning. Socioeconomic status measurements were obtained in February 2022, and these included age, educational level, household monthly income, or job rank. A correlation analysis was performed between these outcomes using Pearson’s correlation index and Spearman’s rho statistic.ResultsResults from the correlation analysis show that there is no significant correlation between any of the outcomes found in the results of the intervention and the socioeconomic status measurements.ConclusionA therapeutic educational program improves pain intensity, pain-related outcomes, and sexual functioning in patients with persistent pelvic pain, independently from their age, educational level, household monthly income, or job rank.Policy ImplicationsEducation is a powerful resource that improves sexuality outcomes despite the patient’s socioeconomical status in patients suffering from genito-pelvic pain/penetration disorder.

Racialized differences across experiences and measurements of pain in genitopelvic pain/penetration disorder.

Despite a growing body of research on genitopelvic pain/penetration disorder (GPPPD), few studies have examined racial and ethnic differences. The goal of this study was to examine differences across racial groups pertaining to GPPPD with sexual vaginal intercourse in young college women at 2 public US universities. Data were collected from 1197 students from 2 public US universities. We limited our sample to 667 sexually active participants aged ≥18 years (mean, 19.21). Participants responded to survey items on their sexual history, wellness, and practices and to the Female Sexual Function Index. Data were analyzed through standard bivariate and regression analyses. Participants were asked, "In general, do you feel pain with sexual intercourse?" and categorized into 1 of 3 pain groups: occasional (10%-25% of the time), frequent (≥50%), and no pain (<10%). GPPPD was prevalent among young college women, with 162 (24.3%) reporting pain occasionally, 119 (17.8%) frequently, and 386 (57.9%) never or very seldom. While there were no differences in pain between Latina and non-Latina participants, our analysis indicated that pain was significantly higher among all other minoritized racial groups as compared with White women but particularly high in Black women, who had 2.15-higher odds of reporting pain than White women. Differences persisted when adjusting for socioeconomic status. Specific descriptors for pain sensation were more aligned with traditional descriptors of GPPPD (eg, burning, stinging, cramping, and pinching) in the White sample than among participants of color. Pain intensity did not differ among racial groups. We also found that a significant number of participants, particularly Black women, reported experiencing painful sex occasionally. No differences were noted across racial groups when assessing sexual function with the Female Sexual Function Index. Existing surveys and physician intake forms should be critically examined for usability with patients of color. As evidenced, Black women's GPPPD seems to go underdetected/undetected by current measures. This study is the first to explicitly compare racial differences among adolescents/young adults. The most notable limitation is the reliance on participant self-report and the absence of gynecologic examination to determine pain-contributing etiologies. Painful intercourse affects young Black women at a higher rate than White women. Further research is needed into categories and metrics that capture their experiences of pain.

Sensory Processing Dysfunction and Genito-Pelvic Pain/Penetration Disorder: Women share their experiences of participating in a sensory-based home programme

INTRODUCTION: Sensory processing dysfunction (SPD) has only recently been described in women with genito-pelvic pain/penetration disorder (GPPPD). However, female sexual pain is a virtually unknown area of practice for occupational therapists providing intervention for adults with SPD AIM: To describe the experiences of women with GPPPD with identified sensory processing dysfunction (SPD) who followed a sensory-based home programme METHODS: Purposive, non-probability sampling was used to recruit participants for the qualitative arm of the study after they presented with SPD in the quantitative part of the study. Semi-structured individual interviews were used to gather information and sufficient information power was reached after five participants were interviewed. Data were analysed descriptively using inductive thematic and saliency analyses RESULTS: Two themes were identified. Theme one: Changes experienced after participating in a sensory-based home programme, reflected increased insight into SPD (allowing participants to identify sensory triggers) and intra-personal changes (increased tolerance of sensory stimuli, feelings of control and I can breathe again). Theme two: Coping strategies employed by women with SPD and GPPPD, included sensory seeking, changes to home and work environments, positive reinterpretation/growth, acceptance, and socio-emotional support (you're not the only one. There are plenty of us out there CONCLUSION: A sensory-based home programme, catering to specific sensory profiles is beneficial as a non-invasive occupational therapy intervention approach (based on sensory integrative therapy) for women with both SPD and GPPPD Implications for occupational therapy: • SPD in the context of sexual pain is an emergent field in occupational therapy, thus occupational therapists need to expand service-delivery to this population and other practitioners such as gynaecologists must be alerted to occupational therapy as a non-invasive, and non-pharmaceutical intervention option for patients. • Contribute to the knowledgebase of sensory integration in the adult population. • Improve the occupational therapist's role in sexuality. • Emphasize the importance of insight as part of a treatment programme.

Alexithymia and Parental Bonding in Women with Genitopelvic Pain/Penetration Disorder.

The role of emotion regulation and alexithymia in the pathophysiology of genitopelvic pain/penetration disorder (GPPPD) is emphasized. Parental bonding is linked to emotion regulation and alexithymia. This study aimed to examine the relationships between parental bonding, alexithymia, and GPPPD. Sixty-four patients with GPPPD were enrolled in the study, and 60 controls were matched for demographic features. Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia, the Bonding to Parents Scale (BPS) was used to assess parental bonding, and sexual functions were assessed via Golombok-Rust Inventory of Sexual Satisfaction (GRISS). The rate of alexithymic traits was statistically higher in the GPPPD group than in the controls (p = 0.005). Patients with GPPPD obtained higher scores on the maternal care/control (p = 0.003) and maternal overprotection (p = 0.008) compared to controls. Difficulty describing feelings factor of alexithymia (p = 0.012) emerged as a predictor of group membership (GPPPD vs controls). To test whether alexithymia was significantly associated with parental bonding, all subjects were divided into two subgroups, alexithymic and non-alexithymic. When the subgroups were compared in terms of parental attitudes, maternal (p = 0.034) and paternal (p = 0.006) overprotection subscale scores were higher in the alexithymic group than in the non-alexithymic group. According to the results, alexithymic traits are characteristic of patients with GPPPD; however, although patients with GPPPD may experience difficulties with perceived parental bonding, this factor does not appear to be a predictor of GPPPD.

Sexual pain disorder

Sexual pain disorder, combining the terms dyspareunia, vaginismus, genitopelvic pain, and penetration disorder, is common in women of reproductive and postmenopausal age worldwide (up to 34-45%) and is more often manifested as recurrent acute pain. A diagnosis of genitopelvic pain/penetration disorder (GPPD) is made when at least one of the following symptoms is present: persistent or recurrent difficulty with vaginal penetration; marked vulvovaginal or pelvic pain during vaginal intercourse and attempts of vaginal penetration; marked fear or anxiety about vulvovaginal or pelvic pain in anticipation, during or as a result of vaginal penetration; marked tension of the pelvic floor muscles during attempts of vaginal penetration. Additional criteria include the presence of the listed symptoms for at least 6 months, resulting in significant sexual distress that causes serious problems in the relationship and is not related to the effects of any substance or any other medical condition. The mechanisms of sexual pain are determined by a wide range of biological, psychiatric and social factors, which explains the difficulty in diagnosing and treating it, as well as the negative impact on sexual functioning in the couple. Timely multidisciplinary care for women suffering from a sexual pain disorder can effectively alleviate the condition and ensure marital sexual harmony in the couple. The modern range of treatment options includes both conservative and surgical treatment methods, the rational choice of which can significantly improve patients’ quality of life.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women—Clinical Approach in Primary Health Care: Review and Meta-Analysis

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0–29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9−11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

The Biopsychosocial Puzzle of Painful Sex.

Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered.

Pharmacotherapy for Sexual Dysfunction in Women.

This review article discusses the controversy in the DSM-5 conceptualization and diagnostic criteria for female sexual dysfunction (FSD). An overview of recent studies on available treatments for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), and genitopelvic pain/penetration disorder (GPPD) is provided. Include delineation of the process of care for pre- and postmenopausal women with HSDD; release of global position statement on testosterone therapy in women; updates on efficacy and safety of vaginal estrogen for genitourinary syndrome of menopause and bremelanotide for HSDD; removal of flibanserin alcohol REMS; and development of new technology to enhance bioavailability and brain delivery of treatments. The DSM-5 revision combining HSDD and FSAD into one diagnostic category is a less accurate characterization of these separate disorders and may hinder access to demonstrated effective treatments for the women with these conditions. There are a wide range of pharmacological, other physiological, and psychological treatment options available for women with FSD, which can be offered based on their specific symptoms, potential benefits/risks, and preferences.

Efficacy of internet-based treatment for genito-pelvic pain/penetration disorder: Results of a randomized controlled trial.

The aim of this study was to evaluate the efficacy of an internet-based treatment for Genito-Pelvic Pain/Penetration Disorder (GPPPD) which adversely affects women's sexuality and is associated with reduced well-being and mental health comorbidities. Two-hundred women with GPPPD (no penetrative intercourse ≥6 months) were randomly allocated to the intervention group (IG) or a waitlist control group (WCG). The intervention included eight modules and one booster session and was delivered through an eHealth platform. Participants were supported by an eCoach regarding treatment adherence. The primary outcome was intercourse penetration behavior. Online assessments were scheduled at baseline (T1), after Session 8/12 weeks (T2), and 6 months (T3) after randomization. Intention-to-treat analyses were reported. Significantly more participants (31.00%, n = 31/100) in the IG were able to have sexual intercourse at T2 compared to those in the WCG, 13.00%, n = 13/100; χ²(1) = 9.44, p < .01. At T3, still more participants in the IG had sexual intercourse (29%) compared to those in the WCG (20%) but the groups no longer differed significantly, χ²(1) = 2.19, p = .19. Genital pain, painful and noncoital penetration behavior, and negative penetration-related cognitions significantly improved with medium to large effects at T2 (d = 0.66-1.25) and small to large effects at T3 (d = 0.23-1.32), whereas fear of sexuality, overall sexual functioning, trait anxiety, and well-being improved with small to medium effects (T2: d = 0.20-0.49, T3: d = 0.23-0.46) in the IG compared to the WCG. On average, participants completed 79% of the intervention. Internet-based treatment has been shown to be effective for GPPPD symptoms and could therefore be a promising treatment modality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Compassion Focused Psychosexual Therapy for Women Who Experience Pain during Sex

Genito-Pelvic Pain Penetration Disorder (GPPPD) affects between eight and twenty percent of women. There is recent evidence that compassion focused therapy (CFT) can help those with general health conditions and persistent pain. This study aims to investigate application of CFT techniques to an existing psychosexual therapy group of women with GPPPD and establish an effect size that could be used in a fully powered trial in future. The study took place within a routine clinical setting. Women who attended a group workshop for GPPPD were invited to complete outcome measures pre-and post-intervention. This study was uncontrolled and unpowered, with the aim of evaluating effectiveness of a novel intervention piloted within a sexual health service. Findings indicated that for the majority of the participants, their self- confidence in managing their sexual difficulty improved over the course of the workshop and their pain frequency and intensity reduced over the sessions. A significant improvement in positive and negative self-compassion and confidence was found. Improvements in sexual distress were also found. The negative aspects of self-compassion were significantly correlated with sexual distress at both pre- and post- intervention. Result from this pilot study appear encouraging and indicate that CFT interventions, specifically related to sexual health and pain, warrant further investigation. Further research would benefit from completing a comparison study and using a larger sample and validated measures.

Perceived partner responsiveness is associated with sexual well-being in couples with genito-pelvic pain.

Intimacy is vital to romantic relationships, yet is often thwarted by relational challenges, such as sexual difficulties. With prevalence estimates ranging from 10% to 28%, genito-pelvic pain/penetration disorder (GPPPD) is an important sexual problem resulting in negative consequences for affected women and their partners, including significant sexual dysfunction and dissatisfaction. Findings from cross-sectional studies indicate that higher levels of intimacy are associated with better sexuality outcomes in couples coping with GPPPD. However, single-occasion measurements may not capture the daily variations in intimacy that could have important implications for couples' sexual well-being. The present study focused on a key intimacy-building component-perceived partner responsiveness (PPR)-and its daily associations with women's pain and both partners' sexual function and satisfaction. Using daily diaries over an 8-week period, 160 women (Mage = 26.23, SD = 6.26) with GPPPD and their partners (Mage = 27.73, SD = 7.35) reported on PPR, sexual function and satisfaction, as well as women's pain, on days when sexual activity occurred (M = 8.87, SD = 5.87). Drawing on the Actor-Partner Interdependence Model, a multivariate multilevel modeling approach was adopted. Controlling for trait-level PPR, when women and partners reported greater PPR, women reported greater sexual function and satisfaction and partners reported greater sexual function. When partners reported greater PPR, they reported greater sexual satisfaction. No association was found between PPR and women's pain. PPR may facilitate better sexual function and satisfaction and could be an important target in sex and couple therapy for GPPPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Coping with dyspareunia, the importance of inter and intrapersonal context on women\u2019s sexual distress: a population-based study

BackgroundRecently known as the genito-pelvic pain/penetration disorder (GPPPD), Dyspareunia is considered a negative factor affecting a couple’s sexual health. This paper analyzes pain in Dyspareunia cases and determines protective factors causing lower levels of sexual distress among patients.MethodsIn a population-based cross-sectional study conducted in 2017, the cluster quota sampling technique was adopted to randomly select 590 Iranian married women aged 18–70 years from 30 health centers. The research tools included demographic data, a sexual distress scale, and Binik’s GPPPD questionnaire.ResultsIn this study, the prevalence of self-report Dyspareunia, confirmed moderate Dyspareunia, and confirmed severe Dyspareunia (based on Binik’s proposed criteria) were 33 %, 25.8 %, and 10.5 %, respectively. Interestingly, 32 (34 %) out of 94 women who experienced severe pain based on Binik’s criteria reported no sexual distress. Compared to women with distress, they also had more positive body images, higher self-confidence, higher levels of sexual satisfaction, and more intimacy in their relationships (P = 0.000). In contrast, 8.5 % of the participants reported significant sexual distress even without confirmed Dyspareunia.ConclusionsImproving intrapersonal characteristics such as self-confidence and body image as well as interpersonal factors such as sexual satisfaction and intimacy with a spouse can effectively treat Dyspareunia by alleviating sexual distress. The partner’s role in female pain and distress management would be more critical than previously thought.

Effect of Stretching versus Breathing Exercises on Self-reported Pain for Women with Genito-pelvic Pain Penetration Disorder

Background: Genito-pelvic pain penetration disorder is a common and neglected problem that can affect a woman's quality of life. Aim of the study: Evaluate the effect of stretching versus breathing exercises on self-reported pain with penetration during sexual intercourse for women with genito-pelvic pain penetration disorder. Method: A quasi-experimental study was conducted on 150 women who were selected using a purposive sampling technique. Data was collected at the gynecology outpatient clinic at Zagazig University Hospital and a private clinic. The evaluation was performed via a structured interview questionnaire and the Marinoff Pain Intensity Scale before the start of the study and at the end of the intervention exercises. Results: The two groups showed a significant decrease (P &lt;0.001) in the women self-reported pain intensity upon penetration during sexual intercourse, while there was a more noted decrease in the stretching group compared to the breathing group (P &lt;0.001). Conclusion: The study concluded that stretching exercises have a significant role in reducing the self-reported pain intensity of penetration during sexual intercourse and pelvic floor muscle spasm for women with genito-pelvic pain penetration disorder.

Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S.

IntroductionDespite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. AimThe purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. MethodsData were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, “In general, do you feel pain with sexual intercourse?” Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. Main Outcome MeasuresWomen were asked, “In general, do you feel pain with sexual intercourse?” and categorized into one of three pain groups: occasional (10%–25% of the time), frequent (50% or more), and no pain (less than 10%). ResultsGPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. ImplicationsHealthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. ConclusionPainful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage.Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770–782.

Vaginal Dilators: Issues and Answers.

Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual intercourse among populations of women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with a wide variety of pelvic floor disorders who experience genito-pelvic pain/penetration disorder (GPPPD) are often advised to incorporate vaginal dilators into their pelvic floor rehabilitation program and treatment regimens to enable penetrative intercourse with less pain. However, little is known about the behaviors of dilator users, what treatment protocols are most effective, how patients are currently using their dilators, and how effective are clinicians in helping their patients achieve success with their dilation therapy. A recent PubMed literature search was performed using the key words vaginal dilator, vaginal dilator therapy, sexual quality of life, vaginal stenosis, vaginal dilation, vaginismus. A total of 29 English articles were reviewed and summarized. Articles were excluded for the following reasons: not in English and unrelated to dilator therapy. This article will summarize the current research on vaginal dilators and discuss needs for future research to maximize patients' compliance and success with this treatment. Much of the summary data regarding user behavior will come from the early survey data with Milli, a novel, patient-controlled electronic dilator that slowly expands 1mm at a time from its smallest diameter, 15mm to a maximum diameter of 40mm. Milli is currently being used by more than 1,000 women, and 3-month follow-up data were recorded on 335 of those patients. Dilators exist in multiple forms (plastic, latex, and medical grade material), may come individually or in sets, and many have special features such as vibration or the ability to be heated or cooled before use. Little is known about patients' use of dilators and the Milli's 3-month survey serves as an insight to patient dilator behavior. The most common medical goals for patients undergoing dilation treatment were return to penetrative intercourse and pain reduction during coitus. Patients were dilated on average 2.72days/week; 56.8% of patients had suffered from sexual pain for 2 or more years and 36.3% had previously used static dilators. More than 70% of Milli users purchased Milli and are using Milli without the direct guidance of a clinician. The most common emotions patients used to describe their treatment were not only "anxious," "frustrated," but also "empowered" and "optimistic." The most common dilatory session duration was 6-10minutes, mostly in the evening/bedtime (68.3%), located in the bedroom (96.8%). Adjunctive treatment included the following: vaginal moisturizers, local estrogen products, coital lubricants, and genital pelvic floor physical therapy. During the dilation sessions, women most often watched TV/videos, practiced mindfulness, or listened to soothing music. Factors that showed trends toward improved patient outcomes were length of dilation treatment (greater than 3months) and use of meditation and soothing music. Factors not associated with improvement trends were as follows: when/where patients dilated and patient demographics including age, race, or religious preferences. Patients who purchase dilators have often suffered with their condition for a long time and had difficulty finding a competent health-care clinician well versed in sexual pain syndromes that can help them. When patients did find a clinician, there were no clinically proven standardized protocols or formalized guidelines to give to patients about how to best use their dilators. Larger long-term interventions investigating a standardized dilation protocol are planned in future studies to better elucidate the effective and optimal dilation treatment plans. Liu M, Juravic M, Mazza G, etal. Vaginal Dilators: Issues and Answers. Sex Med Rev 2021;9:212-220.

Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women

IntroductionTo date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD). AimTo evaluate the prevalence of GPPPD and its associated factors. MethodsThis was a population-based, cross-sectional study of 590 healthy married women age 18–70 years conducted between May and October 2017 in Tehran, Iran. Main Outcome MeasuresResearch tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik’s guideline for the diagnosis of GPPPD. Results196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik’s guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik’s guideline was lowered to also include those reporting “somewhat” pain in addition to the group reporting “moderate” and “quite a bit or always,” then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD. Clinical ImplicationsReliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians’ judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain. Strengths & LimitationsThe present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik’s guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias. ConclusionFurther research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures.Alizadeh A, Farnam F, Raisi F, et al. Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women.J Sex Med 2019;16:1068–1077.