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Female Sexual Pain
Female Sexual Pain (FSP) disorders affect about 15% of women, and include symptoms of pain in and around the vulva, vagina, or uterus. FSP can have a significant impact on daily functioning, sexual satisfaction, and relationships. Cognitive behavioral therapy (CBT) can be helpful for women with FSP, in combination with other treatments including medication and hormone therapy.
Female Sexual Pain
Female Sexual Pain (FSP) includes chronic and/or intermittent pain experienced in or around the vulva, vagina, or uterus. Common FSP problems include chronic pelvic pain, vaginismus (tightening of the vaginal muscles upon penetration), dyspareunia (pain during sex), and vulvodynia (pain in the vulva). The pain associated with FSP is often described as a sharp pain in and around the vulva, inside the vagina, or a cramping in the muscles in the area (but different than what menstrual cramps feel like).
The majority of women will experience some form of pain during intercourse at least once in their lifetimes, often due to inadequate lubrication. The vulva is comprised of soft, delicate tissue that can become sensitive and painful during intercourse without sufficient lubrication or with intense penetration. However, if the pain persists after several days or continues to occur after several acts of intercourse, it is important to see a specialist. Note that not all doctors will be familiar with FSP and this lack of awareness of FSPs means that they are oftentimes misdiagnosed, and thus not treated correctly. An obstetrician/gynecologist who specializes in FSP can recognize and treat this pain with medication, and may also recommend physical therapy and psychological therapy. Waiting too long for an appropriate diagnosis can make it much more difficult to detect the cause of the pain, as emotional and relationship difficulties become linked to the physical pain. So, don’t “tough it out,” but get help as soon as possible.
CBT combined with traditional medicine has a long history of success in treating other types of pain. It’s also used successfully for treating FSP. People who use CBT for chronic FSP see that women with FSP treated with CBT experience great improvement or complete relief of symptoms 6 months after treatment in almost half the cases. Even better, relief from pain is maintained or even improved upon over the next two years. One study found that almost 80% of women said they were “cured” after using CBT and physical therapy.
CBT for FSP may include psychoeducation about the structure and function of the female genitalia and sex organs to better understand where the pain is coming from, learning muscle relaxation, developing self-coping statements, learning effective communication skills for talking about sexual concerns and needs with partners, learning how your thoughts influence your physical responses, and developing more helpful ways of thinking. CBT sessions will typically address anxiety about painful sex and pain management. This can be done through using pain diaries to identify any triggers for pain and keeping track of improvements, as well as events that lead to the worsening of pain over the course of treatment. Treatment sessions will also address identifying thought patterns that escalate fear or worry about sex, and suggesting more positive and helpful thought patterns to use instead. Because anxiety and pain are so intertwined, breaking this cycle of anxiety and pain will be a major target of treatment. A CBT FSP therapist may also assist with developing skills of mindful awareness (being present in the moment) and guided imagery (using pleasant images) to assist in reducing anxiety and increasing relaxation in daily life as well as during sexual intercourse.