A JOINT APPROACH TO MANAGING GENITO-PELVIC PAIN/PENETRATION DISORDER

In Genito-pelvic pain/penetration disorders (GPPPD), involuntary contractions of the vagina muscles make intercourse or examinations painful and difficult (Bergeron et al, 2021). Very often, GPPPD is exacerbated by the anxiety and distress experienced with repeated negative experiences (Dias-Amaral & Marques-Pinto, 2018). In our clinic, this is addressed through Physiotherapist guidance through pelvic floor desensitization exercises. These exposure exercises emphasise gradual progression, building familiarity and confidence with intra-vaginal insertion. A Psychologist teaches emotion regulation and relaxation techniques, also addressing negative beliefs and misconceptions. While most can incorporate psychological techniques to progress through desensitization exercises independently, a subset require coordinated Psychology-Physiotherapy support. This case report of a representative patient illustrates this.

A 28-year-old lady presented with 1-year history of GPPPD that prevented intercourse. Medical causes were ruled out. She had received physiotherapy for 3 months with limited progress. The Psychologist and Physiotherapist noted that the patient had identified successful intercourse as a direct singular goal. There was intensive attention placed on pain and failure consequences, heightening helplessness cognitions that reduced an overall sense of efficacy. She also had an anxious pre-morbid personality that manifested as goal-oriented attempts to rush through desensitisation practices. This contradicted experiential and relaxation aspects the practice emphasised, further limiting progression. This caused discouragement and reduced motivation for regular practice, compounding the problem.

We collaborated to personalise a graded desensitization plan incorporating principles of SMART (specific, measurable, achievable, relevant, time-based) goals and a fear hierarchy. We addressed unrealistic progression expectations, constantly monitoring patient’s motivation and progression, tweaking steps to accommodate her pace. The psychologist also joined physiotherapy desensitisation sessions, teaching the patient to recognise anxious responses and apply emotional regulation and relaxation techniques in-vivo. Cognitive re-structuring techniques addressing irrational cognitions were also taught.

The patient attained successful coitus after 12 months therapy.

For highly anxious GPPPD patients with a goal-focused orientation, progress is often limited with a general desensitisation treatment approach. There is utility in having a personalised treatment plan that incorporates joint Psychology and Physiotherapy expertise. Confidence and motivation improve along with appreciation of the mind–body connection.

NIL.