Genito-pelvic pain penetration disorder (GPPPD) is a condition that causes persistent pain, fear, or anxiety in response to vaginal penetration or its anticipation. This penetration can include menstrual products, pelvic exams, or penetrative intercourse.

While some individuals with GPPPD experience voluntary muscle tightening of the pelvic floor, others may experience involuntary tightening. Additionally, some people may have pain due to inflammation, hormonal changes, or nerve sensitivity.

Because GPPPD involves both physical and psychological components, treatment often requires a multifaceted approach that addresses both aspects of health.

You may have heard of terms such as dyspareunia (pain during intercourse) and vaginismus (involuntary tightening of the muscles surrounding the vagina). Both of these terms fall under GPPPD and are symptoms of the condition.

More specifically, this condition involves the following symptoms:

• Difficulties with vaginal penetration that persist long-term.
• Involuntary tension or muscle spasms of the pelvic floor that occurs with an attempt at penetration.
• High levels of fear or anxiety involved with the anticipation or act of penetration.
• Pain felt in the pelvic, vaginal, or vulval areas during intercourse or with attempts to begin intercourse. In some cases, pain may be felt deeper in the pelvis.
• For some individuals, utilizing a tampon, inserting a sexual aid, or receiving an internal examination may be more difficult or painful.

This condition can develop at any point in a person’s life—such as with their first experience with penetration, or later in life, even if they have had successful and pain-free penetration previously.

The severity of this condition can vary widely by the individual, and may worsen over time if left untreated. Many individuals avoid treatment due to the fear of talking about a topic they may consider embarrassing.

In other cases, an individual may simply think pain during penetration is a normal sensation—which is untrue!

Hive Therapy and Wellness wants to dispel the shame around vaginal health and sexual health. Your body, health, comfort, and quality of life matter, and you deserve high quality care that protects those things. There’s no need to feel embarrassed about GPPPD. It is more common than you think, and is treatable!

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Genito-pelvic pain penetration disorder can be caused by a multitude of physical and psychological factors that range from person to person.

Patients often experience a combination of both types of causes. We’ll go over each category of potential causes below:

Psychological Factors

These factors include aspects such as anxiety, trauma, stress, and fear associated with penetration. Fear can be a strong influx of emotion that may trigger a fight-or-flight response in the body.

Psychological factors can be due to:

• Past emotional or physical trauma.
• Fear of pain associated with penetration.
• Stress, anxiety, or pain caused by other conditions such as endometriosis, pelvic floor dysfunction, or pelvic floor tension myalgia. 

Individuals who have experienced negative sexual experiences such as experiencing pain during their first time having intercourse may be more likely to fear future penetration.

Additionally, some patients may struggle with religious or cultural aspects relating to sex and sexuality that may affect how they perceive intercourse or themselves—leading to emotional distress or anxiety.

This may lead a patient to avoid treatment, which only allows the condition to persist or worsen. Psychological aspects such as fear and anxiety can contribute to avoidance, leading the patient to no longer attempt penetration or intercourse.

One last element that may come into play is education on bodily anatomy. Lacking an understanding of anatomy of the pelvic floor, vagina, vulva, or other nearby genitalia can lead to fear and anxiety surrounding sensations during penetration and pain.

All of these psychological factors can contribute to the tightening of the pelvic floor muscles during an attempt at penetration. This tightening creates pain and can negatively affect sexual health, sexual enjoyment, and even self-image.

Physical Factors

Physical factors refer to many different aspects, such as pre-existing conditions or pelvic floor dysfunction. Pre-existing conditions that can contribute to genito-pelvic pain penetration disorder include conditions such as the following:

• Pelvic, vaginal, or urinary infections
• Endometriosis
• Pelvic inflammatory disease
• Fibromyalgia
• Interstitial cystitis
• Irritable bowel syndrome
• Uterine, vaginal, or pelvic prolapse
• Vaginal stenosis
• Central sensitization
• And more

Additionally, vulvar pain disorders such as vulvodynia or vulvar skin conditions such as lichen sclerosus can contribute to pain, fear, or anxiety associated with penetration.

Even without the presence of these conditions, an individual may have pelvic floor dysfunction that contributed to or led to genito-pelvic pain penetration disorder. In this case, they would have overactive or hypertonic pelvic floor muscles.

These pelvic floor muscles are tight, persistently contracted, and can often be painful even outside of intercourse or penetration. They may create a variety of other symptoms involving the bladder or bowels, too.

These tight muscles can be caused by many of the above-mentioned conditions, but can also form due to stress, poor posture, restroom habits (straining during bowel movements, holding urine), pregnancy, childbirth, surgery, injury, or physical trauma.

Lastly, hormonal changes can contribute to symptoms of genito-pelvic pain penetration disorder and pelvic floor dysfunction. This can include hormonal changes from menopause, pregnancy, or from contraceptives. 

These changes can affect arousal, natural vaginal lubrication levels, and vaginal tissue elasticity; all of which can increase discomfort with penetration. 

Pelvic floor physical therapy is just one part of treatment for genito-pelvic pain penetration disorder—but it plays a very important role in restoring pelvic floor function, reducing pain, and allowing the patient to rebuild their confidence.

The pelvic floor physical therapists at Hive Therapy and Wellness curate comprehensive treatment plans for each and every patient.

This is important for patients with GPPPD, as they will need a holistic and individualized treatment approach in order to address their needs. GPPPD varies widely from person to person, so a curated plan of care is essential.

The pelvic floor physical therapists at Hive understand that genito-pelvic pain penetration disorder will need both physical treatment and psychological interventions. They are prepared to collaborate with other professionals or providers in order to best provide treatment for their patients.

Rest assured that Hive’s pelvic floor therapists understand that seeking treatment for genito-pelvic pain penetration disorder can be intimidating and stressful.

While working with a pelvic floor physical therapist may commonly involve both internal and external physical examinations, the physical therapists at Hive Therapy and Wellness will only provide treatment with your explicit consent—you never have to participate in treatment that you are uncomfortable with!

Even if you agree to internal examination or treatment at first, but later decide you are uncomfortable, remember that you have the right and freedom to stop treatment.

Your physical therapist will simply adapt their treatment to suit your comfort level. Don’t let fear of examination or treatment stop you from getting the care you need!

That being said, pelvic floor physical therapists can utilize a variety of treatments to lessen pelvic floor tension and tightness, educate patients about their pelvic floor, as well as encourage relaxation. These treatments have been outlined below:

Desensitization

While every patient may have different levels of severity for their symptoms, desensitization can improve their response to touch and relieve discomfort from tightness.

Desensitization can include the use of dilators, which are tools of varying sizes designed for penetration. They can help gradually build a patient’s confidence and response to penetration.

Dilators are a fantastic tool that allows the patient to slowly and gradually improve their physical and emotional response to penetration. They are available in very small starting sizes (even the size of a pinky), so patients can start as slowly and carefully as they may need.

Manual therapy

Manual therapy involves hands-on techniques, external or internal, that manually manipulate muscle tissue in order to relieve tightness, reduce muscle spasms, and address trigger points. Manipulation of these muscles can reduce pain, improve blood flow, and reduce sensitivity.

Pelvic floor training

Your physical therapist will utilize neuromuscular re-education and biofeedback to improve your awareness and activation of your pelvic floor.

Regaining an understanding of your pelvic floor is essential to reducing tension and gaining control of those muscles, including relaxing those muscles as needed.

Relaxation techniques

The previous treatments aim to help you become more aware of your tight pelvic floor muscles and allow you to actively work to relax them.

To aid in relaxation, your physical therapist can teach you strategies such as diaphragmatic breathing and other methods that can relieve tension.

Exercise prescription and stretching

To reduce pressure on the pelvis due to muscle imbalances, your physical therapist will curate an exercise routine to strengthen your core, hips, or lower back—as well as teach you targeted stretches to improve mobility and flexibility of the muscles in and around the pelvis.

Behavioral modifications

To further reduce pelvic tension and muscle strain, your physical therapist will eliminate behaviors that may be contributing to your condition.

Poor posture, harmful restroom habits, poor diet or hydration can all contribute to pelvic tension—therefore, you can expect to make some lifestyle changes!

Education

Education is a powerful tool for individuals with GPPPD.

Hive’s physical therapists can educate patients on body anatomy, the pelvic floor, how the pelvic floor plays a huge role in GPPPD, and why pain may occur with penetration. They will also provide instruction and suggestions for utilizing dilators at home as part of your treatment.

Hive’s pelvic floor therapists can even explain pain neuroscience so that patients can better understand the link between their pain, brain, and nervous system. Additionally, they can provide suggestions on positioning and tools that may prove useful during intercourse to improve comfort and reduce pain.

The physical therapists at Hive Therapy and Wellness are ready to work with you and find the methods of treatment that best suit your individual needs.

While seeking treatment for genito-pelvic pain penetration disorder can be intimidating, know that Hive’s physical therapists are willing to work at your comfort level and pace. They’ve got years of experience with a variety of patients and conditions, and are determined to help you feel welcome and comfortable in their clinic.

At Hive, there are many different treatments that can be used for patients with GPPPD. Your customized plan of care could include any of the following treatment methods:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback