Helping Your Patients through Vaginal Pain Disorders

Do you have patients who are trying to work through vaginal pain issues?

One of the biggest struggles for patients is being able to talk about their sexual issues openly. This isn't just a matter of being comfortable with you, their therapist, but also being comfortable with admitting it to themselves. Vaginal pain during penetration is a topic that used to be incredibly taboo, and even though things have changed in the medical and mental health communities, it can still be very challenging to treat.

I recently had a special opportunity to speak to a reporter from a major news magazine about painful vaginal intercourse. The reporter was under the impression that things had significantly improved for women who experience sexual pain disorders. While I agreed that, at least today, most women no longer are told the problem is "in their head" or be forced to go from doctor to doctor trying to find treatment, there are still some real misconceptions based around vaginal pain during penetration. 

First and foremost is the role that emotional and mental issues can play in vaginal pain. While the pain is definitely not in a woman’s head, what is in a woman's head can impact the effectiveness of treatment. This can play a major role in their treatment. For example, they could take an antidepressant to manage emotional pain, go to pelvic floor physical therapy, or even undergoing surgery for conditions like vulvodynia (painful inflammation of the tissues of the vulva, the area between the labia). 

In the Blended Learning Program, we spend several hours on understanding and treating Genito-Pelvic Pain/Penetration Disorder (GPPPD), primarily vaginismus (penetration impossible) and dyspareunia (intercourse possible but painful). Attendees learn that a fear response to the possibility of intercourse can contribute to pain, its severity, or to the avoidance of sex altogether. 

Strategies to manage fear are essential if a couple wants to have penis-vagina intercourse, or for lesbian couples who enjoy digital vaginal penetration or the use of toys. Sometimes treatment must go much further if a woman has experienced rape or sexual molestation. Moreover, what is in their partner’s head may also matter in resolving painful intercourse. If their partner is upset, nervous, or worried about them, a woman may pick up on their tension and have difficulty relaxing.

Helping patients manage their vaginal pain issues can be quite challenging for sex therapists. I know that I would have a tough time treating my clients seeking help for sexual pain disorders if I was unable to refer to the pelvic floor physical therapists at the clinic where I work at Hoag. That is why we always have Dr. Christine King (or another therapist if she is unavailable) come in to explain the function of the pelvic floor, why problems happen, and how they are treated. We also make sure to explain that psychotherapists are not responsible for making a physical diagnosis (phew!) but to leave that to the PT or the referring physician.

I realize that vaginal pain is far from the sexiest topic that sex therapists deal with. Other programs may have workshops that focus on sexier topics like sexual fantasies or the importance of attachment. While these programs have value, they may not teach you how to help clients with problems like GPPPD; working with people who have mental health issues such as being on the spectrum; and who may have chronic illness or disabilities like cancer. 

In the Blended Learning Program, we focus on how to get into the trenches with your client to resolve sexual dysfunction so that they can experience optimal pleasure—and we include the sexier topics within that material. For example, if someone who has been abused has problematic sexual fantasies, you can use the lessons taught in the Blended Learning Program to help them to create new, less-problematic fantasies. 

The work we do in the Blended Learning Program gives sex therapists the tools they need to treat sexual conditions of all kinds. We have a fantastic weekend coming up in our Blended Learning Program in November, but it's essential to sign up as soon as you can. There are (intentionally) a very limited number of spots available as we want to keep attendance low to maximize interaction.

But what if you’re not quite ready to jump into the deep end of the pool? You could consider starting on the road of sex therapy by taking the Core Knowledge Program, which is 100% online. We also offer many stand standalone courses that can help you address specific challenges with your patients.

P.S. When the article comes out, I’ll be sure to circulate it. I have my fingers crossed that they add in a clever thing I said at the end of the interview, lol!


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