Sexual Pain & Dysfunction: Interdisciplinary Approach Key to Restoring Couple’s Quality of Life – Latest Findings from latin American Sexual Medicine Congress
São Paulo, Brazil – A complex case study presented at the recent Congress of the Latin American Society of sexual Medicine (SLAMS) highlighted the critical need for integrated, interdisciplinary care in addressing genit-pelvic pain disorder and associated sexual dysfunction in couples. The case, involving a woman experiencing chronic sexual pain and her partner’s subsequent erectile dysfunction, underscores the interwoven nature of physical, psychological, and relational factors in sexual health.
This case is notably timely as awareness of female sexual dysfunction – historically underdiagnosed and undertreated – gains momentum within the medical community. While often viewed in isolation, sexual difficulties frequently stem from a confluence of biological, psychological, and social influences.
The Case: A Cycle of Pain, Fear, and Avoidance
The patient, identified as Claudia, initially presented with sexual pain. She was recommended a thorough physiotherapy regimen, including manual therapy, biofeedback, transcutaneous nerve electrical stimulation (TENS), and targeted pelvic floor exercises, alongside encouragement of regular physical activity.
Though,the situation evolved. Claudia’s partner developed erectile dysfunction (ED) after eight months, impacting both intercourse and masturbation, despite preserved morning erections. He specifically expressed fear of causing her pain during sexual activity. Importantly, he had no underlying medical conditions (comorbidities).
Urologist Dra. Milena Mayer (Argentina) diagnosed the ED as psychogenic in origin, meaning it stemmed from psychological factors. Her advice included a psychological assessment and, potentially, the use of 5-phosphodiesterase inhibitors (like Viagra) to alleviate performance anxiety and build confidence. Dr. Mayer noted the common presence of hypervigilance in such cases – an exaggerated focus on sensations, often negative, that can exacerbate the problem.
Dr.Ior Finotelli, psychologist and president of Sbrash (Brazilian Society of Sexual Medicine), emphasized a critical observation: couples often seek medical intervention before psychological support, delaying a crucial emotional exploration of the issue.
The case revealed a damaging cycle. Three years of living with sexual pain had diminished both spontaneous and responsive sexual desire within the couple. Initially triggered by the pain, the couple developed patterns of avoidance and emotional numbing. When the partner experienced arousal, his instinct was to pursue penetration, but Claudia’s fear of pain lead to withdrawal, reinforcing mutual frustration.
Beyond the Case: Understanding Genit-Pelvic Pain disorder & Psychogenic ED
Genit-pelvic pain disorder (PGPD), previously often categorized under the broader umbrella of dyspareunia (painful intercourse), is now recognized as a distinct condition.It’s characterized by persistent or recurrent pelvic pain not adequately explained by identifiable medical conditions. Diagnosis requires a thorough medical evaluation to rule out other causes, such as infections, endometriosis, or structural abnormalities.
Psychogenic ED, as seen in Claudia’s partner, is a form of ED not directly caused by physical factors like vascular disease or hormonal imbalances. Rather, it arises from psychological issues such as stress, anxiety, depression, relationship problems, or, as in this case, fear of causing pain to a partner. The preservation of morning erections is a key indicator of a psychogenic origin.The Interdisciplinary Solution: A Holistic Approach
The expert panel at SLAMS unanimously agreed that this case exemplifies a typical presentation of genit-pelvic pain disorder/penetration with significant psychosocial consequences. Effective treatment must be interdisciplinary, integrating expertise from:
Gynecology: To rule out and address any underlying gynecological conditions. Pelvic physiotherapy: To address muscle dysfunction, pain sensitization, and improve pelvic floor control. Urology: To evaluate and manage any potential urological contributions to the ED and consider pharmacological interventions if appropriate.
Psychotherapy: Crucially, to address the psychological factors contributing to both the pain and the ED, including fear, anxiety, interaction issues, and relationship dynamics. Cognitive Behavioral Therapy (CBT) and couples therapy are often beneficial.
Key Details Not Included in Original article:
Prevalence: Genit-pelvic pain disorder affects an estimated 15-20% of women of reproductive age. Psychogenic ED accounts for approximately 10-20% of all ED cases.
Diagnostic Criteria: PGPD diagnosis relies on specific criteria outlined in the Diagnostic and Statistical Manual of mental Disorders (DSM-5).
Treatment Duration: Interdisciplinary treatment for PGPD and psychogenic ED can be lengthy, frequently enough requiring several months to a year or more to achieve significant enhancement.
Importance of Communication: Open and honest communication between partners is paramount to successful treatment.
* Role of Sensate Focus: Sensate focus exercises, a technique used in sex therapy, can help couples reconnect with pleasurable sensations without the
