Sexual Health and Wellbeing
Challenges with sexual health, including pain and function are more common than many people realise. Approximately 66% of Australian adults who identify as women and 54% of Australian adults who identify as men report experiencing at least one difficulty associated with sexual performance or pleasure. Sexual difficulties occur across the lifespan and can impact any gender (not just those who identify as men and / or women). People may experience problems from the time they first become sexually active or may encounter issues after a period of enjoyable and unproblematic sex. Common issues include the belief that the individual is taking too long to climax or climaxing too quickly, difficulty becoming physically or emotionally aroused, feeling anxious or not enjoying sex, and experiencing pain during or after sexual contact.
It is important to remember that not everyone wants to have sex – and that is OK! For those who do, sexual health and satisfaction is important. Our sexual wellbeing can impact our psychological well-being, and vice-versa. Psychological Therapies and Treatments can be used to address the psychological component of sexual difficulties. You can see the list of treatment options here.
What are some common disorders associated with sexual health and wellbeing?
Vulvodynia
Vulvodynia is chronic, superficial pain felt on the vulva (the genitalia that surrounds the entrance to the vagina). Vulvodynia isn’t limited to sexual contact – wearing tight pants, certain types of underwear, or sitting for long periods of time can also trigger pain. Pain may be localised to one site (e.g., inner labia, clitoris), or generalised across different parts of the vulva.
Vulvodynia may begin with a medical issue that sensitises the area, such as recurrent thrush or hormonal changes caused by some forms of birth control. Psychological issues, such as trauma caused by an unpleasant sexual experience, may also sensitise pain pathways, leading the individual to experience pain when their vulva is touched.
Vaginismus
Vaginismus is the painful, involuntary contraction of the vaginal muscles. Pain caused vaginismus tends to be felt deeper in the body. Just like vulvodynia, vaginismus is not limited to sexual contact. Trying to insert a tampon or getting a medical exam (basically any time anything is inserted into the vagina) may also be associated with pain. Some people will recognise vaginismus from its depiction in the TV show Sex Education.
Vaginismus can be caused by physical issues, such as an overly tight pelvic floor or muscular changes after childbirth. However, vaginismus has a significant psychological component. For example, problematic beliefs about one’s own body, anxiety about the vagina tearing during sex, fear of penetration and pain, and traumatic sexual experiences could all cause and perpetuate the muscle contractions that lead to pain in vaginismus.
Dyspareunia
Dyspareunia is a term used to describe pain during sexual contact. Dyspareunia can be associated with co-morbid vulvodynia or vaginismus but may also occur for other reasons. Medical factors can include irritable bowel syndrome, skin disorders, and infections, such as UTIs. Psychological causes are like those described above – stress, anxiety, low mood, self-esteem issues, relationship problems, and responses to traumatic experiences can lead to persistent pain during sex.
Genito pelvic pain and penetration disorder (GPPPD)
This (lengthy) label was introduced in the most recent DSM-5 to provide a description of a variety of symptoms associated with pelvic pain disorders. GPPPD is designed to encompass both vaginismus and dyspareunia as research has shown a high level of co-morbidity between these two disorders.
GPPPD is defined by recurrent or persistent difficulties with one or more of the following: (1) vaginal penetration during intercourse; (2) vulvovaginal or pelvic pain during vaginal intercourse or attempts at penetration; (3) fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; and (4) tightening or tensing of the pelvic floor muscles during attempted vaginal penetration. To meet diagnostic criteria, at least one of these symptoms must have persisted for at least six months and cause significant distress.
As the description points out, fear responses are common for people who experience any form of GPPPD. This can manifest as avoidance of sexual contact or the drive to ‘push through the pain’ (the latter which can quickly make things worse!). Shame, embarrassment, and a sense of hopelessness regarding one’s own ability to enjoy sex are also common.
Prostatitis
Though not encompassed within the GPPPD label, it is important to note that people with penises can also experience pain associated with sexual activity. Inflammation of the prostate can lead to prostatitis, which causes pain around the perineum. Though prostatitis is generally caused by medical issues, it can lead to psychological difficulties, such as anxiety, which can exacerbate sexual dysfunction.
Erectile dysfunction
Erectile dysfunction is the difficulty of keeping and/or maintaining an erection. Erectile dysfunction can be caused by a variety of medical issues, such as high blood pressure, heart disease, low testosterone, and some treatments for prostate cancer. Lifestyle factors can also have a big impact – obesity, nicotine use, poor sleep, and alcoholism have been linked with the development of erectile dysfunction. As always, psychological factors can play a role - people experiencing depression, anxiety, stress, or relationship issues may have difficulty becoming aroused. Conversely, erectile dysfunction can lead to the development of mood issues that maintain arousal difficulties even after initial cause is treated.
If you would like to find out more about what the different treatment options are for issues related to Sexual Health and Wellbeing, you can read more about them here.
Laura Coat is one of Senior Clinical Psychologists in the team who has a special interest in Sexual Health and Wellbeing. You can contact us to discuss further.