Genital pain related to sexual activity in young women: A large group who suffer in silence
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Unni Merete Kirste
and
Harald Breivik
In this issue of the Scandinavian Journal of Pain, Johanna Thomtén publishes a report of a postal survey mailed to a random sample of 4252 women (age 18-35) in two cities in the middle part of Sweden [1]. The method of random sampling is a very reliable one, but the response rate was only 23%. Still, close to 1000 young women answered this questionnaire about intimate aspects of life.
1 Genital pain is common among women between 18 and 35 years of age
Surprisingly, as many as 16% of these women have genital pain, i.e.pain related to sexual and often non-sexual activity that had lasted at least 6 months. In addition, 10% reported that they had previously had genital pain that lasted more than 6 months, but that after treatment (mostly treatment for fungal infection), they were now pain free. This means that about 1 in 4 of this sample of young women in this age group had or had previously had genital pain that lasted more than 6 months.
2 Genital pain related to sexual activity and sexual dysfunction
The pain was related to penetrating sexual activity in ¾ of women with genital pain, to other sexual activity in 50%, insertion of tampon in 50%. Physical exercise and wearing tight cloths provoked pain in almost half of the women with genital pain. The pain subsided immediately or soon after termination of the pain provoking activity in 2/3, 7% had pain for more than 24 h, a few (4%) had constant pain. Most of the women with genital pain had symptoms of sexual dysfunctions such as lack of desire, lack of arousal, difficulties having orgasm, vaginal muscle tension. They more often had fungal infection and other pain problems as well compared with women who did not have genital pain [1].
3 Many suffer in silence
Only half of the women with genital pain had sought professional help from a midwife or a medical doctor. Many of those who did not seek help admitted that they feel ashamed or do not expect to get effective help. These women suffer in silence, their quality of life and that of their partners and family suffer.
4 Effective treatments for genital pain and chronic pelvic pain are not widely available
It seems that only a little more than half of the young women in this survey did seek medical help, and mostly they received only partial help with their health problem. The treatments they did receive were mainly topical cream and simple analgesics, a few had relaxation training and dilatation exercises. Very few received psychological counselling [1].
We agree with the author in her call for help for these women: a more focused attention by the professional health care providers seeing young women is called for. They should actively probe for such symptoms and be prepared to offer professional help.
Specific physiotherapy, relaxation training, psychological training are effective treatments for women with genital pain [2,3]. Cognitive behavioural therapy combined with focused physiotherapy is effective for chronic (deep) pelvic pain [2,4,5,6]. This therapy is offered to women with chronic pelvic pain in some areas in Norway [5]. The fact that around half of the women with pain in this study reported pain on movement suggests that myofascial pain is a common feature also of genital pain. Therefore, focused physiotherapy with a cognitive behavioural base may also have a role in the treatment of more typical genital pain.
In addition to correct diagnosis and treatment of “traditional” vulvar conditions gynaecologists and general practitioners who see these women should be familiar with chronic pain treatments and seek cooperation with physiotherapists experienced in and interested in treating patients with chronic genital and pelvic pain conditions.
The on-going training of physiotherapists in this effective treatment modality [5] gives hope for the many young women in Scandinavia who are burdened with chronic genital and pelvic pain conditions.
DOI of refers to article:http://dx.doi.org/10.1016/j.sjpain.2013.10.002
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Conflict of interest: The authors do not have any conflict of interest concerning this paper or the paper they are commented, reference [1].
References
[1] Thomtén J. Living with genital pain: sexual function, satisfaction, and helpseeking among women living in Sweden. Scand J Pain 2014;5:19–25.Search in Google Scholar
[2] Kirste UM, Haugstad GK, Leganger S, Blomhoff S, Malt UF. Chronic pelvic pain in women. Tidsskrift Nor Lægeforen 2002;122:1223–7.Search in Google Scholar
[3] Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalifé S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther 2002;28:183–92.Search in Google Scholar
[4] Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Wojniusz S, Klemmetsen I. Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: results of 1-year follow-up study. Am J Obstet Gynecol 2008;199:615e1–8.Search in Google Scholar
[5] Killi Haugstad G, Kirste U, Leganger S, Haakonsen E, Haugstad TS. Somatocognitive therapy in the management of chronic gynaecological pain. A review of the historical background and results of a current approach. Scand J Pain 2011;2:121–3.Search in Google Scholar
[6] Martinsen EW. Combination of physiotherapy and cognitive therapy in chronic pain. Scand J Pain 2011;2:121–3.Search in Google Scholar
© 2013 Scandinavian Association for the Study of Pain
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Articles in the same Issue
- Scandinavian Journal of Pain
- Editorial comment
- High risk of depression and suicide attempt among chronic pain patients: Always explore catastrophizing and suicide thoughts when evaluating chronic pain patients
- Clinical pain research
- Suicide attempts in chronic pain patients. A register-based study
- Editorial comment
- Polymorphism in the μ-opioid receptor gene OPRM1 A118G —An example of the enigma of genetic variability behind chronic pain syndromes
- Original experimental
- A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity
- Editorial comment
- Genital pain related to sexual activity in young women: A large group who suffer in silence
- Original experimental
- Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden
- Editorial comment
- The Norwegian version of the Neck Disability Index (NDI) is reliable and sensitive to changes in pain-intensity and consequences of pain-in-the-neck
- Clinical pain research
- Reliability and responsiveness of the Norwegian version of the Neck Disability Index
- Editorial comment
- Quality of life in low back pain patients with MRI-lesions in spinal bone marrow and vertebral endplates (Modic-changes): Clinical significance for outcome of spinal surgery?
- Clinical pain research
- Association of Modic changes with health-related quality of life among patients referred to spine surgery
- Editorial comment
- Warming and alkalinisation of lidocaine with epinephrine mixture: Some useful aspects at first glance, but not so simple?
- Clinical pain research
- Warmed and buffered lidocaine for pain relief during bone marrow aspiration and biopsy. A randomized and controlled trial
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