When sex hurts: Female genital pain is no fun! Neither is painful sex in men

Nanna Brix Finnerup; Unni Merete Kirste

doi:10.1016/j.sjpain.2014.04.005

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When sex hurts: Female genital pain is no fun! Neither is painful sex in men

Nanna Brix Finnerup und Unni Merete Kirste

Veröffentlicht/Copyright: 1. Juli 2014

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Aus der Zeitschrift Scandinavian Journal of Pain Band 5 Heft 3

1 Pain care is a human right

Chronic pain is often related to severe disability and has a huge impact on a person’s quality of life. Access to pain treatment is thus considered a fundamental human right [1]. There may, however, be many barriers to effective pain management. Lack of awareness of chronic pain in the community and fear of being considered as someone who complains, is weak, seeks attention, or avoids responsibility may be important barriers for seeking help for a pain problem. From the health professional side, lack of education and lack of understanding possible mechanisms and available treatment options may further impede treatment for those seeking help. In this issue of the Scandinavian Journal of Pain, a position paper by Johanna Thomtén and Steven J Linton, argues that female sexual pain has not received appropriate attention and that the barriers for effective treatment are particular extensive in this patient population [2].

2 Sexual pain

Sexual pain is a common condition. As for other chronic pain conditions, the exact prevalence is not known and estimates vary, partly because of different or unclear definitions. In the position paper, the authors define sexual pain as chronic genital pain associated with pain during sexual intercourse [2]. Many different ways of classifying pain exist, e.g. based on pain duration, location, or underlying mechanisms, but pain is rarely classified based on the type of interference, as is the case for sexual pain. However, in the DSM IV, a category termed dyspareunia was included, in which somatic causes of pain were excluded. In the DSM V, under the heading of sexual dysfunctions, the term genito-pelvic pain/penetration disorder is now included. The apparent need to classify a group of pain conditions as sexual pain suggests that the interference with sexual function poses a particular problem as compared with pain that interferes with walking, sleeping, shoulder movement, concentration, etc. Further identification of what role the interference with sexual intercourse plays for patient-related and health-care-related barriers for appropriate treatment seems essential.

3 Treatment of sexual pain

Since sexual pain is a group of pain conditions that are identified based on pain location and impact of pain, recommending a common treatment algorithm is difficult. As is the case in any pain condition, treatment should be directed at the pain type and underlying mechanisms whenever these can be identified. The evidence-based treatment algorithm will, e.g., not be the same in patients with sexual pain due to infection, endometriosis, nerve lesion, or muscle dysfunction. However, when pain becomes chronic and the underlying cause cannot be treated efficiently, a common model for understanding the physiological and psychosocial mechanisms and implications can be helpful. A recent study found that genital pain, which is often related to pain during sexual intercourse, was associated with anxiety [3], and although more studies are needed to understand the relation between mechanisms and consequences, Johanna Thomtén and Steven J Linton suggest that psychosocial mechanisms have not been recognized and that there is a need to understand and address these components in sexual pain. Examining the condition from all perspectives and trying to establish how different aspects contribute to pain, sexual health, and social function will undoubtedly bring us forward.

It may be worth mentioning that male genital pain with sexual consequences may be even less recognized. Also, the impact of pain in general, including non-genital pain, on sexual function is a neglected area that deserves attention. In addition to the impact of pain per se, most patients, women as well as men, who are treated long-term with opioids experience decreased testosterone secretion, loss of libido, and reduced quality of life [4].

The high impact of female and male sexual pain on psychological and social functioning calls for multidisciplinary treatment programmes in order to successfully improve personal control, quality of life, and disability in people with sexual pain.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2014.04.001.

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References

[1] Cousins MJ, Lynch ME. The Declaration Montreal: access to pain management is a fundamental human right. Pain 2011;152:2673–4.Suche in Google Scholar

[2] Thomtén J, Linton SJ. When sex hurts: female genital pain with sexual consequences deserves attention. Scand J Pain 2014;5:202–5.Suche in Google Scholar

[3] Thomtén J, Karlsson A. Psychological factors in genital pain: the role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden. Scand J Pain 2014;5:193–9.Suche in Google Scholar

[4] Rhodin A, Stridsberg M, Gordh T. Opioid endocrinopathy: a clinical problem in patients with chronic pain and long-term oral opioid treatment. Clin J Pain 2010;26:374–80.Suche in Google Scholar

Published Online: 2014-07-01

Published in Print: 2014-07-01

Artikel in diesem Heft

https://doi.org/10.1016/j.sjpain.2014.04.005