Current Sexual Health Reports

, Volume 10, Issue 2, pp 35–37 | Cite as

Limits of Pelvic Floor Physical Therapy in the Treatment of GPPD

  • Talli Y. RosenbaumEmail author
Invited Commentary

Genito-pelvic pain/penetration disorder (GPPD) first appeared in the most recent edition of the DSM [1]. It is a consolidation of presentations listed in the previous DSM [2] under the category of “sexual pain disorders” (SPDs). The former binary division between vaginismus, an involuntary spasm of the musculature of the outer third of the vagina, that interferes with sexual intercourse, and dyspareunia, the actual experience of pain with penetration, likely contributed to the incorrect conceptualization of dyspareunia as organic and vaginismus as psychological at the core. The new designation acknowledges a multifactorial experience for both pain and defensive reactivity, as they co-exist, but continues to focus on the ability to be penetrated as a fundamental determinant of sexual function in women [3].

The generality and inclusiveness of GPPD represent the lack of a clear and concise understanding of the specific etiology and treatment needs of women who present for treatment. The...


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  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th edition. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4th edition, text revision. Arlington: American Psychiatric Publishing; 2000.Google Scholar
  3. 3.
    Tosh J, Carson K. A Desire to be ‘normal’? A discursive and intersectional analysis of ‘penetration disorder’. Intersectionalities Glob J Soc Work Anal Res Polity Pract. 2016;5(3):151–72. RetrievedGoogle Scholar
  4. 4.
    Rosenbaum T. The role of physical therapy in female sexual dysfunction. Curr Sex Health Rep. 2008;5:97–101.CrossRefGoogle Scholar
  5. 5.
    Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalife S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther. 2002;28:183–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Rosenbaum TY. Physiotherapy treatment of sexual pain disorders. J Sex Marital Ther. 2005;31:329–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Rosenbaum T, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain related sexual dysfunction. J Sex Med. 2008;5(3):513–23. quiz 524-5CrossRefPubMedGoogle Scholar
  8. 8.
    Rosenbaum, TY Physical therapy treatment of sexual pain disorders in text Principles and Practice of Sex Therapy Edited by Sandra Leiblum, PhD Guilford Publications; 2007.Google Scholar
  9. 9.
    Morin M, Carroll M-S, Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sex Med Rev. 2017;5:295–322.CrossRefPubMedGoogle Scholar
  10. 10.
    Vandyken C, Hilton S. Physical therapy in the treatment of central pain mechanisms for female sexual pain. Sex Med Rev. 2017;5(1):20–30. Scholar
  11. 11.
    Rosenbaum TY. Addressing Anxiety In-Vivo in Physiotherapy Treatment of Women with Severe Vaginismus: A Clinical Approach. J Sex Marital Ther. 2011;37(2):89–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Rosenbaum, TY An integrated mindfulness-based approach to the treatment of women with sexual pain and anxiety: promoting autonomy and mind/body connection. J Sex Rel Ther.
  13. 13.
    Macey, et al. Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC Womens Health. 2015;15:49. Scholar
  14. 14.
    Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction: an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerPhysical therapists in women with and without vaginismus. Int Urogynecol J. 2001;12:328–31.CrossRefGoogle Scholar
  15. 15.
    Both S, van Lunsen R, Weijenborg P, Laan E. A new device for simultaneous measurement of pelvic floor muscle activity and vaginal blood flow: a test in a nonclinical sample. J Sex Med. 2012;9:2888–902.CrossRefPubMedGoogle Scholar
  16. 16.
    Khandker M, Brady SS, Stewart EG, Harlow B. Is chronic stress during childhood associated with adult-onset vulvodynia? J Women’s Health. 2014;23(8):649–56.CrossRefGoogle Scholar
  17. 17.
    Harlow B, Stewart E. Adult-onset vulvodynia in relation to childhood violence victimization. Am J Epidemiol. 2005;161:871–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Laan E, van Lunsen RHW. Overactive pelvic floor: female sexual functioning. In: Padoa A, Rosenbaum T, editors. The Overactive Pelvic Floor. Cham: Springer; 2016.Google Scholar
  19. 19.
    Rosen NO, Rancourt K, Bergeron S, Corsini-Munt S. Not just the “woman’s problem”: the role of relationship processes in genital pain. Cur Sex Health Rep. 2013;6:1–10. Scholar
  20. 20.
    Rosenbaum T. Applying theories of social exchange and symbolic interaction in the treatment of unconsummated marriage/relationship. Sex Relat Ther. 2009;24(1):38–46.CrossRefGoogle Scholar
  21. 21.
    Ayling K, Ussher J. MIf sex hurts, am I still a woman? The subjective experience of vulvodynia in heterosexual women. Arch Sex Behav. 2008;37(1):294–304.CrossRefPubMedGoogle Scholar
  22. 22.
    Heinemann J, Atallah S, Rosenbaum T. The impact of culture and ethnicity on sexuality and sexual function. Curr Sex Health Rep. 2016;8:144–50. Scholar
  23. 23.
    Weitlauf JC, Frayne SM, Finney JW. et alSexual violence, posttraumatic stress disorder, and the pelvic examination: how do beliefs about the safety, necessity, and utility of the examination influence patient experiences? J Women's Health (Larchmt). 2010;19:1271–80.CrossRefGoogle Scholar
  24. 24.
    Kleinplatz. History of the treatment of female sexual dysfunction(s) Annual Review of Clinical Psychology. 2018Google Scholar

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Authors and Affiliations

  1. 1.A.A. Rosenbaum, LtdBet ShemeshIsrael

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