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Women's Health Issues

Women's health issues such as infertility, endometriosis, and genito-pelvic pain conditions can contribute to significant stress, anxiety, and depression. In some cases women have waited a significant time and undergone stressful medical examinations and procedures to receive a diagnosis. Others have gone through such examinations without having any answers. Hormonal treatments can impact on mood and emotional wellbeing, and unsuccessful treatments can contribute to a sense of hopelessness and a need to restructure one's vision of what future life will be like. 

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Psychology can help with adjusting to a diagnosis, managing chronic pain, adjusting to the possibility of infertility, and managing the stress and anxiety associated with these conditions. 

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Psychology for Genito-Pelvic Pain/Penetration Disorder (GPPPD)

What is GPPPD?

Genito-pelvic pain/penetration disorder (GPPPD) is a medical condition that involves the persistent or recurrent involuntary contraction of the pelvic muscles making penetration difficulty, painful, or impossible. It includes the conditions referred to as vaginismus (levator ani syndrome) and pain (including vestibulodynia, other vulvovaginal pain, and pelvic pain). GPPPD occurs in a reflex-like manner due to fear or anxiety about imagined, anticipated, or actual attempts at vaginal penetration.

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Risk factors for the development of GPPPD 

  • Fear of vaginal or hymen tearing, sexual pain, pregnancy, pain, performance, being seen naked, or not feeling ready for sex

  • Unhealthy or sex negative messages resulting in shame, disgust, or anxiety about sexual intercourse (e.g. being brought up in an environment which viewed female sexuality as shameful or “wrong”, overly restrictive or rigid upbringing, lack of sexual education where sex was a taboo subject, unbalanced religious teaching regarding sex)

  • Negative past sex experiences 

  • Medical issues such as infection, surgery, childbirth injury, hormonal changes/menopause/vaginal atrophy, or other gynaecological conditions

  • Painful or traumatic experiences including sexual trauma, emotional abuse, early exposure to pornography, painful or difficult gynaecological examinations, difficult birth experiences or birth trauma

  • Relationship dynamics characterised by a lack of emotional safety, distrust, dislike, uncertainty, emotional detachment, or fear of commitment

  • Anxiety and trauma disorders involving hypervigilance to potential harm, catastrophic thinking, and/or high needs for control

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Psychotherapy for GPPPD

GPPPD treatment involves multidisciplinary care from a general practitioner, gynaecologist, pelvic floor physiotherapist and psychologist. GPPPD can result in adverse impacts on a woman’s emotional wellbeing, relationship quality, and self-esteem. Psychotherapy may help to address both the adverse impacts GPPPD is having on a woman’s livelihood as well as amenable predisposing and perpetuating factors. Psychotherapy may focus on:

  • Addressing the fear and anxiety contributing to and caused by vaginismus

  • Treatment of generalised anxiety, depression, and low self-esteem

  • Addressing shame and stigma around sexual difficulties

  • Understanding and addressing negative beliefs about sex and penetration that contribute to vaginismus

  • Planning for and understanding the role of graded exposure/systematic desensitisation exercises in support of physiotherapy or gynaecological treatments

  • Understanding the pain cycle underpinning GPPPD 

  • Support for contributing and consequential relationship issues

  • Addressing the impacts of past trauma

  • Challenging poor body image and fostering a sense of body positivity

  • Fostering strategies for promoting deactivation of the threat nervous system and activation of the calming nervous system

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