Genito-Pelvic Pain/Penetration Disorder (GPPPD): An Overview of Current Terminology, Etiology, and Treatment
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Abstract
Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a relatively new diagnostic category of female sexual dysfunction, which was introduced during the release of the DSM-5 in 2013. GPPPD reflects the combination of two previous categories of female sexual dysfunction, dyspareunia and vaginismus, into one entity. As such, there is confusion surrounding the proper terminology and diagnostic criteria used when evaluating female sexual or genital pain. This review article attempts to clarify the terminologies used within the medical and scientific community, and provides an overview of current views on etiology and treatment. The likely biological antecedents to genital pain are an exaggerated and prolonged inflammatory response in the vestibular mucosa causing neuroproliferation, and leading to eventual hyperalgesia, allodynia, and pelvic muscle tension in the genital region. These processes interact with psychosocial factors to produce chronic pain. Treatment includes education, CBT, pelvic floor physiotherapy, medical interventions, and surgical interventions, though sexual function may be optimized through a multifaceted approach.
Résumé
La GPPPD est une catégorie diagnostique relativement récente de la dysfonction sexuelle féminine, qui a été introduite dans le DSM-5 en 2013. La GPPPD reflète la combinaison de deux catégories précédentes de dysfonctionnement sexuel féminin, la dyspareunie et le vaginisme, en une entité. En tant que tel, il existe une confusion entourant la terminologie appropriée et les critères de diagnostique utilisés lors de l’évaluation de la douleur sexuelle ou génitale féminine. Cet article de revue tente de clarifier les terminologies utilisées dans la communauté médicale et scientifique et donne un aperçu des points de vue actuels sur l’étiologie et le traitement. Les antécédents biologiques probables à la douleur génitale sont une réponse inflammatoire exagérée et prolongée dans la muqueuse vestibulaire entraînant une neuroprolifération, et conduisant à une éventuelle hyperalgésie, allodynie et tension musculaire pelvienne dans la région génitale. Ces processus interagissent avec des facteurs psychosociaux pour produire une dou- leur chronique. Le traitement comprend l’éducation, la TCC, la physiothérapie du plancher pelvien, les interventions médicales et les interventions chirurgicales, bien que la fonction sexuelle puisse être optimisée par une approche multidimensionnelle.
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