Hi there! Thanks for joining in for Episode 11, Season 1, of The Sensate Space podcast. This episode explores how psychology can help with managing pelvic and sexual pain disorders, and understanding how GPPPD/vaginismus treatment requires addressing biological (physical), psychological, and social factors. This episode is relevant for people with genito-pelvic pain/penetration disorder (GPPPD), a pelvic and sexual pain condition encompassing vaginismus and dyspareunia, and other pelvic pain conditions. 

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Hello! Welcome! Thanks for joining for episode 11 of the sensate space podcast, we are almost at the end of the first season - very exciting. I’m batch recording these first episodes in advance which means that I’ve dedicated this time with a big dose of hope and optimism that someone somewhere will listen in and make it all worthwhile. So, if that’s you, thank you for putting a smile on my face when I check the podcast statistics. You are valued.

This episode will focus on how psychology fits within understanding and treating genito-pelvic pain penetration disorder (clunkily abbreviated to GPPPD), aka vaginismus and dyspareunia. So, to recap - GPPPD is characterised by recurrent and persistent pain associated with intercourse or similar activities (so - sex, pap smears, using tampons), increased pelvic muscle tension, anticipation of pain before these activities, and involuntary pelvic floor contraction, which patients often talk about a experiencing a barrier or a wall. If you haven’t already, have a listen to episode 2 to find out more. Now, let’s get started.


So, firstly, what do we mean when we’re talking about psychology? It’s such a broad term. The general consensus is that we’re talking about the human mind, and how it influences a person and their behaviour.

To dive a little deeper - we’re looking at the biological, emotional, personal, social, and cognitive (aka thinking) processes that underlie our human experience. For example, we think about learning, motivation, relationships, and decision-making. More recently, the field has been starting to think about the interactions between our mind and our nervous system as well.

Psychology considers both the explicit (or, the conscious) and implicit (or, subconscious) processes. For example, from a psychology headset, we could think about how our biases [sez - Aus, seez = US] operate beneath the surface of conscious awareness and shift our perceptions and judgements, which can then shape our behaviour without us really being aware of it.

It’s a scientific discipline, so we use research practices to gather psychological knowledge, and then apply this to help understand and treat different issues - whether it relates to our biological, social, physical and mental health, or broader community. The application of psychology is so wide-ranging.

Psychology and GPPPD (Vaginismus/Dyspareunia):

This means that even within the area of genito-pelvic pain such as GPPPD / vaginismus, there is SO much to consider from a psychology headset. Yet, often, it is dismissed as being purely medical/physical and simply requiring physical therapy or medication. OR, we see the opposite, that it’s “all in your head” and 100% psychological in nature. Can you hear the eye roll in my voice as I’m saying this? Really - we know that it’s a mix of both biological, psychological, and social-contextual factors that interplay within GPPPD.
A good medical or allied health professional should take a holistic approach to understanding and managing genito-pelvic pain and sexual pain conditions. This means looking at the biological, psychological, and social or contextual factors at play. Ultimately, this is why we recommend a team based approach with a range of different professionals as needed - for example, a gynaecologist, women’s health physiotherapist or physical therapy, and a psychologist or sex therapist would be a pretty standard team.

Biopsychosocial framework:

So what does a biopsychosocial framework for understanding GPPPD look like? Let’s go through an example together. Keep in mind this example is based on factors that have been identified through research in the area rather than a specific case example from a real patient.

Biological factors

Let’s start with biological factors. There are so many biological and medical issues that can cause or contribute to GPPPD. Some of the most common ones include infections, dermatological conditions (e.g. allergies,lichen sclerosus), nerve issues, trauma for example tears or episiotomy scars from giving birth), hormonal issues for example as part of menopause, side effects from chemotherapy or radiation, or structural issues like endometriosis or hymen abnormalities. This is why it’s so important to have a good assessment from a gynaecologist, and also why other specialists like dermatologists might need to be involved as well. Two of the most common physical issues are pelvic floor dysfunction - so, pelvic muscles not contracting or relaxing as well as they should, and vulvodynia which is pain localised to the vulval region. As you can see, there’s heaps to unpack within biological factors. It’s so important to understand exactly what is happening so that a treatment plan can focus on the right areas. And you can see why it’s so frustrating when people are told it’s all in their head!

Psychological factors

Now, moving on, I could spend all day talking about the role of different psychological factors and processes. Actually, if this is something you’d like to really deep dive into, then let me know - we might be able to dedicate a few more episodes to this if there’s enough interest. Instead of covering all of the different thoughts, feelings, beliefs, biases, etc, I’ll just run through two of the most common psychological factors.

Firstly - the role of anxiety and fear. This is SUCH an important consideration when we’re thinking about GPPPD because there is an established process that typically occurs: a pain and anxiety cycle. Often, GPPPD might start with a painful experience (for example, when using a tampon or during intercourse) which then triggers fear and anxiety next time. The anxiety then increases muscle tension, which makes it more difficult and much more painful the second time around. Anticipation of this pain reinforces the cycle and can cause people to avoid these situations. This is an example of how psychological factors interplay with biology.
More broadly speaking, beliefs about sexuality, intimacy, and past experience can also play a big role.

Social/Contextual factors

The last piece of the puzzle is cultural, societal, and contextual factors. Again, there’s just too many to list! Very, very, briefly, some of the most common influences under this banner include stigma, cultural attitudes towards sexuality, social expectations, religious beliefs, etc. So, an example could be the influence of being raised in a family that promotes abstinence, impurity culture, etc.

This section also thinks about the role of other people, such as how supportive a partner is. Social factors also interplay with psychological factors and biology - for example an unsupportive partner could impact anxiety levels, which then impacts muscle tension. It’s all related, really.

GPPPD (Vaginismus/Dyspareunia) management and treatment:

So, as you can see, it’s too simplistic just to say it’s all in your head OR to say that it’s all in your body. (On that note, the whole brain vs body debate always makes me raise an eyebrow…like, your brain is part of your body still? Anyway). Even in straightforward cases there are biological, psychological, and social-context factors that we need to consider within assessment and therefore treatment for GPPPD. This is why we advocate so strongly for a treatment team.

If you’d like to break this down further and hear more about the individual psychological processes, for example how thoughts, feelings, experiences, and beliefs may play a role with GPPPD , then please reach out and let me know via the website thesensatespace.com or instagram @thesensatespace_ . You can check the show notes for more resources included references for further reading.

As always, remember that information from podcasts and social media can’t replace personalised services from medical and allied health professionals. This is not medical or psychological advice. Please reach out to your doctor to see what services can support you with your own journey.

Okay, that’s all for now - a very very big thank you for tuning in. Take care, you’ve got this 🙂
Conforti, C. (2017). Genito-Pelvic Pain/Penetration Disorder (GPPPD): An overview of current terminology, etiology, and treatment. University of Ottawa Journal of Medicine, 7 (2), 48-53.


Conforti, C. (2017). Genito-Pelvic Pain/Penetration Disorder (GPPPD): An overview of current terminology, etiology, and treatment. University of Ottawa Journal of Medicine, 7 (2), 48-53.




This is a psychology podcast about vaginismus and other pelvic and sexual pain disorders, and related issues (genito-pelvic pain/penetration disorder, dyspareunia, vulvodynia, painful intercourse, gynaecological pain, sexual dysfunction, chronic pelvic pain) for the purpose of education and collaboration; it’s not therapy or medical advice. Information is general in nature and does not replace individualised assessment or treatment advice. Please seek professional support tailored to your specific needs. If you or someone you know is in crisis and needs help now, call triple zero (000). You can also call Lifeline on 13 11 14 — 24 hours a day, 7 days a week. Please see our About page for more information.

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