Sexual pain disorders can be treated through a combination of medical and psychological approaches. Psychologically, cognitive behavioral therapy, mindfulness techniques, and acceptance commitment therapy can help manage the chronic pain and associated catastrophizing and fear. The gate control theory of pain demonstrates how a woman's mental state impacts her perception of pain, with relaxation lowering pain signals. Partners should be involved and supported in learning pain management techniques to foster understanding and a supportive relationship during treatment.

1. Sexual Pain Disorders
Stephanie Buehler, MPW, PsyD, CST-S
The Buehler Institute
Newport Beach, CA
www.thebuehlerinstitute.com

2. Many sex therapists and those
pursuing that path tell me they
know very little about sexual pain
disorders...

3. It is no wonder; since most training
programs, unless highly specialized,
don't include coursework in the
interplay between mind and body
health.

4. There are many aspects of treating
sexual pain disorders.
To treat sexual pain disorders you
must understand the impact of a
woman's mental state on her
perception of pain.

5. The "Gate Theory" of Pain:
*When a woman is more relaxed or
happily distracted, fewer pain signals
pass through the "gate."
*When a woman is stressed or
unhappy, the "gate" opens and the
perception of pain changes so that it
is felt more acutely.

6. In a review article entitled
"Psychological Therapies for the
Management of Chronic Pain"
(Sturgeon 2014), pain becomes
chronic for three reasons:

7. 1. Abnormal healing
2. Additional bodily damage
3. Failed medical intervention.

8. Medical interventions cannot always
address chronic pain, so the chronic
pain and the psychological reactions
to it must be managed.

9. Pain management techniques can
especially help with pain
catastrophizing and pain-related fear,
both of which have been shown to be
present in women with sexual pain
disorders.

10. There are essentially four approaches to
pain management:
1. Operant-behavioral therapy to
extinguish maladaptive pain responses.
2. Cognitive-behavioral Therapy (CBT) to
educate the person about pain and to
teach new adaptive behaviors...

11. 3. Mindfulness-based stress reduction
(MBSR) to teach a non-judgemental
approach to pain and increase
awareness of what is actually
occurring in the body moment to
moment...

12. 4. Acceptance and Commitment
Therapy (ACT) in which the client
stops fighting or avoiding pain and
instead engages in meaningful
goals.

13. Any or all of these techniques may
be useful to the client who is trying
to cope with chronic sexual pain.

14. In my practice, I often will teach the
partner or the spouse the same
techniques so they can understand,
for example, what MBSR is like.
Partners can then support one
another in this and other practices.

15. The simple act of being able to do
something to manage the pain can
increase self-efficacy,
self-empowerment and self-esteem.

16. When a partner sees that the woman
with sexual pain is involved in its
management, the partner is more
likely to be supportive, including
when sexual behaviors will need to
be modified on a temporary or
perhaps permanent basis.

17. Resources/Links
The National Vulvodynia Assocation
www.nva.org
"Psychological Therapies for the Management
of Chronic Pain" http://www.ncbi.nlm.nih.gov
/pmc/articles/PMC3986332/pdf/prbm-
7-115.pdf
"Recognition and Management of
Non-Relaxing Pelvic Floor Dysfunction"
http://www.ncbi.nlm.nih.gov/pmc/articles
/PMC3498251/

18. The Buehler Institute offers many
professional development
opportunities throughout the year.
Please visit:
www.thebuehlerinstitute.com
Stephanie Buehler, MPW, PsyD, CST-S