Chicken or Egg: Dyspareunia and Body Image

A recent article examines the relationship between sexual dysfunction and body image. The authors note that little is known about the relationship between dyspareunia (painful intercourse) and body image and genital self-image. Could it be that body image issues link to the fact that women who report dyspareunia also complain of overall sexual impairment, anxiety, and feelings of sexual inadequacy?

The research included an on-line survey of 330 premenopausal women, and 58% reported dyspareunia, 42% were pain-free controls. The women with dyspareunia reported more distress about their body image and more negative genital self-image. This study presents an excellent literature review related to the myriad of challenges a woman faces when dealing with pain limiting intercourse. Such examples include decreased sexual desire, feelings of guilt, shame, failure, and a sense of being incomplete. Women will frequently describe their genital area as a "dead" part of the body. These intense thoughts and feelings are rarely addressed in studies of dyspareunia, and in the treatment of the condition, according to the authors. In studies using the Female Genital Self-Image Scale (FGSIS) in a sample of young college women, women reporting impaired sexual function also reported negative genital self image.

How do we help? In addition to providing caring pelvic rehabilitation, how can the medical community offer a more comprehensive approach that encompasses body image? As discussed in the article, if health care providers view dyspareunia as a chronic pain syndrome rather than only as a sexual dysfunction, patients may benefit from addressing how their "sense of self" becomes negative in relation to the pain. Interestingly, body image and sexuality are intertwined, as a positive body image may "...facilitate the subjective experience of sexuality..." while a negative body image can inhibit sexual health.

In our role as pelvic rehabilitation providers, we can discuss the potentially negative relationship between a woman's sexual dysfunction and her body image. As a minimal level of intervention, instructing in awareness of the problem, in use of positive self-talk, and in ways to evaluate self-worth as a "whole" person despite sexual health issues. Ideally, rehabilitation and medical management can alleviate sexual dysfunction, yet the patient may continue to struggle with anxiety, fears, and self-doubt. Through education, encouragement, rehabilitation, and further research, patients may continue to address issues of sexual health as well as body image. We may not know if decreased genital self-image causes decreased sexual dysfunction, or if having sexual dysfunction causes the poor body image, but this research creates an excellent, well-cited platform from which we can launch meaningful discussions with our patients. Referring providers can also be consulted when the patient may benefit from a consult with an expert in psychological health or counseling.