Psychological Factors in Sexual Pain: Fear-Avoidance Model in Chronic Pelvic Pain Syndrome Therapy

The presences of sexual dysfunctions in women were not a subject of scientific debate until the 21st century. At the beginning of the new millennium interdisciplinary groups of scientists agreed that female sexuality and sexual dysfunctions have to be taken seriously and analyzed independently of male sexuality. Finally, Rosemary Basson's description of the cyclic model of sexual response resulted in abandon of the linear model, which was characteristic for male sexual response, and creating circular models of female sexual response. The researchers are still studying the nature of sexual pain in women. The aim of this article is to interest physicians, especially gynaecologists, in aetiology and treatment options for chronic pelvic pain syndrome (CPPS). The causes of CPPS may lie in sexual disorders which were until recently classified by the American Psychiatric Association in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as dyspareunia and vaginismus and changed in DSM-5 to Genito-Pelvic Pain/Penetration Disorder (GPPD). The DSM-5 classification emphasizes treatment focusing on elimination fear and anxiety more than on relaxation of vaginal muscles. Therapeutic experience confirms that such an approach is well-grounded; a therapy focusing on non-organic factors gives excellent and promising results. If we point to the necessity of introducing changes in the approach to treatment of GPPD, then we also have to allow for the role of fear and anxiety in the aetiology of these disorders. The Fear-Avoidance Model - FAM – presented in this article gives a scientific bases for psychological treatment of CPPS.