Clinicians must be very cautious in using this diagnosis, as women with CPP are rightfully sensitive to implications that their pain is psychological. In my clinical experience, character disorders such as the borderline personality are infrequent in this patient population but nonetheless require attention because of the demand on clinical time when present. One must be especially aware of potential sexual misinterpretation during the physical examination. The presence of a female assistant during the exam is critical. Figure 1 displays mean pain levels for each of these situations.
Displays mean pain levels for each situation.
Many couples draw on sexual interaction as their primary, if not sole, means of experiencing or expressing love and closeness. Disruption of this process can create havoc for women with CPP, independent of their pain intensity. Sexual problems can also produce significant issues related to identity and femininity. Some of our patients describe decreased feelings of femininity due to their inability to have sex and because their partners withdraw from them both emotionally and sexually. Even very supportive partners may back away from sex out of fear of causing their partner pain.