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Painful sexual act

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Painful sexual act is a condition of repeated or persistent genital pain before, during, or after sexual act due to physical, psychogenic and emotional causes. Doctors call the condition as dyspareunia. It occurs in women and men. The condition affects up to one-fifth of women at some point in their lives.[1]

Symptoms in women

The woman experiencing painful sexual act may be distracted from feeling pleasure and excitement. Both lubrication of vagina and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the penis is painful. Even after the original source of pain has disappeared, a woman may feel pain simply because she expects pain.

Causes in women

In the majority of instances, there is an original physical cause. There are numerous physical conditions that can contribute to painful sexual act. A careful physical examination and medical history are indicated. Common physical causes include infections of the vagina, lower urinary tract, cervix, or fallopian tubes, endometriosis, surgical scar tissue (following episiotomy); and ovarian cysts and tumors.[2] . Among the infections are mycotic organisms, candidiasis, chlamydia, trichomoniasis, urinary tract infections, coliform bacteria, monilial organisms and herpes). [3] Anatomic conditions, such as hymenal remnants, female genital mutilation, when the entrance to the vagina has become too small for normal penetration, can contribute to discomfort of sexual act (Sarrell and Sarrell 1989). Estrogen deficiency is a common cause of painful sexual act among women after menopause. Dryness of the vagina is often reported by lactating women. [4] Women undergoing radiation therapy for pelvic malignancy experience painful sexual act due to the atrophy of the vaginal walls and their susceptibility to trauma. Vaginal dryness is seen in Sjögren's syndrome, which attacks the exocrine glands that produce saliva and tears.

Painful sexual act may be one of the first symptoms of a cystitis. Patients may struggle with bladder pain and discomfort during or after sex. For women with cystitis, pain usually occurs the following day, the result of painful, spasming muscles of pelvis floor. Cystitis patients also struggle with urinary frequency and/or urinary urgency.

In men

There are a number of physical factors as well. Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. Infections of the prostate, bladder, or seminal vesicles can lead to burning or itching sensations following ejaculation. Men suffering from cystitis may experience intense pain at the moment of ejaculation and is focused at the tip of the penis. Gonorrheal infections are associated with burning or sharp penis pains during ejaculation. Urethritis or prostatitis can make genital stimulation painful or uncomfortable. Anatomic deformities of the penis (retraction of a too-tight foreskin) may also result in pain during sexual act.

In men pain in the genital organs during ejaculation or immediately thereafter is experienced as sharp, stabbing, and/or burning, it may be persistent and returning. The duration of pain is usually brief. The immediate cause of psychogenic post ejaculatory pain is the involuntary painful spasm or cramping of certain pain-sensitive muscles in the male genital and reproductive organs, the painful muscle cramps may be attributable to a man’s conflict about ejaculating.

A pelvic floor disorder can also be the cause of pain during and after sex.

Diagnosis

Sufferers will see several doctors before a correct diagnosis is made. Sufferers are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Before being successfully diagnosed patients sometimes are told that the pain is "in their head". For the diagnosis doctor carefully takes a history and carefully examines the pelvis to duplicate the discomfort and to identify a site or source of the pelvic pain. The diagnosis of painful sexual act has to be differentiated from conditions known as ‘’’chronic vulvar pain’’’ and vaginismus. It is worth to be sure whether the painful sexual act is acquired or lifelong and whether it is generalized (complete) or situational. During the first two weeks, painful sexual act caused by penis insertion or movement of the penis in the vagina or by deep penetration is often due to disease or injury deep within the pelvis. Inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. The possible role of psychological factors in either causing or maintaining the pain must be acknowledged.

Atrophy of vagina as a source of painful sexual act is most frequently seen in women after menopause and is generally associated with estrogen deficiency. The latter is associated with inadequacy of lubrication of vagina, which can lead to painful friction during sexual act.

Treatment

  • Doctor explains to the patient what has happened; including identifies the sites and causes of pain. He makes clear that the pain will, in almost all cases, disappear over the time or at least will be greatly reduced. If there is a partner, doctor explains him also the causes and treatment and encourages him to be supportive. Doctor removes the source of pain when needed. He encourages the patient to learn about her body, to explore her own anatomy and learn how she likes to be caressed and touched. Doctor encourages the couple to add pleasant, sexually exciting experiences to their regular interactions, such as bathing together (in which the primary goal is not cleanliness), mutual caressing without sexual act, and using sexual books, pictures, and videos. In couples where a woman is preparing to receive vagina act, such activities tend to increase both lubrication of vagina and its dilation, both of which decrease friction and pain. Prior to sexual act, oral sex may also prove very useful to relax and lubricate the vagina (providing both partners are comfortable with it). Doctor prescribes very large amounts of water-soluble lubricant during sexual act. He discourages petroleum jelly. Moisturizing skin lotion may be recommended as an alternative lubricant, unless the patient is using a condom or other latex product. Lubricant should be liberally applied (two tablespoons full) to both the penis and the orifice of the vagina. A folded bath towel under the receiving partner's hips helps prevent spillage on bedclothes. Doctor instructs the receiving partner to take the penis of the penetrating partner in their hand and control insertion themselves, rather than letting the penetrating partner do it.
  • For those who have pain on deep penetration because of pelvic injury or disease, doctor recommends a change in sex positions to one admitting less penetration. In women receiving vaginal penetration maximum vaginal penetration is achieved when the receiving woman lies on her back with her pelvis rolled up off the bed, compressing her thighs tightly against her chest with her calves over the penetrating partner's shoulders. Minimal penetration occurs when a receiving woman lies on her back with her legs extended flat on the bed and close together while her partner's legs straddle hers.
  • A manual physical therapy treating pelvis and vagina sticking togethers may decrease or eliminate pain during sexual act. [5] [6]

References

  1. ↑ Shein; Zyzanski, SJ; Levine, S; Medalie, JH; Dickman, RL; Alemagno, SA; et al. (1988). "The frequency of sexual problems among family practice patients". Fam Pract Res J. 7 (3): 122–134. PMID 3274680. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
  2. ↑ Bancroft J (1989). Human sexuality and its problems (2nd ed.). Edinburgh: Churchill Livingstone. ISBN 0-443-03455-9.
  3. ↑ Denny E, Mann CH (2007). "Endometriosis-associated painful sexual act: the impact on women's lives". J Fam Plann Reprod Health Care. 33 (3): 189–93. doi:10.1783/147118907781004831. PMID 17609078.
  4. ↑ Bachmann GA, Leiblum SR, Kemmann E, Colburn DW, Swartzman L, Shelden R (1984). "Sexual expression and its determinants in the post-menopausal woman". Maturitas. 6 (1): 19–29. doi:10.1016/0378-5122(84)90062-8. PMID 6433154. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ↑ Wurn LJ, Wurn BF, King CR, Roscow AS, Scharf ES, Shuster JJ (2004). "Increasing orgasm and decreasing painful [[sexual intercourse|sexual act]] by a manual physical therapy technique". MedGenMed. 6 (4): 47. PMC 1480593. PMID 15775874. {{cite journal}}: URL–wikilink conflict (help)CS1 maint: multiple names: authors list (link)
  6. ↑ Wurn LJ, Wurn BF, King CR, Roscow AS, Scharf ES, Shuster JJ (2006). "Improving sexual function in patients with endometriosis via a pelvic physical therapy". Fertil Steril. 86 (3 Suppl): S29–30. doi:10.1016/j.fertnstert.2006.07.081. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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