Monterey Pelvic Medicine and Pain Management

Painful Intercourse and Sexual Disorders

Sexual Disorders can present as: Dyspareunia (painful intercourse or orgasm), Sexual arousal disorders (inability to respond to sexual arousal), Persistent Genital Arousal Disorder (PGAD, unrelenting, spontaneous and uncontainable often painful genital arousal that is not linked to sexual desire.)  Genitals Pain upon sexual contact, Vaginismus(Spasm of Vaginal Muscle and Pelvic floor muscle spasm during intercourse), Clitoral Phimosis (Skin coverage over clitoris)

Dyspareunia (Painful Intercourse) has long been considered to be subjective (psychogenic). Now, new evidence supports the consideration of dyspareunia as primarily a pain syndrome, rather than a subjective sexual dysfunction. Biological causes of this condition include: hormonal, anatomical, inflammatory, muscular, iatrogenic (self inflected ijury), neurologic, vascular, connective tissue and immune system. A specific pathology of pain requires signals from affected tissue to the “neuropathic” system, increasing peripheral input and/or lowered central pain threshold. Careful evaluation to all these conditions is necessary to reach the root cause and proper treatment.

Sexual Arousal Disorders should not be dismissed as subjective (psychogenic; genital, hormonal and neurological component abnormalities must be carefully examined and treated.

Persistent Genital Arousal Disorder also known as restless genital syndrome (ReGS or RGS), results in a spontaneous, persistent, and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. It was first documented by Dr. Sandra Leiblum in 2001, only recently characterized as a distinct syndrome in medical literature. The disorder has been newly included in DSM-5, which was released in May 2013. After proper diagnosis, treatment is complex and include local and systemic medication and release of pudendal nerve if needed.

Vaginismus, with its associated defensive contraction of perivaginal muscles when intercourse is attempted, is credited to be the pelvic expression of a more general muscular defense posture, associated with a variable phobic attitude towards coital intimacy. Vaginismus may prevent intercourse in the most severe degrees, whilst in the milder ones it becomes a cause of dyspareunia. Psychosexual factors associated with, or secondary to, sexual pain related disorders–may contribute to the worsening of coital pain over time.

Clitoral Phimosis (also occurs in man’s penis) indicates incomplete skin retraction and limited exposure of the clitoris (penis) causing sexual pain and/or diminished sensitivity and impaired orgasmic capability. This condition is usually caused by recurrent vulvar infections of blunt trauma (as in childbirth, cycling) or changing in skin elasticity with age. Minor anatomical correction sometimes is needed to relieve pain associated with this condition.

Clitorodynia, pain is centered around the clitoris that interfere with and causes pain during intercourse. Treatment including identifying causes and addressing these causes appropriately.

Evaluation Treatment Plan