Sexual Pain Disorders

(I) Genito-Pelvic Pain/ Penetration Disorder:

Females with genito pelvic pain/ penetration disorder present with the following chief complaints:

1. Difficulty having intercourse
2. Genito-Pelvic pain
3. Fear of pain or penetration
4. Tension of the pelvic floor muscles may last for several hours.

Aetiology:

1. History of rape/ childhood trauma
2. Strict religious upbringing in which patient associates sex with sin
3. Tension & Anxiety about sexual acts
4. Relationship problems
5. Painful surgical / dental interventions in childhood

Classification:

1. Vaginismus:

Vaginismus is constriction of outer 3rd of the vagina due to involuntary pelvic floor muscle tightening or spasm. It interferes with penile insertion & intercourse.

It is most commonly seen in highly educated women & high socioeconomic groups.

Women with vaginismus may consciously wish to have coitus but unconsciously keep penis away from entering their bodies.

Types:

(a) Complete Vaginismus: In this, no penetration is possible, whether by penis, finger or a speculum during a gynaecological examination.

(b) Partial Vaginismus: In this, penetration is difficult but not impossible. Penetration is possible with the smallest size of speculum or little finger.

2. Dyspareunia:

Dyspareunia is recurrent or persistent genital pain occuring before, during or after intercourse. Repeated episodes of vaginismus can lead to dyspareunia & vice versa.

(II) Post Coital Headache:

Post coital headache is characterized by headache immediately after sexual act. Headache is usually throbbing, localized to the occipital or frontal area & may last for several hours.

Causes:

Exact cause is unknown. But possible causes are:

1. Vascular
2. Muscular (Tension)
3. Psychogenic causes

***Coitus may precipitate migraine or cluster headache in predisposed persons.

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