(I) Genito-Pelvic Pain/ Penetration Disorder:
Females with genito pelvic pain/ penetration disorder present with the following chief complaints:
- Difficulty having intercourse
- Genito-Pelvic pain
- Fear of pain or penetration
- Tension of the pelvic floor muscles may last for several hours.
- History of rape/ childhood trauma
- Strict religious upbringing in which patient associates sex with sin
- Tension & Anxiety about sexual acts
- Relationship problems
- Painful surgical / dental interventions in childhood
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.
(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.
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.
Exact cause is unknown. But possible causes are:
- Muscular (Tension)
- Psychogenic causes
***Coitus may precipitate migraine or cluster headache in predisposed persons.