Dyspareunia is recurrent or persistent genital pain occurring in either men or women before, during, or after intercourse. Much more common in women than in men, dyspareunia is related to, and often coincides with, vaginismus. Repeated episodes of vaginismus can lead to dyspareunia and vice versa.
Painful coitus can result from tension and anxiety about the sex act that cause women to involuntarily contract their vaginal muscles. The pain is real and makes intercourse unpleasant or unbearable. Anticipation of further pain may cause women to avoid coitus altogether. If a partner proceeds with intercourse regardless of a woman’s state of readiness, the condition is aggravated. Dyspareunia can also occur in men, but it is uncommon and is usually associated with an organic condition, such as herpes, prostatitis, or Peyronie’s disease, which consists of sclerotic plaques on the penis that cause penile curvature.
Organic abnormalities leading to dyspareunia and vaginismus include irritated or infected hymenal remnants, episiotomy scars, Bartholin’s gland infection, various forms of vaginitis and cervicitis, and endometriosis. Postcoital pain has been reported by women with myomata and endometriosis and is attributed to the uterine contractions during orgasm. Postmenopausal women may have dyspareunia resulting from thinning of the vaginal mucosa and reduced lubrication. Two conditions not readily apparent on physical examination that produce dyspareunia are vulvar vestibulitis and interstitial cystitis. The former may present with chronic vulvar pain and the latter produces pain most intensely following orgasm. Dyspareunia can also occur in men, but it is uncommon and is usually associated with an organic condition, such as Peyronie’s disease, which consists of sclerotic plaques on the penis that cause penile curvature.
Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse. The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. The woman does not directly control or ‘will’ the tightness to occur; it is an involuntary pelvic response. She may not even have any awareness that the muscle response is causing the tightness or penetration problem. Sexual Aversion Disorder is phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress. This is the most severe form of sexual desire disorder. It involves a fear of sexual intercourse and an intense desire to avoid sexual situations completely. Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps, and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.
Postcoital Headache, characterized by headache immediately after coitus, may last for several hours. It is usually described as throbbing and is localized in the occipital or frontal area. The cause is unknown. There may be vascular, muscle-contraction (tension), or psychogenic causes. Coitus may precipitate migraine or cluster headaches in predisposed persons.
Orgasmic Anhedonia is a condition in which a person has no physical sensation of orgasm, even though the physiological component (e.g., ejaculation) remains intact. Organic causes, such as sacral and cephalic lesions that interfere with afferent pathways from the genitalia to the cortex, must be ruled out. Psychiatric causes usually relate to extreme guilt about experiencing sexual pleasure. These feelings produce a dissociative response that isolates the affective component of the orgasmic experience from consciousness.
Persons may experience pain during masturbation. A small vaginal tear or early Peyronie’s disease can produce a painful sensation. The condition should be differentiated from compulsive masturbation. Persons may masturbate to the extent that they do physical damage to their genitals and eventually experience pain during subsequent masturbatory acts.
Weakness due to excessive loss of semen. The syndrome is characterized by vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite and guilt attributed to semen loss through nocturnal emissions, urine and masturbation. DHAT syndrome occurs due to increased noradrenaline tone in the body and is normally associated with sleep disturbances and multiple body pains. The patient may also complain of decreased penile length and erectile dysfunction.