Pain Disorders in Women
Sexual pain disorders, “recurrent or persistent genital or non-genital pain associated with sexual activity” most often combine biologic, psychologic and interpersonal factors. For many women, sexual pain disorders are physically disconcerting, emotionally distressing and socially disruptive, having a negative impact on quality of life. Sexual pain disorders may also be associated with recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina which interferes with vaginal penetration, and which causes personal distress.
Data on the prevalence of sexual pain disorders are limited, but the National Health and Social Life Survey reports approximately 20% of women claim that sexual activity was not pleasurable. Symptoms based on a web-based survey of 428 women with sexual pain included: painful intercourse (86%), burning (84%), rawness (71%), redness (69%), itching (64%), throbbing/aching (47%), difficulty walking (31%), and limited activities they could do or limited clothing they could wear (27%).
Some of the biologic causes of sexual pain treated in our clinic include disorders of the clitoris, the labia, the urethra or bladder, the vestibule (the skin next to the opening of the vagina comprising the area between the hymen and the labia minora), the bulbocavernosus muscle of the vagina, the vagina, the uterus and cervix and the ovary.
At the Center for Sexual Medicine, patients with sexual pain disorders undergo the following evaluation. Initially, our psychologist interviews patients. A thorough medical, psychosocial and sexual history is taken including completion of a detailed “sexual pain questionnaire”. A physical examination is performed, usually with the physician wearing magnifying glasses called surgical loupes. As indicated, a Q-tip will be gently placed in various sites of the genitalia to localize areas of pain. A 1- 10 scale of pain will be used to assess the degree of the pain. As indicated, local anesthesia (xylocaine) may be injected using very fine “insulin-type needles” into painful areas to identify the number and extent of the painful regions. Additional tests, such as genital sensation and genital blood flow may be performed if indicated. Also hormonal blood tests of estrogen and androgen values may be performed.
Treatment of the sexual pain condition varies widely depending on the specific diagnosis. Often, a patient will have several conditions causing the sexual pain problem. Based on the evaluation process, an individual treatment plan will be discussed with you. Follow-up examinations may be performed every 4 – 8 weeks as needed.
Communication is critical to the restoration of sexual health. We offer traditional telephone consultation (617 638-8576) and, on occasion, e-mail communication (csm@bmc.org), should questions arise between visits. We understand that the whole experience may seem overwhelming, but we will do our utmost to see that you feel safe and comfortable during the entire management process.
