Category: Sex & Dyspareunia

Sexual Lubrication

Post author By The Beauty Nation
Post date 03/02/2021

Probably the most frequent cause for dyspareunia originating with symptoms of burning, itching, or aching is lack of adequate production of vaginal lubrication with sexual functioning.

During attempted penile intromission or with long-maintained coital connection, there must be adequate lubrication or there will be irritative distress for either or both coital partners.

Adequate production of vaginal lubrication is for women the physiological equivalent of erective attainment for men and her representation to her male partner of a psychological readiness for vaginal penetration.

A consistent lack of functional levels of vaginal lubrication is as near as any woman can come to paralleling a man’s lack of effective erection.

Inadequate development of vaginal lubrication has many causes, but by far the most common is lack of interest in the particular opportunity or identification with the involved sexual partner. Women must experience positive input from their sexual value systems if they are to respond repetitively and effectively to their mate’s sexual approaches.

Women who cannot think or feel sexually, those reflecting fears of sexual performance, and even those acting out a spectator’s role in sexual functioning, either do not develop sufficient vaginal lubrication to support a painless coital episode or, if penetrated successfully, they cease production of the necessary lubricative material shortly after intravaginal penile thrusting is initiated.

Deep Penetration

Additionally, women fearful of pain with deep vaginal penetration, fearful of pregnancy with any coital connection, fearful of exposure to social compromise, and fearful of sexual inadequacy are frequently poor producers of vaginal lubrication. Any Component of fear present in sexual experiences reduces the receptivity to sensate input, thereby blunting biophysical responsivity.

If there is insufficient vaginal lubrication, there may or may not be acute pain with full penile intromission, depending primarily upon the parity of the woman, but there usually will be vaginal burning, irritation, or aching both during and after coital connection.

There are tens of thousands of women who become markedly apprehensive at onset of any definitive sexual approach, simply because they know severe vaginal irritation will be experienced not only during but frequently for hours after any significantly maintained coital connection.

Not to be forgotten as a specific segment among the legions of women afflicted by inadequate production of vaginal lubrication are those in their postmenopausal years. If they are not supported by adequate sex-steroid-replacement techniques, production of vaginal lubrication usually drops off markedly as the vaginal mucosa routinely turns atrophic.

There well may be aching and irritation in the vagina for a day or two after coital connection for women contending with this evidence of sex-steroid starvation.

A major category of women tending to be poor lubrication producers during coital connection is that significant segment of the female population with overt lesbian orientation. Many women psychosexually committed to a homophile orientation attempt regularity of coital connection for socioeconomic reasons. Frequently, they may not lubricate well during heterosexual activity, although there usually is ample lubrication when they are directly involved in homosexual expression.

In most instances:
Inadequate production of vaginal lubrication can be reversed with definite therapeutic approach. Certainly women burdened by a multiplicity of sex-oriented fears can be provided psychotherapeutic relief of their phobias and subsequently reversed with relative ease from their particular pattern of sexual inadequacy.

Those women with chronic vaginal itching and irritation can be protected from continuing dyspareunia, because both infectious and chemical vaginitis are reversible under proper clinical control. Senile vaginitis responds in short order to adequate sex-steroid-replacement techniques.

There are only two major categories of women for whom the cotherapists have little to offer in an effort to constitute effective production of vaginal lubrication: first, women mated to men for whom they have little or no personal identification, understanding, affection, or even sexual respect; and second, homosexually oriented women practicing coition for socioeconomic reasons with no interest in their male companions as sexual partners.

Undesired Sex

As opposed to the symptoms of aching, irritation, or burning in the vagina, complaints of severe pain developed during penile thrusting provide the most difficulty in delineating between subjective and objective etiology.

Although many women register this type of complaint when seeking to avoid undesired sexual approaches, there are some basic pathological conditions in the female pelvis that can and do engender severe pain in response to active coital connection.

One of the difficulties in delineating the severity of the complaint of dyspareunia is to identify pelvic pathology of quality sufficient to support the female partner’s significant complaints of painful coition. Pelvic residual from severe infection or pelvic implants of endometriosis usually are easily identified by adequate pelvic and rectal examinations.

These clinical entities will be discussed briefly in context later in the topic. Current attention is drawn to probably the most frequently overlooked of the major physiological syndromes creating intense pelvic pain during coital connection.

Tags Lubrication, Sexual, Sexual Lubrication

Sex & Dyspareunia

Sex, Pelvic Syndromes

Post author By The Beauty Nation
Post date 03/02/2021

One of the most obscure of pelvic pathological syndromes, yet one of the most psychosexually crippling, is traumatic laceration of the ligaments supporting the uterus. This syndrome was described clinically. Five women have been referred to the Foundation for relief of subjective symptoms of dyspareunia after referral sources had assured the husbands that there was no plausible physical reason for the constant complaint of severe pain with deep penile thrust.

These 5 postpartum women had severe broad ligament lacerations and were relieved of their distress by definitive surgical approaches, not by psychotherapy. Therefore, they do not represent a component of the statistical analysis of treatment for sexual dysfunction.

Three women reflecting onset of dyspareunia subsequent to criminal abortion techniques also have been seen in consultation and are not reflected in the statistics of the sexual inadequacy study. Three more women have been seen in gynecological consultation for acquired dyspareunia subsequent to gang-rape experiences.

They also have not been an integral part of the sexual-dysfunction study. These clinical problems will be mentioned in context. When first seen clinically, women with traumatic lacerations of the uterine supports, acquired with delivery or by specific criminal abortion techniques, present complaints that commonly accrue from pelvic vasocongestion, dyspareunia, dysmenorrhea, and a feeling of being excessively tired.

These complaints are secondary or acquired in nature. The traumatized women consistently can relate onset of their acquired dyspareunia to one particular obstetrical experience even from among three or four such episodes.

The basic intercourse distress arises with deep penetration of the penis. Women describe the pain associated with intercourse to be as if their husbands had “hit something” with the penis during deep vaginal penetration.

These involved women may note other physical irritations frequently seen with chronic pelvic vasocongestion, a constantly nagging backache, throbbing or generalized pelvic aching, and occasionally, a sense that “everything is falling out.”

These symptoms are made worse in any situation requiring a woman to be on her feet for an exceptional length of time, as a full day spent doing heavy housecleaning or working as saleswoman in a department store.

Most women lose interest in any regularity of sexual expression when distressed by acquired dyspareunia. Handicapped by constant anticipation of painful pelvic stimuli created by penile thrusting, they also may lose any previously established facility for orgasmic return.

The basic pathology of the syndrome of broad ligament laceration is confined to the soft tissues of the female pelvis. The striking features of the pelvic examination are the position of the uterus and almost always in severe third-degree retroversion and the particularly unique feeling that develops for the examiner with manipulation of the cervix.

This portion of the uterus feels just as if it were being rotated as a universal joint. It may be moved in any direction, up, down, laterally, or on an anterior-posterior plane with minimal, if any, correspondingly responsive movement of the corpus and body of the uterus.

Even the juncture of the cervix to the lower uterine segment is ill-defined. The feeling is one of an exaggerated Hegar’s sign of early pregnancy, in which the cervix appears to move in a manner completely independent of the attached corpus.

In addition to the “universal joint” feeling returned to the examiner when moving the cervix, a severe pain response usually is elicited by any type of cervical movement. However, pain is primarily occasioned by pushing the cervix in an upward plane.

In the more severe cases, either in advanced bilateral broad ligament laceration or in a presenting complaint of five years or more in duration even mild lateral motion of the cervix will occasion a painful response. During examination the retroverted uterus appears to be perhaps twice increased in size.

Pressing against the corpus in the cul-de-sac in an effort to reduce the third-degree retroversion also will produce a marked pain response. When the examiner applies upward pressure on the cervix or pressure in the cul-de-sac against the corpus, the patient frequently responds to the painful stimulus by stating, “It’s just like the pain I have with intercourse.”

A detailed obstetrical history is the salient feature in establishing the diagnosis of the broad ligament laceration syndrome. The untoward obstetrical event creating the lacerations may be classified as surgical obstetrics, as an obstetrical accident, or even as poor obstetrical technique.

Occasionally, women with both the positive pelvic findings and the subjective symptoms of this syndrome cannot provide a positive history of obstetrical trauma, but this situation does not rule out the existence of the syndrome.

Many women are unaware of an unusual obstetrical event because they were under advanced degrees of sedation or even full anesthesia at the time.

Precipitate deliveries, difficult forceps deliveries, complicated breech deliveries, and postmature-infant deliveries are all suspect as obstetrical events that occasionally contribute to tears in the maternal soft parts.

If these tears are established in the supports of the uterus (broad ligaments) the immediate postpartum onset of severe dyspareunia can be explained anatomically and physiologically. It is important to emphasize clinically that although a woman may not be able to describe a specific obstetrical misfortune in her past history, she well may be able to date the onset of her acquired dyspareunia to one particular obstetrical event.

Three cases have been seen in which a criminal abortion was performed by extensively packing the vaginal barrel, leading ultimately to dilation of the cervix and expulsion of uterine content.

These extensive vaginal-packing episodes created tears of the broad ligaments, completely parallel to those occasioned by actual obstetrical trauma. Each woman, although unaware of the etiological significance, dated the onset of the symptoms of acquired dyspareunia to the specific experience with the vaginal-packing type of abortive technique.

Tags pelvic, Pelvic Syndromes, Sex, Syndromes

Sex & Dyspareunia

Sex and Pelvic Infection

Post author By The Beauty Nation
Post date 03/02/2021

When considering intense pain elicited during coital functioning as opposed to vaginal aching or irritation, the therapist generally should look beyond the confines of the vaginal barrel for existent pathology involving the reproductive viscera.

Acute or chronic infections and endometriosis are pathological conditions involving the reproductive viscera; uterus, tubes, and ovaries that consistently may return a painful response as the female partner is sharing coital experience.

Although these two entities will be discussed separately, they do have in common similar physiological creation of painful response patterns during intercourse.

In both instances the response arises from peritoneal irritation resulting in local adhesions not only between folds of peritoneum but also involving tubes, ovaries, bowels, bladder, and omentum.

The combination of involuntary distention of the vaginal barrel created by female sex-tension increment and active male thrusting during coital connection places tension on relatively inelastic pelvic tissues stabilized by minor or even major degrees of fibrosis resulting from the infection or the endometriosis.

In short:
Any clinical condition that creates an untoward degree of rigidity of the soft tissues of the female pelvis, so that they do not move freely during sexual connection can return a painful response to the female partner involved.

Infections in the reproductive organs start with chronic involvement of the cervix (endocervicitis). By drainage through lymphatic channels, long-maintained endocervicitis can involve the basic supports of the uterus (Mackenrodt’s ligament) in a chronic inflammatory process. The resultant low-grade peritoneal irritation initiates painful stimuli when the cervix is moved in any direction, particularly by a thrusting penis.

The uterus itself can be involved with infection in the uterine cavity or endornetritis, or with a residual of infection throughout the muscular walls (myometritis) to such an extent that any pressure upon the organ is responded to with pain.

Retrograde involvement of the peritoneal covering of the uterus and its supports is quite sufficient to cause distress if the uterus is moved, either with involuntary elevation into the false pelvis with female sex-tension increment or during a male thrusting phase in coital connection.

Obviously there are many sources of infection of the oviducts (tubes). Any infections that originate in the cervix have opportunity to spread through the uterine cavity and into the tubal lumina.

The major infective agents are:
Gonococcus, streptococcus, staphylococcus, and coliform organisms. First infections in the tubal lumina frequently spill into the abdominal cavity, causing at least localized pelvic inflammation and at most generalized abdominal peritonitis.

Subsequently, as the acute stage of the infection subsides those areas involved in the infectious process remain open to the development of adhesions between loops of bowel, the omentum, and the pelvic viscera.

There even may be abscess formation involving the tubes and ovaries. In all these situations there is tension on and tightening of the peritoneum and rigid fixation of the pelvic soft-tissue structures to such an extent that vaginal distention and coital thrusting create a markedly painful response for the woman.

In no sense does this brief clinical description of pelvic inflammatory processes imply that whenever any woman acquires infection in the pelvic viscera she is committed thereafter to pain during coital connection.

With early and adequate medical care most pelvic infections do not create a residual of continuing pain with coital exposure. The degree of residual pelvic pain depends upon the severity of the occasional sequelae of the infectious process.

Where are the adhesions and how extensive are they? To what extent is natural expansion of the vaginal barrel restricted by filling of the cul-de-sac with an enlarged tube, by an ovary firmly adhered to the posterior wall of the broad ligament, or by a uterus held in severe third degree retroversion by adhesions? Any of these situations may create painful stimuli with penile thrusting.

Tags Infection, pelvic, Sex, Sex Infection

Sex & Dyspareunia

Sex and Dyspareunia

Post author By The Beauty Nation
Post date 03/02/2021

The term dyspareunia, difficult or painful coitus, has always been presumed to refer to coital distress in women. The word stems from the Greek, and somewhat freely translates into “badly mated.”

Since no comparable word reflecting or suggesting coital distress for men has been established, poetic license will be begged. Here is comprised of two separate sections devoted to consideration of individual complaints of female and male sexual dysfunction identified by the individuals involved as difficult or painful coitus. Men can be “badly mated” too!

That factor in the total of male and female sexual dysfunction perhaps most difficult for the therapist to define involves the psycho physiological complaint of dyspareunia. Diagnostic insecurity relates directly to the fact that dyspareunia has a varied number of both subjective and objective origins that frequently give rise to combinations of psycho physiological distress rather than complaints that can be categorized individually.

Avoid Sex

For years, woman’s complaint sex hurts when had intercourse has been an anathema to the therapist. Even after an adequate pelvic examination, the therapist frequently cannot be sure whether the patient is complaining of definitive but undiagnosed pelvic pathology or whether, as has been true countless thousands of times.

A sexually dysfunctional woman is using the symptomatology of pain as a means of escaping completely or at least reducing markedly the number of unwelcome sexual encounters in her marriage.

For it is true that once convinced that there is no recourse for reversal of his or her dysfunctional status, the sexually inadequate partner in any marriage manufactures excuse after excuse to avoid sexual confrontation.

As women have long since learned, a persistent, aggressive male partner can overwhelm, neutralize, or even negate the most original of excuses to avoid sexual exposure.

However, presuming any degree of residual concern for or interest in his partner as an individual, the husband is rendered powerless to support his insistence upon continuity of sexual contact when the wife complains of severe distress during or after sexual connection.

If the female partner complains and flinches with penile insertion, moans and contracts her abdominal and pelvic musculature during the continuum of male thrusting, cries out or screams with deep vaginal penetration, sheds bitter tears after termination of every sexual connection, or complains angrily of aching in the pelvis or burning in the vagina during or even hours after a specific coital episode.

The male sexual approach must be accepted as the probable potentiator of a physiological basis for his female partner’s evidenced sexual dysfunction. Thereafter, the husband has minimal recourse. There is little he can do other than to avoid or at least reduce marital-unit sexual exposure on his own cognizance, and/or to insist that his wife seek professional consultation.

Once consulted, the twofold problem that constantly baffles authority is first whether a specific physiological basis can be defined for the objective existence of pain. Second, if not, whether the existence of pelvic pathology should arbitrarily be ruled out, thereby defining the registered complaint of dyspareunia as subjective in origin. When a woman complains of pain during or after intercourse, there are very few diagnostic landmarks to follow for treatment, so that consideration of the etiology of the painful response seems appropriate.

As in vaginismus, a differential diagnosis cannot be established for a complaint of dyspareunia unless careful pelvic and rectal examinations are conducted. Even then there can be no sure diagnosis if the existence of pelvic pathology is denied purely on the basis of negative examinations by competent authority.

Yet, in a positive vein, there are obvious pelvic or rectal findings that can and do support objectively a woman’s subjective complaint of coital discomfort. The female partner’s persistent complaint of pain with any form of coital connection must not be authoritatively denied or, for that matter supported, purely on the basis of interrogation, regardless of how carefully or in what depth the questioning has been conducted.

There are many varieties of dyspareunia, varying from postcoital vaginal irritation to severe immobilizing pain with penile thrusting. Symptomatic definition relating not only to the anatomy of the vaginal barrel but also to the total of the reproductive viscera is in order.

In no sense will the discussion include all possible forms of pelvic distress. Considered, however, will be the major sources of pelvic pathology engendering painful response from the female partner during or after coital connection. The dyspareunia will be considered in relation to specific areas of the vaginal barrel, the reproductive viscera, and the soft tissue components of the pelvis, and to painful stimuli developing, in a time-related sequence during or after coital connection.

Sex and Painful Vagina

The complaint of pain with penile intromission should demand clinical inspection of the vaginal outlet and the labial (major and minor) area. Direct observation can easily delineate any of the following minor areas of concern, minor only in the sense of easy reversibility of physical distress by adequate clinical measures.

An intact hymen or the irritated or bruised remnants of the hymenal ring can and do cause outlet pain during attempted coital connection. Less obvious is an unprotected scar area just at the mucocutaneous juncture of the vaginal mucosa and the perineal body.

These scars, primarily residuals of episiotomies sustained during childbirth, occasionally have been observed to result from criminal abortion techniques or gang-rape episodes. The Bartholin-gland area in the minor labia should be carefully palpated for enlargement in the gland base, which can contribute to a locally painful reaction as the vaginal outlet is dilated by the penile glans at onset of intromission.

Finally, in postmenopausal women the labia and vaginal outlet may have so lost elasticity and become so shrunken in size that any penile insertive attempt will return a painful response.

Sex and Clitoris Irritation

With any complaint of outlet pain, the clitoral area also should be inspected carefully. Many women simply cannot define anatomically or are too embarrassed to discuss objectively the exact location of the outlet distress occasioned by attempts at coital connection.

Smegma beneath the clitoral foreskin can cause chronic irritation and burning that becomes severe as the penis is introduced into the vaginal orifice. Rarely adhesions beneath the minor labial foreskin anchoring the foreskin to-the clitoral glans can cause distress when the foreskin is moved or pulled from its specific pudendal-overhang position by manipulative approaches to the mons area or by intromissive attempts.

When the minor labial hood of the clitoris is pulled down toward the perineum by the act of penile intromission, an intense pain response from the presensitized clitoral glans or even the clitoral shaft may become of major clinical moment.

The same type of reaction can be elicited if foreplay in the clitoral area has been irritative rather than stimulative in character, as so often happens when the sexually uneducated male tries to follow “authoritative” directions in attempts to stimulate his partner sexually. Heavy handed manipulation or frequent masturbatory irritation can elicit painful responses from the clitoral-glans area. This irritative reaction may develop rapidly

Tags Dyspareunia, Sex, Sex Dyspareunia

Sex & Dyspareunia

Problems of Dyspareunia

Post author By The Beauty Nation
Post date 03/02/2021

There have been three cases referred as problems of dyspareunia in which individual women were involved in gang-rape experiences. In all three instances there were multiple coital connections, episodes of simultaneous rectal and vaginal mountings, and finally traumatic tearing of soft tissues of the pelvis associated with forceful introduction of foreign objects into the vagina.

Superficial and deep lacerations were sustained throughout the vaginal barrel and by other soft tissues of the pelvis. Included in the soft-tissue lacerations were those of the broad ligaments (in each case only one side was lacerated), but these lacerations were quite sufficient to produce severe symptoms of secondary dyspareunia.

For some years after the rape episodes each of the three women was presumed to be complaining of the subsequently acquired pain with intercourse as a residual of the psychological trauma associated with their raping.

The immediately necessary surgical repair to pelvic tissues had been conducted, but beyond the clinically obvious lacerations of vaginal barrel, bladder, and bowel, the remainder of the pelvic pathology understandably had not been described at the time of surgery.

Before gaining symptomatic relief by a second surgical procedure, these three women underwent a combined total of 21 years of markedly crippling dyspareunia, involving a total of five marriages.

The only way that broad-ligament lacerations can be handled effectively is by surgery. Operative findings are relatively constant: (1) The uterus usually is in third-degree retroversion and enlarged from chronic vasocongestion; (2) A significant amount of serous fluid (ranging from 20 to 60 ml in volume) arising from serous weeping developing in the broad-ligament tears is consistently found in the pelvis; (3) There may be unilateral or bilateral broad ligament and/or sacrouterine-ligament lacerations.

It is the inevitable increase in pelvic vasocongestion associated with sexual stimulation added to the already advanced state of chronic pelvic congestion in these traumatized women that can elicit a painful pelvic response.

Particularly does such a response arise when the chronically congested pelvic viscera are jostled by the vaginally encased thrusting penis.

It is not within the range of this textbook to describe the surgical procedures for repair of the traumatic tears of the uterine supports. The reader is referred to the bibliography for more definitive consideration. Subsequent to the definitive surgery, the symptoms of acquired dyspareunia, dysmenorrhea, and the sensations of extreme fatigue usually show marked improvement or may be completely alleviated.

These pelvic findings have been described in far more than usual detail for this type of text, primarily to alert examining physicians to the possibility of the broad-ligament laceration syndrome.

When these pelvic findings have been overlooked, the complaining woman frequently has been told by authority that the pain described with intercourse is due to her imagination. The intelligent woman bas grave difficulty accepting this suggestion. She knows unequivocally that coital activity particularly that of deep vaginal penetration is severely painful.

Actually, she finds that with vaginal acceptance of the full penile shaft, pain is almost inevitable.

Even if she has been orgasmic previously, it is rare that she accomplishes orgasmic release of her sexual tensions during intercourse after incurring broad-ligament lacerations, simply because she is always anxiously anticipating the onset of pain.

Any woman with acquired pelvic disability restraining her from the possibility of full sexual responsivity is frustrated. Without orgasmic release with coital connection there will be a marked residual of acute vasocongestion to provide further pelvic discomfort during a long, irritating resolution phase.

Probably the most frustrating factor of all is to have the acquired dyspareunia disbelieved by authority when the pain with penile thrusting is totally real to the woman involved. The vital question for the therapist to ask should be, “Did this pain with deep penile thrusting develop after a specific delivery?”

If the woman can identify a particular pregnancy subsequent to which the dyspareunia became a constant factor in her attempts at sexual expression, the concept of the broad-ligament-laceration syndrome should come to mind.

Tags Dyspareunia, Problems

Sex & Dyspareunia

Penis Irritations

Post author By The Beauty Nation
Post date 03/02/2021

Many men complain:
Burning, itching, and irritation after coital connection with women contending with chronic or acute vaginal infections.

Not infrequently small blisters appear on the glans penis, particularly around the urethral outlet. If there are any abrasions on either the glans or shaft of the penis, secondary infection can occur in these local sites.

Irritative Penile Reaction

The same type of irritative penile reaction may develop from exposure to a non-infectious vaginal environment as a response to the chemicals in contraceptive creams, jellies, foams, etc.

It may not be the female that responds in a sensitive manner to an intravaginal chemical contraceptive agent but rather her male partner. Sensitivity to intravaginal chemical contraceptives is seen quite frequently in the male and, if symptoms develop, the contraceptive technique should be changed.

The same sort of irritative penile reaction can be elicited by a repetitive pattern of vaginal douching.

There are some douche preparations to which not the female but the male partner becomes sensitive.

Not infrequently, vesicles form on the glans penis. If these blisters rupture, the raw areas on the glans are quite painful, particularly during sexual connection.

Gonorrhea

In the actual process of ejaculation, there are many situations that return painful stimuli to the involved male. If the individual has had gonorrhea there may be strictures (adhesions) throughout the length of the penile urethra, and attempts to urinate and/or ejaculate may cause severe pain spreading throughout the penile urethra and radiating to the bladder and prostate.

Infection in the Bladder, Prostate, or the Seminal Vesicles

There may be the sensation of intense burning during and particularly in the first few minutes after ejaculation. Particularly if the offending agent has been the gonococcus, the pain with ejaculation sometimes is exquisite. Immediate medical attention should be given to any complaint of burning or itching during or immediately after the ejaculatory process.

Prostate and Ejaculation

There is a spastic reaction of the prostate gland seen in older men during the stage of ejaculatory inevitability. In this situation, the prostate contracts spastically rather than in its regularly recurring contractile pattern, and the return can be one of very real pelvic pain and/or aching radiating to the inner aspects of the thighs or into the bladder and occasionally to the rectum.

This pathologic spastic contraction pattern can be treated effectively by providing a minimal amount of testosterone replacement therapy.

Care should be taken to evaluate the possibility of concurrent infection in the prostate. Occasionally, chronic prostatitis has caused significant degrees of pain during an ejaculatory process.

As a point in differential diagnosis, the painful response with prostatic infection is with the second, not the first, stage of the orgasmic experience, while that of prostatic spasm has just the reverse sequence. Careful questioning usually will establish specifically the timing in the onset of the painful response and thus suggest a more definitive diagnosis.

Prostate

Benign hypertrophy of the prostate gland primarily and carcinoma of the prostate rarely may be responsible for the onset of pain with the ejaculatory process. The pain is secondary (acquired) in character and radiates to the bladder and rectum.

Usually confined to older age groups, the onset of this type of dyspareunia should be investigated immediately by the competent authority. This review of the major causes of dyspareunia has been primarily directed toward the female partner, for from her come by far the greater number of complaints of painful coital connection.

However, male dyspareunia no longer should be ignored by the medical and behavioral literature. The review of the etiology of male dyspareunia has not been exhaustive, nor is it within the province of this text to do so.

In concept, the entire chapter has been designed to suggest to co-therapists, faced daily with a myriad of problems focusing upon both male and female sexual dysfunction, that there are physiological as well as psychological causes for sexual inadequacy.

Combined pelvic and rectal examinations for the female and rectal examination for the male partner are a routine part of the total physical examination provided for both members of any marital unit referred to the Foundation for treatment of sexual dysfunction.

To attempt to define and to treat the basic elements of sexual dysfunction for either sex without including the opportunity for thorough physical examination and complete laboratory evaluations as an integral part of the patient’s diagnostic and therapeutic program is to do the individual and the marital unit a clinical disservice.

Tags Irritations, Penis, Penis Irritations, Prostate, Sexual Dysfunction

Sex & Dyspareunia

Penis Foreskin

Post author By The Beauty Nation
Post date 03/02/2021

Painful Coition Is Not Limited to Women.

Many men are distracted from and even denied effective sexual functioning by painful stimuli occasioned during or after sexual functioning.

The symptoms will be described in relation to the anatomical site of pain, the external anatomy, such as the surface of the penis and the scrotal sac, or the internal anatomy, such as the penile urethra, the prostate, or the bladder.

No attempt will be made to provide definitive discussion for the varieties of male-oriented dyspareunia. Situations are mentioned only to emphasize their existence and to provide the therapist with an awareness of the fact that, in truth, there are badly mated men.

Penis Exterior Anatomy

Many men complain of severe sensitivity of the glans penis, not only to touch but to any form of containment, including intravaginal retention, immediately after ejaculation. This severity of glans pain recalls the intensely painful response that may be elicited from the clitoral glans when it is approached during forceful male manipulative attempts to incite sex-tension increment for his female partner.

Once a man is fully aware that immediately after his ejaculatory episode there may be exquisite tenderness of the glans, he realizes that he must immediately withdraw from intravaginal containment.

Generally there is marked variation in the severity of the individual response pattern. Men noting variation in the severity of glans pain have no pre-ejaculatory warning of the intensity of the particular response pattern, which may range from minor irritation with containment to crippling pain with the slightest touch.

The glans
Occasionally is irritated rather than protected, as might be presumed, by a retained foreskin. Two men have been referred to the Foundation complaining that relief from painful stimuli immediately after ejaculation can be obtained only by retracting the foreskin well back over the glans and in this fashion relieving the irritation of glans confinement.

Foreskin
There are occasional irritative responses created by the retained foreskin of uncircumcised men. In almost all instances these irritative responses have to do with lack of effective hygienic habits.

Primarily, smegma and, secondarily, various bacterial, trichomonal, or fungal infections sometimes collect beneath the foreskin. If the foreskin is not retracted regularly and the area washed with soap and water, chronic irritation can easily develop.

With chronic irritation or even frank infection present, there usually will be pain with coital thrusting or with any form of penile containment. In almost all instances the dyspareunia responds readily to adequate cleansing principles.

Phimosis

A tightness or constriction of the orifice of the prepuce, clinically is marked by a foreskin that cannot be retracted over the glans penis. With an excessively constrained foreskin, infection is almost always present to at least a minor degree, and penile irritation is a consistent factor for men so afflicted.

Adhesions frequently develop between the foreskin and the glans proper so that there is no freedom of movement between the two structures.

Engorgement of the penis with sex-tension increment may bring pressure to bear on the foreskin constraint of the glans. Without freedom of foreskin movement, this constriction frequently causes local pain with penile erective engorgement. When any male is diagnosed as having a degree of clinical phimosis sufficient for chronically recurrent infectious processes and/or pain or irritation with coital connection, circumcision certainly is in order.

There are also occasional men with a true hypersensitivity of the penile glans. These men are almost constantly irritated by underclothes or by body contact. They are continually aware of a multiplicity of irritants and are particularly susceptible to trauma to the glans.

One man referred for consideration found glans constraint in the vaginal environment intolerable. There was a constant blistering and peeling of the superficial tissues of the glans surface.

Despite a history of numerous changes in sexual partners, the postcoital results were identical. This individual simply could not tolerate the natural pH levels of the vagina. Since the reaction was confined to the glans area and never involved the penile shaft, there is room for presumption that if he had not been circumcised routinely, he might not have been so handicapped.

Protective coating of the glans area precoitally resolved his problem but was a nuisance factor for him and possibly for his sexual partners.

There are occasional instances of referred pain from the posterior urethra (usually occasioned by posterior urethritis) that produce pain in the glans penis. Very rarely, this type of glans pain is a factor in coition.

Tags Foreskin, Penis, Penis Foreskin

Sex & Dyspareunia

Pelvic Disease

Post author By The Beauty Nation
Post date 03/02/2021

Endometriosis is a disease in which implants of endometrial tissue spread throughout the pelvic viscera and their protective covering, the peritoneum. When examined microscopically, this ectopic tissue resembles the lining of the inner cavity of the uterus.

The tubes, ovaries, broad ligaments, omentum, and the posterior wall of the uterus may be involved by firm fibrous adhesions. There are even many instances of tying together omentum and bowel with the reproductive viscera into large pelvic masses. The etiology of endometriosis has not been fully established.

It would not serve the purposes of this text to enter into a detailed discussion of the subject. Although endometrial implants appear in many anatomical areas other than the pelvic viscera, consideration will be focused alone on local pelvic implants.

Even if there are no major adhesions in the pelvis, there are at least minor elements of continuous local peritoneal irritation. Endometrial nodules usually can be felt most effectively with simultaneous manual pelvic-rectal examination.

The pain created by intercourse is due to the constriction and immobilization of the peritoneum and the firming up of the soft tissues of the pelvis by adhesions. The pelvic structures have progressively less facility to distend, expand, and move freely as the endometriosis progresses.

There is consequently more local tissue resistance to involuntary vaginal expansion, uterine elevation, and male pelvic thrusting.

In all situations that create chronic irritation of the pelvic peritoneum, fixation of the uterus, or constriction of the vaginal barrel, pain with intercourse is a relatively constant finding.

Treatment for endometriosis is either medical or surgical depending upon the degree of soft-tissue and pelvic visceral involvement. But once endometriosis has developed to a point at which there is significantly severe pain in response to coital activity, there must be definitive treatment of the condition, or the individual woman will have little hope of relief from the symptoms of progressively increasing dyspareunia.

Post Surgical

There are three important sources for acquired dyspareunia following removal of the uterus for specific organ pathology. First, dyspareunia results from thoughtless surgical technique. Physicians, when performing a hysterectomy, may overlook the fact that the cervix enters the vagina through the superior wall of that organ. When the wound in the vaginal barrel is repaired after removal of the cervix, if care is not taken to retain a superior position for the vaginal cuff, the scarred area, instead of being retained in the superior vaginal wall, may be pulled into the depth of the barrel by tissue constriction or by excessive folding or removal of vaginal tissue.

Postoperatively when the husband thrusts deeply into the vagina, the penis can come into contact with the resistant scarred area. There is little residual facility for involuntary vaginal distention in the area of the surgical scar.

Therefore, dyspareunia of significant proportion develops occasionally as a post surgical complication. Since this unfortunate result usually does not develop for months or even a year after surgery, the operating surgeon may never be made aware of the acquired dyspareunia.

The second opportunity to acquire dyspareunia is occasioned by the surgical indications for removal of the ovaries at the time the uterus is removed, or for that matter, at any time. If post operative sex-steroid-replacement is not initiated, many women will develop senile changes in the vagina and, in time, secondary dyspareunia.

The third incidence of dyspareunia after hysterectomy rarely comes to the attention of the operating surgeon. The etiology of the acquired dyspareunia may be subjective in origin.

Sexual Anxious Woman

If the woman facing hysterectomy and/or removal of the ovaries is not reassured with her husband that there need not be reduction of sexual drive or orgasmic facility after surgery, her fantasy and her friends’ old wives’ tales may, by power of suggestion, create fears of sexual performance for the anxious woman.

If she feels that she is going to be castrated, and sex-steroid-replacement therapy is not explained and offered as indicated, she well may believe that after surgery there will be loss of ability to respond in a sexually effective manner in the future. What is worse, an uninformed husband may have similar concepts.

If anything, sexual responsivity should be higher shortly after than immediately before surgery. The pelvic pathology for which the hysterectomy or oophorectomy is indicated usually detracts from sexual effectiveness by creating a state of ill health which, in turn, reduces innate sexual tension.

When the offending condition is removed and the general state of health consequently improved, there usually is a reawakening of sexual interest. If women are not reassured before surgery, many presume that, in the future, intercourse will provide no return for them or for their husbands, or that intercourse will even be painful.

Any woman has only to be sure that she will be distressed by future coital connection to take a long step toward acquired dyspareunia.

There are, of course, many factors other than the major ones of infection, endometriosis, post surgical objective and subjective complications, and the syndrome of broad-ligament laceration that create painful stimuli from irritated peritoneal and pelvic soft tissues in response to coital connection.

These include tumors of the uterus, such as myomas (fibroids), ovarian cysts and solid tumors, and, carcinoma of the female reproductive tract. Any of these tumor growths occasionally incite onset of the complaint of acquired dyspareunia. Those interested can find more definitive evaluations of this physiological source of dyspareunia in current gynecology textbooks.

Thus, the basic premise with which the Foundation approaches the problem of dyspareunia is one of elimination of possible pathological reasons for the complaint. If a woman complains of pain with intercourse, her complaint is accepted at face value, and steps are taken to identify the biophysical source of the coital distress.

The diagnosis of psychosomatic dyspareunia, unquestionably of moment in the sexual-response field, must be made by exclusion. To assign subjective origins to pelvic pain, regardless of the patient’s personality structure, without definitive physical evaluation of the pelvis, can result in clinical mismanagement of patients. Certainly there are times when, after every effort has been made to establish physical source of the pelvic pain, subjective etiology for the complaint will be considered strongly. But the initial bio physical investigative effort must be made by competent authority.

Sex & Dyspareunia

Male Sex Distress

Post author By The Beauty Nation
Post date 03/02/2021

Among the most distressing of the many factors in dyspareunia are the complaints of burning, itching, or aching in the vagina during or after intercourse. The existence of chronic vaginal irritation frequently robs women of their full freedom of sexual expresssion, for they are well aware that any specific coital connection may be severely irritative rather than highly stimulative.

Presuming adequate production of vaginal lubrication, rarely, if ever, does a woman complain of burning, itching, or aching during coition or describe these symptoms immediately after or even in a delayed postcoital time sequence without concomitant evidence of established pathology in the vaginal barrel.

This form of dyspareunia registered as a complaint by the female partner should have an important connotation to the cotherapist. This specific response pattern is not described by women who are subjectively impelled to register an excuse to avoid impending or threatened coital connection.

When women use the complaint of pain to avoid or delay the necessity for submitting to psycho genically unappealing coital experience, their most frequent complaint is one of severe pain with penile thrusting, “a hurting” deep in the pelvis.

When considering the complaints of burning, itching, or aching in the vagina, initially clinical concern is focused on infectious vaginal invaders. The primary sources of vaginal infection are coition and rectal contamination; secondary sources are manual contact, clothing material, insertion of foreign material, and functional disuse.

Support of and control of the acidity of the vaginal environment is the fundamental means of protection against the bacterial pathogens that can create symptoms of burning, itching or aching. The vagina naturally maintains a strongly acid environment as a protective mechanism against all forms of infectious invasion.

With an experimentally controlled environment, vaginal acidity has been established as varying clinically from pH 3.5 to pH 4.0. Thus, there is a rather wide margin for error in vaginal protection against concurrent infectious agents, for acidity must be sufficiently neutralized to raise the pH level to five or above, before bacterial invaders can flourish freely in the vaginal environment.

The one time that natural vaginal protection against infection breaks down is during the period of established menstrual flow. For many women vaginal acidity consistently registers in the neighborhood of pH 5 or above during menstrual flow, particularly if vaginal tampons are employed.

The neutralizing effect of blood serum constrained to the vaginal tract by retentive tampons directs vaginal acidity into pH 5 levels routinely. It is not surprising, then, that most vaginal infections either have clinical onset or flourish during menstrual flow.

Bacteria

The infective organisms most constantly encountered in vaginal infections, yet trichomonal and fungal forms of infection are seen frequently enough to provide additional causes for clinical concern. Probably the most persistent vaginal-tract invader in any woman’s lifespan are the coliform organisms (Strepto coccus faecalis, Escherichia coli, and the type of Streptococcus viridans), which are the basic contaminants of bowel environment.

From the point of view of patterns of sexual functioning alone, a persistent vaginitis, from which pathogenic organisms repeatedly are cultured in the adult, sexually functioning woman, should always make the therapist question the possibility of occasions of rectal intercourse.

A popular technique employed during rectal intercourse includes the expected format of initial rectal penetration during the excitement phase and repetitive thrusting during the plateau phase of the male sexual response cycle.

Infected Penis

But many men withdraw from the rectum and plunge the bacterially contaminated penis into the vaginal barrel just before or during the stage of ejaculatory inevitability, terminating the orgasmic phase of their sexual cycle by ejaculating intravaginally. Recurrent coliform vaginal infections that are resistant to treatment may have origin in this coital technique.

When rectal intercourse is practiced, the ejaculatory episode should be confined to the lumen of the bowel. There should never be penetration of both rectal and vaginal orifices during any single coital episode, if the woman wishes protection against the probability of recurrent vaginal infections.

If coliform vaginitis persists despite both adequate treatment and patient denial of rectal intercourse, a direct rectal examination frequently will solve the therapist’s diagnostic dilemma. If a woman is experiencing rectal intercourse with some regularity, there may be a specific involuntary reaction of the sphincter to the rectal examination.

When the examining finger is inserted, the response of the rectal sphincter at first will be one of slight to moderate spasm, following the expected reactive pattern of most men or women undergoing routine rectal examinations. But if the examining finger is retained rectally for a few seconds, the sphincter may relax quite rapidly in a completely involuntary manner, as opposed to the routine response pattern of continuing in spastic contraction for the duration of the examination.

If involuntary sphincter relaxation develops, this response pattern, while certainly not reliably diagnostic, should make the cotherapist skeptical of the patient’s denial of rectal coital episodes.

The involuntary sphincter relaxation develops because the retained examining finger stimulates a pleasurable response for those women enjoying regularity of rectal coital exposure as opposed to those finding rectal examinations subjectively objectionable and objectively painful.

Clinical note:
The same type of involuntary sphincter relaxation may develop in male homosexuals whose preferred pattern of sexual expression includes interest in regularity of rectal penetration. Again, the involuntary sphincter response pattern has been used by the Foundation’s professional staff as a clinical diagnostic aid when dealing with homosexual male patients employing the rectum as the means of providing ejaculatory release for sexual partner or partners.

When the cotherapist can be reasonably certain by both history and examination of some regularity of rectal intercourse, techniques to avoid vaginal contamination with fecal material should be discussed at length with the women involved.

Although the basic premise of the clinical advice is to avoid recurrent episodes of coliform vaginitis if possible, there is an accrued secondary effect of reducing dyspareunia during occasions of intravaginal coitus.

Uncircumcised Penis

When trichomonal vaginitis is suggested by direct inspection of the vaginal barrel and confirmed by adequately stained vaginal smear or hanging-drop preparation of the vaginal discharge, which may be profuse and irritating.

The husband also should be suspected of harboring the trichomonads, possibly beneath the foreskin if he is uncircumcised, but more frequently in the prostate gland, the seminal vesicles, or the urinary bladder.

If both husband and wife are not treated simultaneously for this particular distress, the infection may become a source of chronic dyspareunia, as it may be exchanged frequently between marital partners during repeated opportunity at coital connection.

It does little good to treat the wife for trichomonal vaginitis and then have her reinfected by her husband. And it obviously does little good to treat the husband individually and have him reinfected by his wife. With chronic trichomonal vaginitis there may be recurrent bouts of dyspareunia, particularly with coital connection of any significant duration.

Fungal vaginitis is seen clinically more and more frequently. Incidence of this particular infectious entity used to be primarily confined to the late spring, summer, and early fall months, but now such pathogens as Monilia and Candida albicans are encountered regularly throughout the year.

Chronic fungal infection creates a debilitating situation for the recipient woman. Burning and itching is intense and swelling and weeping of soft tissues are frequent complications. Coital connection is virtually impossible due to the pain involved when a fungal infection dominates in the vaginal environment.

Infections with antibiotics frequently will protect women from the complications of fungal vaginitis.

Tags Distress, Male, Male Distress, Male Sex, Male Sex Distress, Sex, Sex Distress

Sex & Dyspareunia

Curve Penis

Post author By The Beauty Nation
Post date 03/02/2021

Peyronie
A disease produced by induration and fibrosis of the corpora cavernosa of the penis and evidenced as an upward bowing of the penis, plus a gradually increasing angulation to the right or left of the midline, makes coital connection somewhat difficult, and in advanced stages coition is virtually impossible.

There also may be pain attached to attempts at coital connection due to the unusual angulation of the penis creating resultant penile shaft strain, both with inserting and with thrusting experience.

Penile Chordee or Curved Penis

It is seen rarely in situations of penile trauma and only occasionally with neglected gonorrheal urethritis. Consultation has been requested by four men with severe penile chordee as a post traumatic residual.

In two instances the fully erect penis was struck sharply by an angry female partner. The remaining two men each described severe pain with a specific coital experience. During uninhibitedly responsive coital connection with the female partner in a superior position, the penis was lost to the vaginal barrel. In each case, the women tried to remount rapidly by sitting down firmly on the shaft of the penis.

The vaginal orifice was missed in the hurried insertive attempt and the full weight of the woman’s body sustained by the erect penis.

Each of the four men gave the remarkable verbal description that he felt or heard something snap. Shortly thereafter an obvious hematoma appeared on the anterior or posterior wall or lateral walls of the penile shaft.

Over a period of weeks, as the local hemorrhage was absorbed, fibrous adhesions developed and, with subsequent scar formation, there slowly developed a downward bowing and (in three cases) mild angulation of the penis.

Urologists state that due to the type of tissue involved in the penile trauma, there is little to offer in the way of clinical reprieve for men afflicted with these embarrassing erective angulations, Peyronie’s disease or chordee.

Attempts at surgical correction currently are of relatively little value and not infrequently make the situation worse. Any of these situations create responses of pain and tenderness during both masturbation and coital connection.

It always should be borne in mind that the erect penis can be traumatized by a sudden blow, by rapidly shifting coital position, by applying sudden angulation strain to the shaft, or from violent coital activity that places sudden weight or sudden pressure on the fully erect penis. The unfortunate residuals of such trauma have been described above.

Direct trauma of the penis occasioned by major accidents, war injuries, or direct physical attack sometimes requires that treatment for sexual dysfunction be patterned to include marked variation in the anatomical structuring of the penis. In anatomical deformity of the penis, the complaint of dyspareunia can be raised by either the male or female sexual partner.

Testicular Pain

Usually of the dull, aching variety, develops for some men who spend a significant amount of time in sexual play or in reading pornographic literature, concurrently maintaining erections for lengthy periods of time without ejaculating within the immediate present.

Frequent returns to excitement or even plateau-phase levels of sexual stimulation without ejaculatory relief of the accompanying testicular vasocongestion can cause an aching in either or both testes, particularly in younger men. Relief is immediate with ejaculation, which disperses the superficial and deep vasocongestion and returns the testicles to their normal size.

No permanent damage is occasioned by maintaining chronic testicular congestion for a period of days. Men with this syndrome of testicular pain occasioned by long-maintained sexual tension are in the minority.

Usually, the syndrome of involuntary testicular pain is relieved somewhat as the man ages.

There are painful reactions that develop during or shortly after coital connection that particularly reflect the influence of the vaginal environment. These situations are mentioned only in passing, but the therapist should keep in mind the fact that the basic pathology involved rests within the vaginal environment.

Tags Curve, Curve Penis, Penis

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