Women's Health Community

Dear Brechin: Actually a number of women have written us about having pain with orgasm (both with intercourse and masturbation). After reviewing the medical literature it seems that the most generally accepted explanation is muscular spasms of: uterus, pelvic floor muscles, neck of the bladder--or a combination there of. Another POSSIBILITY might be pelvic congestion syndrome. Here is a citation on this:

Postgrad Med J. 2010 Dec;86(1022):704-10.
Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain.
Freedman J, Ganeshan A, Crowe PM.
Source

Department of Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, UK.
Abstract

Chronic pelvic pain is a common problem for female patients and is defined as pain that has been present for 6 months or more. Chronic pelvic pain with associated ovarian vein varicosities is termed pelvic congestion syndrome (PCS) and is an important but under-diagnosed condition. The aetiology of pelvic varicosities is reflux of blood in the ovarian veins due to the absence of functioning valves, resulting in retrograde blood flow and eventual venous dilatation. The cardinal presenting symptom of PCS is pelvic pain, usually described as a dull ache, without evidence of inflammatory disease. Clinical signs may include vulval varicosities extending on to the medial thigh and long saphenous territory as well as tenderness on deep palpation at the ovarian point; however, such signs are not always present. Non-invasive imaging (ultrasound, CT and magnetic resonance venography) plays a central role in establishing the diagnosis, excluding alternative causes of pelvic pain and providing a road map for novel minimally invasive treatment options that are now available. Day-case percutaneous-directed venous embolisation is now accepted as a valuable treatment option for PCS with promising results from early clinical trials and is fast becoming the first-line treatment option for this condition. This paper aims to raise awareness of PCS among clinicians and reviews the pathogenesis, imaging assessment and minimally invasive treatment options that are now available.

Unfortunately most of the treatment studies have been done in men (yes, they have it as well)). In one recent study using the drug tamsulosin (which relaxes the muscles of the prostate and bladder in men), relief of the pain was achieved. MULTIPLE searches at the National Library of Medicine site have not yielded a single treatment study in women.

Bottom line, I would urge you to see a GYN. Try to keep a list of things which worsen, and relieve, the pain. If indicated a GYN can refer you to a physical therapist which has specialty training in pelvic muscle conditions.

Yours,
Jane