Pelvic Pain and Sexual Intimacy

We've been talking a lot about pelvic pain and some things that could be causing it like endometriosis, polycystic ovaries (PCO), or pelvic congestion.  I hear from many of you over and over about why does sex hurt so much (dyparunea), which is definitely related to many of the pelvic pain syndromes.  In fact sometimes painful sex can be the catalyst that brings you in to see me.  

Women learn early on that sex is not always comfortable and depending on where you are at in your cycle, the pain can improve or worsen.  All women have pain now and then, but it should not be so intense that you don't want sex for fear of the pain or have to ask him to stop during intercourse because the pain is so intense you can't continue.

We know from the past blogs I wrote that becoming sexually excited and then stopping before orgasm can lead to more pain from pelvic congestion.  Pelvic congestion is when the pelvis and female organs fill with blood during sexual excitement and then release during orgasm.  We see a similar phenomenon in men when they get an erection from sexual excitement, and if they don't have an orgasm or ejaculate they will get pelvic congestion. It can produce the same pressure and pain we feel and is localized in the scrotum and testicular area (Blue balls).  This is why it is so important for an anorgasmic woman to learn what she needs to do to teach her body to have an orgasm.

This may mean using a vibrator or letting him use one on you either prior to his orgasm, or after if you did not get there with penetration and thrusting.  Most women need clitoral stimulation, which may not happen with penetration and can take practice to position yourself (and him) to accomplish this.   It is good if you can talk with your partner about this and work together.  If you still have problems then make an appointment with your gynecologist to help guide you through the next steps.

Detumescence is the flow of extra blood out of the area. So during sexual excitement blood rushes into the pelvic area and fills or engorges the vagina, uterus and clitoral area.  The contractions of orgasm put pressure on all the blood vessels in the swollen organs and tissues, and squeezes the extra blood out of them. The clitoris returns to its normal size within 10 to 20 seconds after orgasm, the vagina takes some 15 minutes to return to its previous state, and the uterus may take a little longer, between 10 and 30 minutes to become decongested and return to its previous size and position.

When there is no orgasm, the involuntary muscle contractions to put pressure on the blood vessels are absent so the excess blood pools in the female organs and tissues, which will remain swollen much longer.  Problems show up when there is continued intense sexual excitement followed by consistent lack of orgasm over a long period of time.  Pelvic congestion builds up. The sensations of this condition include vague discomfort in the pelvic area, backaches, and headaches, to intense, sharp pelvic pain that is not associated with the menstrual cycle.  This in turn can cause sex to become extremely painful and as the congestion and pain worsen we usually seek help for an explanation.  However on physical exam and ultrasound everything appears normal. 

The relationship between health and a satisfying love relationship should not be down played.  It has been shown that orgasm is a powerful muscle relaxant, and its effects can be ten times as strong as the effects of Valium and other tranquilizers. After illness, orgasm assists on the road back to health. So instead of saying, "No, I have a headache", we now know that sexual love with orgasm can actually be the best medicine for a headache or back pain. So next time give it a try. 

      Pelvic pain can be confusing and requires patients on both sides to try to figure out what may be happening.  In the end it may be a combination of different things, but if you find the right doctor to help you, it will be worth all the trouble in the end.