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“If a woman presents with an ability to orgasm during self stimulation, but not an ability to orgasm during sexual activity with a partner. We look for classic things, psychologic issues, physical therapy concerns. And we look for the fact that a woman can stimulate a lot more during self-stimulation. So there may be some sensation loss, or maybe some testosterone hormonal problem, or really a brain blood flow problem where we would give chemicals that increase the excitatory chemicals and decrease the inhibitory. So women with sexual dysfunction often have pain during sexual activity, as their presenting symptoms. It’s literally amazing if you compare the numbers of men who have pain during sexual activity, it’s about 5%. Above 33 to 40% of women will describe pain and discomfort during a sexual activity that interferes with their enjoyment. We need to be very careful on physical examination.
When we examine these women to really understand all the various parts of their anatomy that may be contributing to the dysfunction. So we have a procedure called Vulvoscopy which will identify multiple regions starting at organs like the clitoris or the opening to the vagina called the vestibule or the paraniem or inside the vagina, the cervix, even the vulva can all participate in various different ways women have pain. Women can have deep pain with thrusting versus entrance pain, and that is typically seen in a condition called endometriosis. Women can have poor hormonal support like in menopause. So there’s multiple reasons. Women can have dermatologic conditions like lichen sclerosus and lichen planus. Women can have excess fluid coming from the vagina called discamative and inflammatory vaginitis. Multiple, multiple reasons for pain. And the doctors requirement to be the detective and figure it out so that correct treatments can be provided.”
