In those patients who have never experienced an orgasm sex therapy and support groups to educate women about their bodies and learning to appreciate their bodily responses may be helpful.
Sexual Pain Disorders
Sexual pain disorders, medically known as dyspareunia, is recurrent or persistent genital pain associated with sexual intercourse. Its true incidence is unknown, however, 60 percent of women report some pain sometime in their live, but one-third report continuous problems.. The physical and psychological aspects of dyspareunia are often interrelated. Women may be the victim of sexual trauma and perceive intercourse as painful even in the absence of pelvic pathology. Guilt and shame can lead to an unsatisfactory relationship particularly if the partner does not provide foreplay to arouse them.
On the other hand, a physical cause is not uncommon and an evaluation by a gynecologist or sexual specialist should be performed first ascertaining whether the pain is during penetration or deep thrusting is necessary. Penetration pain is likely related to vulva, vagina, or bladder conditions. Hymenal tags or episiotomy scars may also cause such.
Pain on deep penetration indicates significant pelvic disease and may be the hallmark of endometriosis, pelvic inflammatory disease, pelvic adhesions, previous pelvic surgery, uterine fibroids, retroverted uterus, or ovarian pathology. A pelvic exam can determine the correct cause although in some cases it is extremely difficult.
Vaginismus is a subcategory of sexual pain disorder and is defined as the recurrent or persistent involuntary spasm of the musculature of the outer-third vagina which interferes with vaginal penetration and causes personal distress. The incidence is not well known, is relatively rare, and is believed to be the leading cause of unconsummated marriage. Vaginismus usually dates from the first attempt at intercourse and is due to psychological factors such as sexual inhibition, rape or incest, negative feelings towards the sexual partner, or intense fear of pregnancy. Spasm of the musculature appears to be independent of these thoughts and emotions which frequently remain subconscious. Treatment of vaginismus consists of muscle awareness and relaxation exercises, vaginodilatation, counseling, and sex therapy.