CLINICAL ACTIONS:

A patient may complain of deep pain upon thrusting during intercourse and you have ruled out infections, fibroids, ovarian cysts or other potential causes. Next steps to consider include:

• Determine from the history that pain is experienced deep in the vaginal canal near the area of the cervix
• If possible, replicate pain in the office using dilators
• Rule out infections, tight muscles, iatrogenic causes
• Provide behavioral modifications

SYNOPSIS:

The key diagnostic clue that will guide management is the determination that the pain is in fact deep upon thrusting and not more proximal involving the vulva.  In the case of deep pain, the cause is related to the length of the partner’s penis, which is longer than comfortably fits into the woman’s vaginal canal.  The discomfort experienced by the patient is a result of the penis hitting the cervix. This pain can be replicated in the physician’s office, gently using a dilator.

KEY POINTS:

• If pain is only experienced with deep thrusting, it can often be the result of the length of the partner’s penis
• Once it has been established that there are no other contributing causes, behavioral solutions should be suggested:
  • The easiest solution is for the partners to experiment with different positions for penetration. Partners facing each other, side by side, is one position that does not allow for deep penetration
  • An alternative solution is to cushion the penis in order to shorten the length in the vaginal canal. The fact that the penis is cushioned during intercourse also allow for the sensation of the penis being fully stimulated during intercourse, even if it is not entirely in the vagina
    • There are products developed specifically for this condition
    • A masturbatory sleeve (which are ubiquitous and inexpensive, can be cut down to provide the correct amount of cushioning)
• ICD-10 DIAGNOSIS CODES:  F52.6, N94.1

Learn More – Primary Sources:

Physical therapy management of female chronic pelvic pain: Anatomic considerations