Your Patient Complains of Deep Pain with Intercourse – A Solution-based Approach
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Identify key clinical clues that can help make the diagnosis of deep pain 2. Discuss treatment options to help alleviate pain with intercourse
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
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
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.
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)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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