[Pelvic sexual pain]

Abstract

Objective: To colligate the clinical and ethiopathogenical elements to take into account in the assessment of sexual activity-related chronic pelvic and perineal pain, in the male as well as in the female subject.

Subjects and methods: Review of articles and consensus conferences published on this subject in the Medline (Pubmed) database, selected according to their scientific relevance.

Results: In the female subject, only dyspareunia has benefitted from a consensual definition. Deep dyspareunia must start investigations in search of pelvic organs disorders, endometriosis, painful bladder syndrome adhesions. Superficial dyspareunia can be a part of provoked vestibulodynia. Vaginismus can be linked to a local disorder, but can also be caused by an excess of nociception. In the male subject, painful ejaculation must start investigation in search of a local urological disorder. It can also be of iatrogenous origin, or be included in a chronic pelvic pain syndrome. Although less documented, other pelvic and perineal pain syndrome, coitus-related or not, exist in the male subject.

Conclusion: Assessment of these sexual dysfunctions is primarily based on history taking and clinical examination. In the absence of systematically researched organic disorder, these pains can be part of functional disorders, in which case a global assessment must be undergone, by taking into account all aspects of the pain, including emotional aspects.