2024 TAOG Taiwan Association of Obstetrics and Gynecology Annual Scientific Conference
Paper Presentation on 2024.03.09-10: Title: The Location of Pain During Intercourse Does Not Necessarily Indicate the Source of the Pain
The link to the Good Doctor News Network report is as follows:
https://www.5678news.com/news_details.php?n=202403130728171508
The issue of pain during intercourse, which troubles many women and even affects family harmony, has long been underappreciated and understudied in the medical community. Dr. Zhang Minjie of Kaohsiung, who has conducted clinical research on this condition for over 30 years, has compiled evidence-based research papers from recent years. These findings were presented at this year’s annual conference of the Taiwan Association of Obstetrics and Gynecology, receiving significant attention.
Pain during intercourse refers to recurring or persistent genital pain occurring during sexual activity. It has a significantly disruptive impact on women’s health, relationships, and quality of life. According to a 2006 World Health Organization report, the prevalence of pain during intercourse ranges from 8% to 21.1% globally.
Dr. Chang Min-Chieh pointed out that pain during intercourse can be accompanied by throbbing, burning pain, pelvic cramps, or muscle tension or spasms, and it may occur before, during, or after intercourse. The medical community is still uncertain about the causes, which may involve multiple factors, ranging from physiological to psychological. Treatment usually focuses on underlying causes and adopts a multidisciplinary approach, but there is no definitive cure. To date, all studies have shown that the causes of pain during intercourse are multifactorial, and therefore treatments are based on addressing various potential causes, with varying effectiveness.
Dr. Chang Min-Chieh presented three key points in his paper, highlighting that from 2019 to 2023, he treated 28 cases of women with pain during intercourse in his clinic. The ages ranged from 25 to 71 years, with an average age of 46.5 years. The average time from the onset of symptoms to referral to his clinic was 3 years. All patients came from various hospitals, clinics, and even teaching hospitals.
Almost all patients had their conditions excluded or treated in the following ways at other hospitals:
Vaginal dryness, vaginal atrophy, hormone replacement therapy, postpartum scarring, vulvitis, pelvic inflammatory disease, emotional stress, anxiety, vaginismus, uterine fibroids, adenomyosis, endometriosis, cervicitis, retroverted uterus, uterine prolapse, and pelvic floor dysfunction. These are all traditional pathological suspicions for pain during intercourse.
Dr. Chang Min-Chieh further pointed out that he applied a single treatment method for all 28 patients, specifically “cervical fusion,” rather than a multidisciplinary approach. The average treatment period was 132 days, and the average duration between satisfaction surveys and treatment completion was 455 days. Before treatment, patients’ pain index (PTSS) was considered to be 10, and after treatment, the average PTSS was reduced to 2.8. Before treatment, the majority of pain levels were rated 2 or 3 on the Marinoff Dyspareunia Scale, while after treatment, in telephone satisfaction surveys, the majority of Marinoff Dyspareunia Scale ratings were 0 or 1.
Dr. Chang Min-Chieh stated that the pudendal nerve innervates the pelvic area, including the cervix. Pudendal neuralgia, similar to vulvar pain, is clinically diagnosed in the absence of other pathologies. Characteristic symptoms include frequent urination, urgent need to urinate, difficulty urinating, vaginal burning sensation, and pain during intercourse. Pudendal neuralgia may also be the result of certain infections, as the pudendal nerve or its branches traverse the vulva, vagina, and cervix.
Dr. Chang Min-Chieh emphasized that based on his 30 years of experience, he believes that “endocervicitis” is the primary cause of pain during intercourse. The location of the pain during intercourse is not necessarily the source of the pain. Therefore, he does not treat the vulva, clitoris, or vagina, but rather focuses solely on treating the cervical area through cervical cauterization. In fact, his treatment has proven that the patients’ pain during intercourse disappears. Thus, he believes that pain during intercourse has a primary single cause, which is “endocervicitis,” and that pain during intercourse can be most effectively treated with the primary single treatment method of “cervical cauterization.”
