Female Disorders and Pain

Female Orgasmic Disorder (Anorgasmia)

This disorder is defined by the absence, marked delay or significant reduction in the intensity of orgasm on almost all occasions (75-100%) of sexual activity.

It is essential to assess whether the patient has never experienced orgasm (primary) or whether she has lost the ability at some point (secondary).

The diagnosis should consider whether the stimulation received is adequate in focus, intensity and duration.

Many women are misdiagnosed when the real problem is ineffective stimulation technique by the partner or lack of knowledge about their own anatomy.

Acquired anorgasmia may be related to stressful life events, partner conflict or trauma.

Genito-pelvic pain and penetration disorder

This diagnostic category unifies what was previously known as vaginismus and dyspareunia.

It is characterized by persistent difficulties with vaginal penetration, marked vulvovaginal or pelvic pain during intercourse, and intense fear or anxiety in anticipation of pain.

Often, the pelvic floor muscles tighten involuntarily, making penetration impossible or very painful. The causes can be mixed.

Organic factors such as infections, endometriosis or hormonal changes should be ruled out or treated.

However, the psychological component of "fear of pain" often perpetuates the cycle: anxiety tightens the muscles, which causes pain, which confirms the fear and increases tension for the next time.

The impact of previous sexual trauma

In pain disorders and anorgasmia, a history of sexual trauma is a frequent etiologic factor that should not be overlooked.

An experience of abuse, rape, or even a painful or forced first sexual encounter may condition the body to react defensively to intimacy.

The body's memory of the trauma may activate pain responses or vaginal closure as a protective mechanism, even if the woman consciously desires the current relationship. In these cases, the dysfunction is an adaptive response to a perceived threat.

The approach requires extreme sensitivity, working first on safety and disassociation of the current