Sexual dysfunction can occur in men and women for many reasons.
Dyspareunia in Women
Dyspareunia is pain with intercourse. For women, this may include pain on contact with the genitalia externally, pain on penetration with increasing pressure along the vaginal walls or cervix, or pain during/after orgasm. Dyspareunia can occur in post menopausal women also when changes in hormones levels influence tissue quality.
Vulvodynia refers to pain experienced anywhere within the vulva or entrance to the vagina. Pain can be localized to a certain area, or more general, affecting the hips and legs.
Pain can be constant or intermittent and sensations of burning, stinging, and throbbing are often associated with the condition. Vulvodynia can be provoked or unprovoked.
Provoked Vuvodynia (PVD) is pain that occurs when the area is touched and can be primary or secondary.
Primary PVD: Women have been experiencing symptoms since the first time having intercourse.
Secondary PVD: Women have a had a period of pain free intercourse and are suddenly symptomatic.
The cause of vulvodynia is still unknown, although certain theories suggest genetic factors, alteration of vaginal acidity, and inflammation as possible causes.
Pelvic floor physical therapy performed by a skilled therapist can be an effective form of treatment for vulvodynia. Treatment may include manual therapy, neuromuscular re-education, stretching, and patient education. Patients may also be given an individualized home exercise program consisting of instruction on the use of a dilator or additional modalities to help manage symptoms and facilitate healing.
Vaginismus is a condition where involuntary muscle spasms cause difficulty with penetration of the vagina. Pelvic floor muscles may be abnormally tight, shortened, and restricted. This can make the insertion of tampons, gynecological examinations, and intercourse painful and often intolerable. The cause of vaginisimus is often unclear; however, pelvic trauma, postural alignment, decreased lower extremity flexibility and emotional stress, may be contributing factors.
Skilled physical therapy can be an effective form of treatment, aimed at restoring altered muscle tone to its normal resting state. Internal manual treatment and release of the pelvic floor muscles, neuromuscular re-education, and relaxation exercises are beneficial to individuals diagnosed with vaginismus.
Dyspareunia (pain with intercourse) in Men
For men, sexual dysfunction may include pain during and after ejaculation or with intercourse in general. The inability to obtain or maintain an erection may also occur. There are multiple factors that influence pain including physical, psychological/emotional factors and relationship/social factors that can affect sexual appreciation. Infection of the bladder, prostate or sexual organs can cause pain, intense itching or burning post ejaculation. Interstitial cystitis (also know as painful bladder syndrome) may experience pain at the moment of ejaculation.
In addition to the pain that may result from inflammation of the prostate (prostatitis mentioned above), a number of other conditions can result in pain in the groin or pelvic area. See here for further information on the different types of pelvic pain in men.
Pudendal Neuralgia/Pudendal Nerve Entrapment
The pudendal nerve is the main nerve that supplies the pelvic floor, genitals, and anus with sensation and muscle control. If this nerve becomes injured or entrapped by scarring, the result can include pain or a burning sensation in testicles and/or tip of penis. Pain is most often worse with sitting.
Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It can be caused by weakness of the pelvic floor muscles.
Retractile testicle or scrotal retraction occurs when testicles are pulled out of the scrotum and upwards into the groin. It is caused by an overactive cremaster muscle which normally helps to control the position the testicles. The testicles are kept at a lower temperature than body temperature. In warmer temperatures the cremaster is relaxed allowing the testicles to sit lower away from the body to cool off. In cooler temperatures the cremaster contracts lifting the testicles closer to the warmth of the body.