Dyspareunia is recurrent or persistent genital pain occurring in either men or women before, during, or after intercourse. Much more common in women than in men, dyspareunia is related to, and often coincides with, vaginismus. Repeated episodes of vaginismus can lead to dyspareunia and vice versa. Painful coitus can result from tension and anxiety about the sex act that cause women to involuntarily contract their vaginal muscles. The pain is real and makes intercourse unpleasant or unbearable. Anticipation of further pain may cause women to avoid coitus altogether. If a partner proceeds with intercourse regardless of a woman's state of readiness, the condition is aggravated. Dyspareunia can also occur in men, but it is uncommon and is usually associated with an organic condition, such as herpes, prostatitis, or Peyronie's disease, which consists of sclerotic plaques on the penis that cause penile curvature. Organic abnormalities leading to dyspareunia and vaginismus include irritated or infected hymenal remnants, episiotomy scars, Bartholin's gland infection, various forms of vaginitis and cervicitis, and endometriosis. Postcoital pain has been reported by women with myomata and endometriosis and is attributed to the uterine contractions during orgasm. Postmenopausal women may have dyspareunia resulting from thinning of the vaginal mucosa and reduced lubrication. Two conditions not readily apparent on physical examination that produce dyspareunia are vulvar vestibulitis and interstitial cystitis. The former may present with chronic vulvar pain and the latter produces pain most intensely following orgasm. Dyspareunia can also occur in men, but it is uncommon and is usually associated with an organic condition, such as Peyronie's disease, which consists of sclerotic plaques on the penis that cause penile curvature.
Vaginismus is an involuntary muscle constriction of the outer third of the vagina that interferes with penile insertion and intercourse. This response may occur during a gynecological examination when involuntary vaginal constriction prevents the introduction of the speculum into the vagina. Women with vaginismus may consciously wish to have coitus, but unconsciously wish to keep a penis from entering their bodies.
Postcoital headache, characterized by headache immediately after coitus, may last for several hours. It is usually described as throbbing and is localized in the occipital or frontal area. The cause is unknown. There may be vascular, muscle-contraction (tension), or psychogenic causes. Coitus may precipitate migraine or cluster headaches in predisposed persons.
Orgasmic anhedonia is a condition in which a person has no physical sensation of orgasm, even though the physiological component (e.g., ejaculation) remains intact. Organic causes, such as sacral and cephalic lesions that interfere with afferent pathways from the genitalia to the cortex, must be ruled out. Psychiatric causes usually relate to extreme guilt about experiencing sexual pleasure. These feelings produce a dissociative response that isolates the affective component of the orgasmic experience from consciousness.
Persons may experience pain during masturbation.A small vaginal tear or early Peyronie's disease can produce a painful sensation. The condition should be differentiated from compulsive masturbation. Persons may masturbate to the extent that they do physical damage
Weakness due to excessive loss of semen. Characterized by vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite and guilt attributed to semen loss through nocturnal emissions, urine and masturbation. Occurs due to increased nor adrenaline tone in the body and is normally associated with sleep disturbances and multiple body pains. And the patient may also complain of decreased penile length and erectile dysfunction.