Pain with Sexual Intercourse

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Dr. Marshall Smith: "We're here at the 1999 American Association of Gynecologic Laparoscopists in Las Vegas. We have with us Dr. James Carter, who's developed a procedure for women who have pain when they have sex, and it's a very common problem although it's not one that's discussed very often or opened up with. I would like to turn it over to Dr. Carter, and let him discuss a few aspects of it for us - Jim."

Dr. James Carter: "The first difficulty is it's difficult for people to bring this problem up. In my opening questions when I'm doing my history and physical, I have a place where I ask if there's pain with intercourse because there's certain things that can cause this type of pain that are important for your doctor to know. So if you're having this problem, bring it up to your doctor if it's not asked because there are four areas that need to be considered. One - if it's at entry, this could be a problem with a mild infection or there could be a problem with muscles or fascia in that area. If it's a little bit deeper in, it's likely there may be a problem again with muscles or fascia especially if you're a very athletic person or if in the past you've played soccer or have been in ballet or been in any activities where the muscles and ligaments have been stressed. And these type of muscle and mild fascia pains are very common in women who have been athletically active, or in addition, in women where there may be some mild scoliosis or some problems with spine and problems with walking. In addition, if the pain is deep, there may be a problem with endometriosis and that course can be diagnosed by an exam which shows tenderness or nodularity on what we call the "uteral sacral ligaments" - the deep ligaments near the uterus. So if you're experiencing deep pain - it may be from endometriosis. In addition, there is a very common condition that approximately 10%-20% of women suffer from which can contribute to this, and we call that a "retroverted uterus." You may have been told by your doctor that your uterus is in the wrong position, and you may have found that when you have an exam by a physician that you have pain with this exam. If that's correct, then it may be simply that the uterus is tipped, and that may be what you've been told - your uterus is tipped. If it's tipped and you're experiencing pain with intercourse, it may very well be that tipped uterus. And now, Mark, there's a procedure that can be done in fifteen minutes through the laparoscope that can bring that uterus up to the proper position, bring it out of the "cul-de-sac," and get it out of the way so that that pain doesn't occur. We've had tremendous success with that."

Dr. Marshall Smith: "That sounds very, very encouraging, especially for those women that suffer from this problem and probably have suffered in silence. Thank you very much for being here with us today."

Dr. James Carter: "Your right about that Mark, about suffering in silence. Bring this issue up, bring it to the attention of your caregiver - it's important that they understand and know it."

Dr. Marshall Smith: "Very much so, thank you very much."