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intercourse and urinary sensations

  : Dear M.D.
  : my partner, a female, (26 yrs. of age; non smoker; otherwise healthy; healthy BMI; vegetarian no FE++
  shortage) seems to find some sexual intercouse positions uncomfortable. For the last few months she
  has not been experiencing orgasms during intercourse in any position, in contrast to months before. I
  recognize many psychological considerations as well as other factors may contribute to this scenario.
  Although these may explain much of the problem, specific physical symptoms seem to be peculiar.
  The "women on top" position, in particular, she finds uncomfortable. This is coupled with sensations
  of a full bladder. The sensations are stronger during a more "angular" penetration where more direct
  pressure is placed on the anterior wall of the vagina. Going to the washroom does not seem to result
  in any significant change. More direct entry reduces this discomfort but also sensations of any sort.
  : A routine gynaecological exam revealed no infection or irregularities/problems. These problems
  began shortly (a month or so?) after going on the pill. Since then she has stopped taking the pill but
  these problems persist (6 months or so). Could the these symptoms be related to a shift in the
  position of the uterus and consequently, pressure on the bladder during sex? Is there a typical time
  course during which such a change might take place?
  : Thanks for reviewing this question, if I've missed important details please email me and I'll resubmit
  a more detailed account.
Dear Dave
Thanks for your questions.
Psychological issues can play a large role in sexual well being.  It is important to identify any stressors, and try to discuss them openly. A rhetorical question you might ask; is she comfortable with your relationship?
In another note,  I am glad she had a normal physical examination, because an acute change may indicate an infection , mass etc.   These symptoms can not be explained by the pill alone. The uterus does not usually shift positions in the pelvis.   A benign tumor of the uterus, if large, can cause similar symptoms, but are usually picked up on exam.     I recommend for her to continue to have  regular check -ups   with her gynecologist about her symptoms. This will enable her  to diagnose any possible pathology early.  It is possible she may have a urological instead of a gynecologic illness.  A bladder stone or interstitial cystitis ( please use the search function for more info) could possibly present with these symptoms.  She may need a Urology referral to investigate these diagnosis further.
As you know men and women are created opposite with regards to foreplay.  The ease of orgasm is directly related to the length of time for foreplay in females.  Foreplay  increases the length of time until orgasm in males.  This knowledge should help.  Hope this helps.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians
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