Digest of recent discussions on ISSM mail (Sept 2009 - Dec 2009)

IX

GILA BRONNER

Ejaculate-induced Uterine Contractions

November 11, 2009: 4 Messages

1

A 26 year old religious Jewish woman, married with 3 children, and her 28 year old husband, applied to our sex therapy service. She complains of uterine contractions, which begin a few minutes after ejaculation and may continue for a few hours. She describes these contractions as labor pains. Her gynecological medical history: 3 first semester spontaneous abortions which happened following post-coital contractions. After medical assessment she was instructed to avoid intercourse during pregnancy. In the next 3 pregnancies, the couple resumed intercourse only in the 9^th month. Immediately after intercourse she had uterine contractions which ended with normal vaginal delivery. Additional information: she complains also of severe dysmenorrhea. In the last year, she takes oral contraceptive pills regularly: 2 months consecutively and a one week break. Sexual history: In spite of her post-coital pain, she demonstrates a good sexual desire, arousal and orgasm. Previous treatments: She consulted a gynecologist who prescribed analgesic medicine. It had no effect on her pain. She consulted an allergy specialist, who said that there was no semen sensitivity, and had suggested a condom. Due to religious reasons they prefer to avoid a condom. But they have tried once, and she had no pain! Today, to avoid pain, they practice coitus interruptus. 

I'll appreciate advice regarding the following questions:

1. Is there any vaginal contraceptive or suppository that might solve her problem?

2. Can we use non-steroidal anti-inflammatory drugs? Also for a chronic use?

Gila Bronner (gilab@netvision.net.il)

2

Hi Gila: Semen is rich in prostaglandins, which cause uterine contraction. While they may not be able to use condoms, it is religiously acceptable for her to use a spermicide-coated diaphragm, or a sponge.

Talli Rosenbaum (tallir@netvision.net.il)

3

Some Ideas: I suggest it could be a physical arousal disorder, FSAD, and the discomfort may be due to decreased vascularity; like testicular aching in men with decreased arterial supply. The pill may not be helping as she may have developed decreased testosterone levels. Or is she insufficiently aroused and rushing into an orgasmic response she is not physically ready for?

Ruth Hallam-Jones (ruth.hallam-jones@virgin.net)

4

Human semen contains prostaglandin (PG) and that is why intrauterine insemination (IUI) may lead to very painful uterine cramps if semen is not processed (we use 0,5ml of processed semen with swim up to avoid cramps). It is not usual to see first trimester abortions after coitus. The fact that this patient complains of cramps at this time of her sexual life may be related to:

1.Higher exposure of uterus/cervix to semen:

- Major sensitivity to PG after partum or abortions (though related to coitus).

- Major opening of cervical os and semen intracervical/uterine exposure. 

- Oral contraceptives with low estrogens dose may diminish cervical mucus (a physical, natural barrier) quantity or quality.

Sometimes PG are used to treat (complete) an incomplete abortion and in some others an uterine curettage with cervical dilation is used and the uterus might end with cervical incompetence (semen can enter more easily than before).

2. Major concentration of PG in semen.  

I would recommend:

1. Sorting out local infections (Ureaplasma urealyticum, Chlamydia, etc.) in vagina, semen and urine.

2. Using a diaphragm contraceptive method if allowed by religion (this avoids the cervix from contacting the semen)

3. Regarding pain killers, the use of NSAID in the man to diminish PG concentration might be effective, but it requires high doses of NSAID which I would not recommend.

4. Other contraceptives or progestagens may be also used to change the cervical mucus quality and diminish `permeability’.

Victoria Bertolino (victoria.bertolino@fibertel.com.ar)