What causes painful sexual arousal?

Monday October 19 2020
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By Dr Vincent Karuhanga

When I am sexually aroused and I do not have sexual intercourse, I get stomach pain and bleeding. Does this mean I have a problem with my sexual organs? –Gillian

Dear Gillian,
When you want to engage in sexual intercourse but your husband does not, you may not only get disappointed but also angry.

Anger can cause the fear, fight and flight reaction, which can slow down digestion, increase stomach acid production and lower production of stomach acid prostaglandin protection. This leads to stomach pain, especially if you have other stomach conditions such as peptic ulcer disease. This, however, does not explain why you also get associated vaginal bleeding.

 A number of women show their highest sex desire at a time of ovulation. During ovulation, women may get sharp one-sided lower abdominal pain, which may last a day or two. This so called Mittelschmerz pain may happen due to rupture of the area where the egg is (follicle). If this leads to bleeding on to the membrane inside the abdomen called the peritoneum, one is likely to feel sharp abdominal pain, which if serious may apart from being referred to the shoulder also cause fainting.

 Ovulation happens at the fall of the hormone oestrogen that supports the membrane inside the womb (endometrium), hence resulting in slight shedding of the same membrane with spotting or mild bleeding.
Vaginal bleeding and abdominal pain, then, are not just because your husband did not engage in sexual intercourse but because you desire sex at the time of ovulation when, coincidentally, bleeding (oestrogen breakthrough bleeding) and abdominal pain (mittelschmerz) naturally occur.