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I Case Report I Case Report Proctalgia fugax: a cause of marital dysharmony J.A. Mountifield, MD, CCFP D ownthwaitel defined proctalgia fugax as tion, including proctoscopy, yielded no abnormali- "pain seemingly arising in the rectum ties. occurring at irregular intervals and being Reassurance that the patient was suffering unrelated to organic disease", and characterized it from no serious illness and that the attacks usually as "harmless, unpleasant and incurable". I ques- disappear by the age of 70 years1 were of little tion the harmlessness of the condition. consolation. She could have intercourse provided that she did not have an orgasm; however, her husband's fear of precipitating an attack and the Case report unsatisfactory nature of this activity for the patient resulted in no intercourse, much to the detriment A 34-year-old woman sought help to prevent of their relationship. episodes of cramp-like pain in the rectum that was Neither the patient nor her husband felt that a not related to bowel movements. When the pain sexual relationship that fell short of being orgasmic was most intense she experienced nausea and was satisfactory. The suggestion that the patient sweating. The pain lasted for about 30 minutes, try diazepam shortly before intercourse was also during which time the patient would hold a hot unacceptable. She did agree, however, to do Ke- water bottle to the rectal area and take a combina- gel's exercises to try to prevent the attacks. tion of acetylsalicylic acid and codeine. She was completely well afterwards. The first such attack had wakened her from sleep. Subsequently she Discussion had similar pain immediately after intercourse that had culminated in orgasm. She also had pain when Proctalgia fugax is not uncommon, occurring orgasm was achieved by means other than inter- in about 14% of healthy people; it is more com- course. If orgasm did not occur intercourse was mon in women (17.3%) than in men (8.8%).2 In pain-free. However, she found this situation unsat- the patient I have described the pain was, typical- isfactory and therefore avoided situations that ly, localized in the anus; it lasted somewhat longer might lead to intercourse. than is usual, but examination revealed no perianal The patient was in good health and was fissure, fistula or abscess. taking no medication. She did not smoke or drink Pilling and associates3 reported that many of alcohol. She denied being anxious or depressed the patients with proctalgia fugax seen at the Mayo and hitherto had enjoyed a good marriage. Fear of Clinic, Rochester, Minnesota, were found to be becoming pregnant was not a factor, since her perfectionistic, anxious, tense and hypochondria- husband had had a vasectomy. Physical examina- cal. This description did not fit my patient, who appeared to be well adjusted and relaxed. Nor did she have irritable bowel syndrome.3 The nausea Dr. Mountifield is assistant professor at the Department of and sweating she experienced during the attacks Family Medicine and Community Health, University of Toron- are not unusual.4 to. As did the two patients, both men, described medical aid Correspondence to: Dr. J.A. Mountifield, Department of Family by Downthwaite,5 my patient sought Medicine, Wellesley Hospital, 160 Wellesley St. E, Toronto, only when the rectal pain was precipitated by Ont. M4Y 1J3 (reprints unavailable) intercourse. Sinaki and colleagues,6 in a study of CMAJ, VOL. 134, JUNE 1, 1986 94 patients with proctalgia fugax, reported that ship between my patient and her husband and the 15% listed sexual intercourse as an aggravating subsequent detrimental effects on their marriage, factor; however, the sex of these patients was not proctalgia fugax cannot be considered as harmless noted. Downthwaitel reported that though inter- as Downthwaitel suggested. course may precipitate proctalgia fugax in men it is not usually a factor in women. The pain caused by proctalgia fugax has been References attributed to spasm of the sigmoid colon, the levator ani or the pelvic floor.' The fact that my 1. Downthwaite A: Proctalgia fugax. Br MedJ 1962; 2: 164-165 patient was symptom-free if intercourse did not 2. Thompson WG, Heaton K: Proctalgia fugax. J R Col] result in orgasm lends credence to this opinion. Physicians Lond 1980; 14: 247-248 She applied heat to the rectal area and took 3. Pilling LF, Swenson WM, Hill JR: The psychological aspects analgesics, but it is uncertain whether the duration of proctalgia fugax. Dis Colon Rectum 1972; 8: 372-374 of the pain was shortened by this therapy. 4. Some observations of proctalgia fugax [C]. Lancet 1952; 1: Downthwaitel suggested that nightly administra- 52-53 tion of quinine and propantheline is beneficial, 5. Downthwaite A: Chronic spasmodic affections of the bowel. whereas Sinaki and colleagues6 reported that Lancet 1928; 2: 1263-1264 diazepam was helpful in 40% of their patients. 6. Sinaki M, Merritt J, Stillwell G: Tension myalgia of the pelvic In view of the change in the sexual relation- floor. Mayo Clin Proc 1977; 52: 717-722 Intellectual labours Let what you observe penetrate your inmost soul, let it so warm and replenish you that your thoughts constantly refer to it, and then you will find true pleasure and delight in your intellectual labours. - Theodor Billroth (1829-1894) 1986 ASTRA CANADA AWARD FOR BASIC RESEARCH IN SEXUALLY TRANSMITTED DISEASE $10 000 This award is open to researchers who are presently working in any of the following areas: Microbiology & Infectious Disease, Pathology, Clinical Pharmacology, Internal Medicine, Der- matology, Obstetrics & Gynecology, Urology, Epidemiology, Community Health or Pediatrics. Eligible candidates will have either an MD or PhD degree or both. The award may be used towards pursuing some specific academic, professional or technical training in their own or another associated field. In accordance with Canadian immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada. Application forms and further information may be obtained by contacting: Miss Shona Dodds ASTRA PHARMACEUTICALS CANADA LTD. 1004 MIDDLEGATE ROAD, MISSISSAUGA, ONTARIO L4Y 1M4 PHONE: (416) 275-7111 Completed applications must be received by September 15, 1986. I Astra Pharmaceuticals Canada Ltd. A3TRA |1Astra Pharmaceutiques Canada Ltee 1270 CMAJ, VOL. 134, JUNE 1, 1986.
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