The dyspareunia is introital generally but can also appear before, during or after sexual intercourse. The cause can be a psychological factor or a local traumatism ( p ej., the hymen’s laceration, injuries of the urethral meatus ). After a traumatism painful exulcerations can appear.
Other causes include an unsuitable, generally secondary lubrication to inappropriate or insufficient preliminaries; Forceful pressure on a sore urethra during sexual intercourse; Inappropriate penetration; Injury of the introit due to inflammatory alterations ( p ej., vestibulitis ); Infections ( p ej., abscesses of the Batholin’s glands or their conduits ); Gland inflammation sudoriparous labials; Secondary irritation to the use of bad-quality prophylactics or with unsuitable lubrication; Allergic reactions to the contents of foams and contraceptive gels and to the prophylactics; Anomalies of the genital feminine expanse of territory ( p ej., vaginal congenital partition, rigid hymen ) and dermatological diseases ( p ej., sclerosed lichen ). The psychological cause more frequent it is vaginism ( v later on ).
The acquired dyspareunia does not relate with the first sexual intercourse and frequently develops years after of the same. Their causes include: Menopausal involution drily and thinning of the vaginal mucosa, enlargement of the secondary introit to perineorrafia behind episiotomy or plastic reparation of the vagina, uterine marked retroflexion with ovarian prolapse to the caecum, endometriosis, vaginitis, sub-urethral diverticulum and inflammatory pelvic disease. The radiation therapy for the treatment of myxolipofibrosarcomas can be also cause of dyspareunia. The psychological factors and other ones related they are similar to the implicated in the orgasmic feminine upset ( v previously ). The sexual unsuitable stimulation or your psychological inhibition can cause a vaginal inappropriate lubrication and to coital pain.
DIAGNOSIS
The pain during or behind sexual intercourse it is the fundamental symptom.
The location and the nature of the pain can be useful for diagnosis; For example, the pain with the deep penetration can be indicative of an uterine injury and or of the broad ligament. Background general and sexual doctors and the physical and pelvic exploration generally reveal diagnosis. The local lesions of the introit and the uterine shift or other pelvic pathologies can detect themselves with the exploration, for the one that anesthesia can be necessary ( v. Vaginism, later on ).
PROPHYLAXIS And TREATMENT
The exploration of both sexual companions before marriage or the sexual activity, an obvious explanation of the sexual organs and players, their shows and the physiological and psychological factors related with sexual intercourse and the advice on sexual techniques can help the prevention of some problems. What’s most important is listening to the couple and answering to their questions.
Injuries or defects should correct themselves if possible. For example, a hymenal thickened ring can increase to the 1 % in the same previous consultation lidocaína’s application.
The treatment of the non-complicated injuries is simple. It is important to avoid sexual relations temporarily. An anesthetic sour cream should be applicable m externally ( p ej., cinchocaine to the 1 %, lidocaína to the 1 or 2 % ). Hip-baths can relieve the vulval bothers.
The use of a water-soluble lubricant immediately before sexual intercourse generally you avoid the pain and the myospasm. In some cases, the later penetration avoid the pressure in the urethra with enlarged sensibility and reduce the pain. For the treatment of vaginism, seeing later on. The local estrogen preparations or the substitutive treatment with estrogens, pray to them they are useful in women with postmenopausal vaginitis.
Cysts or abscesses should process themselves surgically; The inflamed lips should keep clean and dry. For the treatment of vulvovaginitis, seeing chapter 238. If inflammation and vulval pain exist, a humid compress with dilute aluminum subacetate solution can be applicable m locally. If the pain is severe an analgesic is indicated by v.o., P ej., codeine, 30 to 60 mg, with paracetamol, 500 mg, each 4 h. If the patient is beneficiary of an ill-disposed diaphragm that hurts the uterosacral ligaments, this should place back itself or being extracted from.
The talks with both sexual companions are commendable sexual. However, if the dyspareunia becomes of long evolution or if they cannot correct the psychological subjacent factors, the patient should be forwarded on to a psychiatrist.
Diagnosis and Treatment of Vulvodynia
The diagnosis of vulvar pain and/or irritation requires a careful history by a gynecologist familiar with vulvar problems. The vulva is examined with the aid of a colposcope — an instrument similar to binoculars with an excellent light. The vulva is gently touched with a Q-tip to see if there are specific areas of tenderness. The muscles surrounding the vulva and vagina are checked for tenderness and tension. Any vaginal discharge is checked under a microscope, and cultures may be taken.
Treatment can be simple or complex. One of the most common causes of irritation is frequent washing of the area with soap. As a general rule, do not use anything on the vulva that you wouldn’t put in your eye! Even soaps and products claiming to be gentle and non-allergenic can be irritating. Rinse with plain water, blot dry, and then blow dry with a hair dryer on low heat. An over the counter mild cortisone cream can be applied for a few days, but if the irritation persists a gynecologist should be consulted.
Chronic vulvar pain or burning may respond to cortisone creams or ointments. One specific type of pain is caused by inflammation of the vestibular glands (vestibulitis). This can be difficult to treat, and occasionally requires surgery to remove the inflamed glands.
Vaginal Pain
Vaginal pain is most commonly caused by infection. Sometimes scar tissue can occur after childbirth, surgery or trauma. In endometriosis tissue that normally lines the uterus can grow in the vagina and be painful. Muscle tension or spasm is a common cause of vaginal pain, and may respond to physical therapy and psychotherapy. Inflammation of the bladder from infection orinterstitial cystitis (a sterile inflammation of the bladder) can also cause vaginal pain.
Why a Multidisciplinary Approach…
The treatment of vulvodynia and other conditions requires great patience both on the part of the doctor and of the patient. Most often symptoms will improve, but it can take months of treatment. It is not surprising that vulvar pain can interfere with relationships, and cause a great deal of emotional distress. In addition, tenderness in that area can lead to spasm of the pelvic muscles, which in turn can aggravate the pain.
Many times there are simple medical treatments that relieve these symptoms. But when long term treatment is necessary, a psychotherapist specializing in sex therapy and sexual pain management can help minimize the impact the pain has on a woman’s life. When muscle tension or spasm appears to be a factor, a physical therapist, through gentle massage, biofeedback, or other techniques can help restore normal muscle balance. For many women a multidisciplinary approach is clearly more effective than any single treatment.
