Dyspareunia overview: Difference between revisions
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==Natural history,complications and prognosis== | ==Natural history,complications and prognosis== | ||
Revision as of 19:24, 18 September 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.
historical perspective
Classification
It may be classified into two types in women: superficial, which occurs in or around the vaginal entrance, and is characterized by initial discomfort in initial or attempted penetration of the vaginal introitus. Deep dyspareunia is a pain that occurs with deep vaginal penetration. which resulting from pelvic thrusting during intercourse. Causes are divided into three groups according to Onset, Frequency as well. Based on the onset, dyspareunia can be divided into two groups based on the onset in women: Primary (onset with first sexual experience) Often has psychological causes, such as sexual abuse in childhood, feeling of guilt or shame toward sex, or fear of intercourse or painful first intercourse, and secondary dyspareunia that its beginning is after a previous sexual activity that was not painful. Dyspareunia can be Persistent, which occurs in all situations, possibly due to physical or psychological factors, or conditional dyspareunia that occurs in certain situations. Abdomino-pelvic disorders such as endometriosis, imperforate hymen, vaginal septum, or organic vulvodynia due to infection, lichen sclerosis, or vestibulitis, vaginal infections, prolapse, trauma, or vaginal dryness can cause dyspareunia. It can also be due to gastrointestinal disorders such as chronic constipation, diverticular diseases, inflammatory bowel disease/proctitis. Scarring due to previous pelvic surgery, episiotomy, and perineorraphy, or urological causes such as cystitis, interstitial cystitis, or urethritis can cause dyspareunia as well. Male dyspareunia is divided into broad categories of underlying causes ranging from anatomic anomalies to psychosocial problems. Male dyspareunia is related to the following anatomical structures: 1) prepuce, 2) glans penis, 3) penile shaft, 4) testicles, and 5) urethra and prostate gland. Another classification system defines four broad categories: Isolated painful ejaculation, Chronic prostatitis/chronic pelvic pain, Medical causes, psychological causes.
Pathophysiology
The pathophysiology of dyspareunia can be described based on the underlying cause. For example, estrogen deficiency causes atrophic vaginitis or ectopic uterine tissues in endometriosis causes dyspareunia. Physocholoigacal problems can cause dyspareunia.
Causes
Common causes of dyspareunia include localized infectious and congenital disorders of the vulva, vagina, and perianal regions. Additional causes include systemic conditions and diseases.
Differential diagnosis
Epidemiology and dermographics
Risk factors
Natural history,complications and prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X-Ray Findings
echocardiography and ultrasound
CT-Scan Findings
MRI
other imaging findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery