Sierra Acai Company
Sierra Acai Company
Open 7 Days a Week
MonaVie Independent Distributor
Distributor Training
Shop Online
Enroll Now
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
Friends
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
07-SEPTEMBER-2008 03:17:44 - Dyspareunia Dyspareunia Classification and external resources ICD-10 F52.6, N94.1 ICD-9 625.0 Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by 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. According to DSM-IV American Psychiatric Association 1994, the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus. Clinically, it is often difficult to separate dyspareunia from vaginismus, since vaginismus may occur secondary to a history of dyspareunia and even mild vaginismus is often accompanied by dyspareunia. It is important to establish whether the dyspareunia is acquired or lifelong and whether it is generalized complete or situational. Further inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment. Contents 1 Symptoms in women 2 Causes 2.1 Physical causes 3 Physical causes in men 4 Differential diagnosis 5 Treatment 6 Related conditions 7 References 8 External links Symptoms in women When pain occurs, the woman experiencing dyspareunia may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the phallus is painful. Even after the original source of pain a healing episiotomy, for example has disappeared, a woman may feel pain simply because she expects pain. In brief, dyspareunia can be classified by the time elapsed since the woman first felt it: During the first 2 weeks or so, dyspareunia caused by phallus insertion or movement of the phallus in the vagina or by deep penetration is often due to disease or injury deep within the pelvis. After the first 2 weeks or so, the original cause of dyspareunia may still exist with the still experiencing the resultant pain. Or it may have disappeared, but the woman has anticipatory pain associated with a dry, tight vagina. Causes Numerous medical causes of dyspareunia exist, ranging from infections candidiasis, chlamydia, trichomoniasis, urinary tract infections, endometriosis,1 tumors, xerosis dryness, especially after the menopause and LSEA. Dyspareunia may result from female genital mutilation, when the introitus has become too small for normal penetration often worsened by scarring. Physical causes Because there are numerous physical conditions that can contribute to pain during sexual encounters, a careful physical examination and medical history are always indicated with such complaints. In women, common physical causes for coital discomfort include infections of the vagina, lower urinary tract, cervix, or fallopian tubes e.g., mycotic organisms esp. candidiasis, chlamydia, trichomonas, coliform bacteria; endometriosis; surgical scar tissue following episiotomy; and ovarian cysts and tumors Bancroft 1989. In addition to infections and chemical causes of dyspareunia such as monilial organisms and herpes, anatomic conditions, such as hymenal remnants, can contribute to coital discomfort Sarrell and Sarrell 1989. Estrogen deficiency is a particularly common cause of sexual pain complaints among postmenopausal women, although vaginal dryness is often reported by lactating women as well Bachmann et al 1984. Women undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma. Vaginal dryness is sometimes seen in Sjögren's syndrome, an autoimmune disorder which characteristically attacks the exocrine glands that produce saliva and tears. Dyspareunia is now believed to be one of the first symptoms of a disease called Interstitial Cystitis IC. Patients may struggle with bladder pain and discomfort during or after sex. For men with IC, pain occurs at the moment of ejaculation and is focused at the tip of the penis. For women with IC, pain usually occurs the following day, the result of painful, spasming pelvic floor muscles. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency. Physical causes in men In men, as in women, there are a number of physical factors that may cause sexual discomfort. Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation. Men suffering from interstitial cystitis may experience intense pain at the moment of ejaculation. Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation. Urethritis or prostatitis can make genital stimulation painful or uncomfortable. Anatomic deformities of the penis, such as exist in Peyronie's disease, may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection Bancroft 1989. During vigorous intercourse or masturbation, small tears may occur in the frenum of the foreskin and can be very painful. A rare form of male dyspareunia - postejaculatory pain syndrome - is characterized by persistent and recurring pain in the genital organs during ejaculation or immediately thereafter. The painful sensations are experienced as sharp, stabbing, and/or burning. Although the duration of pain is usually brief, it can persist and be quite intense. Although the immediate cause of psychogenic postejaculatory pain syndrome is the involuntary painful spasm or cramping of certain pain-sensitive muscles in the male genital and reproductive organs, the excruciatingly painful muscle cramps may be attributable to a man's conflict about ejaculating. A pelvic floor disorder can also be the cause of pain during and after sex. Spasming, inflamed, overtoned or shortened pelvic muscles can result in the compression or sometimes the entrapment of the pudendal nerve. Guilt about sexual pleasure or about the paraphiliac nature of the erotic fantasies can lead to pain with orgasm. In other cases, men with liberal sexual attitudes might feel general resentment, or be angry at their current sexual partners for unconscious or conscious reasons. Differential diagnosis Complaints of sexual pain - that is, dyspareunia or vulvodynia - typically fall into one of three categories - vulvar pain pain at the opening or at the external genitalia, vaginal pain, or deep pain - or some combination of all three. There is some evidence for the existence of several subtypes of dyspareunia Binik et al. 2000: vulvar vestibulitis the most common type of premenopausal dyspareunia, vulvar or vaginal atrophy which typically occurs postmenopausally, and deep dyspareunia or pelvic pain associated with such gynecological conditions as endometriosis, ovarian cysts and pelvic adhesions, inflammatory disease, or congestion. Vulvar Vestibulitis Syndrome VVS is the most common subtype of vulvodynia affecting premenopausal women. It tends to be associated with a highly localized burning or cutting type of pain. The feelings of irritation and burning can persist for hours or days following sexual activity, engendering a sense of hopelessness and depression Bergeron et al. 1997; Marinoff and Turner 1991;2 Peckham et al. 1986. The prevalence of VVS is quite high: the syndrome has been cited as affecting about 10%-15% of women seeking gynecological care Bergeron et al. 1997. It is characterized by severe pain with attempted penetration of the vaginal introitus and complaints of tenderness with pressure within the vulvar vestibule. Usually there are no reports of pain with pressure to other surrounding areas of the vulva. Diagnosis is readily made by the cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. Laboratory tests are used to exclude bacterial or viral infection, and a careful examination of the vulvo/vaginal area is conducted to assess whether any atrophy is present. VVS involves multiple tiny erythematous sores in the vulvar vestibule Friedrich 1987; Marinoff and Turner 1991. A number of etiological factors may be involved, including subclinical human papillomavirus infection, chronic recurrent candidiasis, or chronic recurrent bacterial vaginosis Marinoff and Turner 1991; Peckham et al. 1986. Muscular causes have been implicated as well, since chronic vulvar pain may be the result of chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some investigators have postulated the existence of neurological causes such as vestibular neural hyperplasia. Finally, psychological factors may contribute to or exacerbate the problem, since the anticipation of pain often results in a conditioned spasmodic reflex along with sexual desire and arousal problems. Relationship problems are generally the result of chronic frustration, disappointment, and depression associated with the condition. Vaginal atrophy as a source of dyspareunia is most frequently seen in postmenopausal women and is generally associated with estrogen deficiency. Estrogen deficiency is associated with lubrication inadequacy, which can lead to painful friction during intercourse. In women with VVS and vulvar/vaginal atrophy, the pain is associated with penetration or with discomfort in the anterior portion of the vagina. There are some women, however, who report deeper vaginal or pelvic pain. Little is known about these types of pain syndromes, except that they are thought to be associated with gynecological conditions such as endometriosis, ovarian cysts, pelvic adhesions, or inflammatory disease. Treatment Dyspareunia is treated by the taking following steps: Carefully taking a history. Carefully examining the pelvis to duplicate as closely as possible the discomfort and to identify a site or source of the pelvic pain. Clearly explaining to the patient what has happened, including identifying the sites and causes of pain. Removing the source of pain when possible. Prescribing very large amounts of water-soluble sexual or surgical lubricant during intercourse. Discourage petroleum jelly. Moisturizing skin lotion may be recommended as an alternative lubricant, unless the patient is using a condom or other latex product. Lubricant should be liberally applied 2 tablespoons full to both the phallus and the orifice. A folded bath towel under the receiving partner's hips helps prevent spillage on bedclothes. Instructing the receiving partner to take the phallus of the penetrating partner in their hand and control insertion themselves, rather than letting the penetrating partner do it. Encouraging the couple to add pleasant, sexually exciting experiences to their regular interactions, such as bathing together in which the primary goal is not cleanliness, mutual caressing without intercourse, and using sexual books and pictures. In couples where a woman is preparing to receive vaginal intercourse, such activities tend to increase both natural lubrication and vaginal dilation, both of which decrease friction and pain. Recommending a change in coital position to one admitting less penetration. In women receiving vaginal penetration, this is recommended for those who have pain on deep penetration because of pelvic injury or disease: In women receiving vaginal penetration: maximum vaginal penetration is achieved when the receiving woman lies on her back with her pelvis rolled up off the bed, compressing her thighs tightly against her chest with her calves over the penetrating partner's shoulders. Minimal penetration occurs when a receiving woman lies on her back with her legs extended flat on the bed and close together while her partner's legs straddle hers. A device has also been described for limiting penetration.3 Related conditions Vaginismus Endometriosis References ^ Denny E, Mann CH 2007. Endometriosis-associated dyspareunia: the impact on women's lives. The journal of family planning and reproductive health care / Faculty of Family Planning Reproductive Health Care, Royal College of Obstetricians Gynaecologists 33 3: 189-93. doi:10.1783/147118907781004831. PMID 17609078. ^ Marinoff SC, Turner ML 1991. Vulvar vestibulitis syndrome: an overview. Am. J. Obstet. Gynecol. 165 4 Pt 2: 1228-33. PMID 1659198. ^ Kompanje EJ 2006. Painful sexual intercourse caused by a disproportionately long penis: an historical note on a remarkable treatment devised by Guilhelmius Fabricius Hildanus 1560-1634. Arch Sex Behav 35 5: 603-5. doi:10.1007/s10508-006-9057-z. PMID 17031589. The original text for this article is taken from a public domain CDC document PDF. Sandra Risa Leiblum, Ph.D. Sexual Pain Disorders - Dyspareunia ERRATA Missing citations: American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders 4th ed.. Washington, DC: Author. Bancroft 1989 Human Sexuality and its Problems Churchill Livingstone: London. Bergeron et al. 1997 could be one of these two. Bergeron, S., Binik, Y. M., Khalifé, S., Meana, M., Berkley, K. J., Pagidas, K. 1997. The treatment of vulvar vestibulitis syndrome: Toward a multimodal approach. Sexual and Marital Therapy, 12, 305-311. Bergeron S, Binik YM, Khalifé S, Pagidas K 1997. Vulvar vestibulitis syndrome: a critical review. Clin J Pain 13 1: 27-42. PMID 9084950. Binik YM, Bergeron S, Khalifé S 2000. Dyspareunia, Principles and Practice of Sex Therapy, 3rd ed., New York: The Guilford Press, 154-80. ISBN 1-57230-574-6. Friedrich EG 1987. Vulvar vestibulitis syndrome. J Reprod Med 32 2: 110-4. PMID 3560069. External links Vaginimus Awareness Network - Misdiagnosis: Vaginismus vs Dyspareunia Interstitial Cystitis Network WhenSexHurts - a support community for couples struggling with intimacy due to disability Therapy for Vaginismus v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering v d e Diseases of the pelvis and genitals N40-N99, 600-629 Female Adnexa Ovary Oophoritis · Ovarian cyst · Ovarian hyperstimulation syndrome · Anovulation · Mittelschmerz Fallopian tube Salpingitis · Hydrosalpinx · Hematosalpinx Parametrium Parametritis Uterus Endometrium: Endometriosis Adenomyosis · Endometrial polyp menstruation Amenorrhoea, Anovulation, Hypomenorrhea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea Hematometra · Retroverted uterus · Asherman's syndrome Cervix Cervicitis - Cervical polyp - Nabothian cyst Vagina Vaginitis Bacterial vaginosis, Atrophic vaginitis · Leukorrhea · Hematocolpos/Hydrocolpos intercourse Dyspareunia, Vaginismus Prolapse Cystocele, Rectocele, Urethrocele · Fistulae Vesicovaginal, Rectovaginal Vulva Vulvitis · Bartholin's cyst Other/general Pelvic inflammatory disease · Female infertility Habitual abortion Male Testicular Orchitis · Hydrocele testis · Testicular torsion · Male infertility Azoospermia, Oligospermia Epididymis Epididymitis · Spermatocele · Hematocele Prostate Prostatitis · Benign prostatic hyperplasia Penis Balanoposthitis/Balanitis · Phimosis · Priapism · Sexual dysfunction Erectile dysfunction · Peyronie's disease Other Hematospermia · Retrograde ejaculation See also congenital, neoplasia Retrieved from http://en..org/wiki/Dyspareunia Categories: Gynecology | Sexual and gender identity disorders | Pain Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français í•œêµì–´ Hrvatski Italiano Lietuvių Nederlands Polski Português SlovenÅ¡Ä?ina Svenska This page was last modified on 25 August 2008, at 02:02
39 Reasons to Drink Acai Juice Every Day
What is MonaVie - Watch the 8-minute video
Discovering MonaVie Video
The Power of You Video
Effects of MonaVie Active on Antioxidant Capacity in Humans
Log into your Wholesale MonaVie Account
So many of us do not eat a balanced diet, get enough sleep, have too much stress, or are impacted with toxins and pollutants. Drinking 2 ounces of MonaVie twice a day will help your body detoxify as well as build your immune system. Its the smartest thing you can do for yourself, so start today. Buying MonaVie through our company guarantees you support 7 days a week and, if you would like to share MonaVie with your family and friends we will guide you from start to finish.
1. Click on Enroll Now (30 - 55% off retail price)
2. Pay $39 for your Wholesale ID number.
3. NO minimum order required.
4. MonaVie is delivered to your door in 3 to 5 days.