STUDY - Technical - New Dacian's Medicine
Dyspareunia
(Classical / Allopathic Medicine)
A major obstacle
to sexual enjoyment, dyspareunia is painful or difficult
coitus. Although most sexually active women occasionally
experience mild dyspareunia, persistent or severe dyspareunia
is cause for concern. Dyspareunia may occur with attempted
penetration or during or after coitus. It may stem from the
friction of the penis against perineal tissue or from the
jarring of deeper adnexal structures. The location of pain
helps determine its cause.
Dyspareunia
commonly accompanies pelvic disorders. However, it may also
result from diminished vaginal lubrication associated with
aging, the effects of certain drugs, or psychological factors
- most notably, fear of pain or injury. A cycle of fear, pain,
and tension may become established in which repeated episodes
of painful coitus condition the patient to anticipate pain,
causing fear, which prevents sexual arousal and adequate
vaginal lubrication. Contraction of the pubococcygeus muscle
also occurs, making penetration still more difficult and
traumatic.
Other
psychological factors include guilty feelings about sex, fear
of pregnancy or of injury to the fetus during pregnancy, and
anxiety caused by a disrupted sexual relationship or by a new
sexual partner. Inadequate vaginal lubrication associated with
insufficient foreplay and mental or physical fatigue may also
cause dyspareunia.
HISTORY:
Ask the patient to describe the pain. Does it occur with attempted penetration or deep thrusting? How long does it last? Is the pain intermittent or does it always accompany intercourse? Ask whether changing the coital position relieves the pain.
Ask the patient about a history of pelvic, vaginal, or urinary infections. Does the patient have signs and symptoms of a current infection?
Ask the patient to describe discharge, if present.
Ask the patient about malaise, fever, headache, fatigue, abdominal or back pain, nausea and vomiting, and diarrhea or constipation.
Obtain a sexual and menstrual history. Determine whether dyspareunia is related to the patient's menstrual cycle. Are her cycles regular? Ask about dysmenorrhea and metrorrhagia. Also, find out what contraceptive method the patient uses.
Ask the patient if she recently had a baby. If so, did she have an episiotomy? Note whether she's breastfeeding. Ask about previous pregnancy, sexual abuse, or pelvic surgery.
Try to determine the patient's attitude toward sexual intimacy. Does she feel tense during coitus? Is she satisfied with the length of foreplay? Does she usually achieve orgasm? Ask about a history of rape, incest, or sexual abuse as a child.
Ask the patient to describe the pain. Does it occur with attempted penetration or deep thrusting? How long does it last? Is the pain intermittent or does it always accompany intercourse? Ask whether changing the coital position relieves the pain.
Ask the patient about a history of pelvic, vaginal, or urinary infections. Does the patient have signs and symptoms of a current infection?
Ask the patient to describe discharge, if present.
Ask the patient about malaise, fever, headache, fatigue, abdominal or back pain, nausea and vomiting, and diarrhea or constipation.
Obtain a sexual and menstrual history. Determine whether dyspareunia is related to the patient's menstrual cycle. Are her cycles regular? Ask about dysmenorrhea and metrorrhagia. Also, find out what contraceptive method the patient uses.
Ask the patient if she recently had a baby. If so, did she have an episiotomy? Note whether she's breastfeeding. Ask about previous pregnancy, sexual abuse, or pelvic surgery.
Try to determine the patient's attitude toward sexual intimacy. Does she feel tense during coitus? Is she satisfied with the length of foreplay? Does she usually achieve orgasm? Ask about a history of rape, incest, or sexual abuse as a child.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Palpate the abdomen for tenderness, pain, or masses and for inguinal lymphadenopathy.
Inspect the genitalia for lesions and vaginal discharge.
Take the patient's vital signs.
Palpate the abdomen for tenderness, pain, or masses and for inguinal lymphadenopathy.
Inspect the genitalia for lesions and vaginal discharge.
SPECIAL
CONSIDERATIONS:
Radiation therapy for pelvic cancer may cause pelvic and vaginal scarring, resulting in dyspareunia.
Radiation therapy for pelvic cancer may cause pelvic and vaginal scarring, resulting in dyspareunia.
PEDIATRIC
POINTERS:
Dyspareunia can be an adolescent problem. Although about 40% of adolescents are sexually active by age 19, most are reluctant to initiate a frank sexual discussion. Obtain a thorough sexual history by asking the patient direct but non-judgmental questions.
Dyspareunia can be an adolescent problem. Although about 40% of adolescents are sexually active by age 19, most are reluctant to initiate a frank sexual discussion. Obtain a thorough sexual history by asking the patient direct but non-judgmental questions.
AGING ISSUES:
In postmenopausal women, the absence of estrogen reduces vaginal diameter and elasticity, which causes the tearing of the vaginal mucosa during intercourse. These tears as well as inflammatory reactions to bacterial invasion cause fibrous adhesions that occlude the vagina. Dyspareunia can result from any or all of these conditions.
In postmenopausal women, the absence of estrogen reduces vaginal diameter and elasticity, which causes the tearing of the vaginal mucosa during intercourse. These tears as well as inflammatory reactions to bacterial invasion cause fibrous adhesions that occlude the vagina. Dyspareunia can result from any or all of these conditions.
PATIENT
COUNSELING:
Encourage the patient to discuss dyspareunia openly. A woman may hesitate to report dyspareunia because of embarrassment and modesty. If an antimicrobial or anti-inflammatory is prescribed, teach her how to apply the cream or insert a vaginal suppository.
Encourage the patient to discuss dyspareunia openly. A woman may hesitate to report dyspareunia because of embarrassment and modesty. If an antimicrobial or anti-inflammatory is prescribed, teach her how to apply the cream or insert a vaginal suppository.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)