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Dyspareunia pain during intercourse

Dyspareunia (pain during intercourse) occurs in both men and women. Often it can be attributed to local pathology and then encoded accordingly. However, in some cases, obvious causes are not detected and emotional factors may be important. This category should be used only if there is no other primary sexual dysfunction (for example, vanigism or vaginal dryness).

Diagnostic criteria:

1) recurring or persistent pain in the genitals, either in men or in women, before, during or after sexual intercourse;
2) the violation is not caused solely by the absence of normal vaginal moisturizing (lubrication) or vaginismus.

Included:
– psychogenic dyspareunia.

Excluded:
– dyspareunia (organic) in women;
– dyspareunia (organic) in men.

There is no exact information about the prevalence of dyspareunia, but it is known, for example, that during surgical operations on the genitalia it occurs in 30% of cases, and among women who are treated at sex-therapy clinics and complained of pain during intercourse, in 30 – 40% of cases, there is a pathology of the pelvic organs (G. Kaplan; B. Sadok, 1994).

According to the NHSLS survey (1994), 14% of women and 3% of men reported pain during sexual intercourse for several months or more in the previous year. In the USA, dyspareunic complaints are noted in 46% of women aged 18–45 years who go to gynecologists and family doctors (D.J. Jamieson, J.F. Steege, 1996). In the US, patients with complaints of pain associated with sexual intercourse, up to 30% of women seeking sexological assistance. According to researchers, in 48% of women who report pain during intercourse, the frequency and rhythm of sexual intercourse is reduced, and in 33.7%, family relationships are disturbed against this background. (A.E. Glatt, S.H. Zinnner, W.M. McCormic, 1990).
Female dyspareunia is most often caused by various organic factors. Any reason leading to a decrease in lubrication can cause discomfort during coitus. So, dryness of the mucous membrane of the vagina causes the intake of antihistamines, some tranquilizers and tricyclic antidepressants, a number of diseases (diabetes, bacterial vaginitis, etc.). Other causes of female dyspareunia include:

skin lesions (blistering, rash, inflammation) around the entrance to the vagina or on the vulvar mucosa; irritation or inflammatory diseases of the clitoris; pathology of vaginal entry due to scarring after episiotomy; painful remnants of the hymen; damage to the urethra or anus; vaginal pathology as a result of infectious diseases, surgical scars; atrophy of the vaginal walls due to estrogen deficiency or the use of local chemical contraceptives; damage to the ligaments of the uterus; tumors or inflammatory diseases of the pelvic organs (W. Masters, W. Johnson, 1983). If pain during sexual intercourse has a somatic basis, the condition is classified as dyspareunia (organic) in women (N94.1). It must be borne in mind that the original organic symptom can be maintained by the neurotic mechanism of secondary benefits, which for women is the ability to avoid unwanted sexual intercourse or at least limit it (S. Kratochvil, 1982).

Dyspareunia can be based on a strong dislike or physical disgust for a partner, who nevertheless insists on sexual contact. In these cases, dyspareunia is secondary, and the main disorder is sexual aversion.

Psychogenic dyspareunia is possible in women who have been sexually abused, including in childhood. Coitus pain can be the result of emotional stress and anxiety regarding sexual intercourse, which causes a woman to involuntarily contract the muscles of the vagina (G. Kaplan, B. Sadoc, 1994). Usually in such cases there are serious problems in the relationship with a relevant partner, or there is an intrapsychic conflict between sexual desire and the unacceptability of its realization in an intimate relationship with a particular man (for example, in a situation of adultery of one or both partners, which causes a strong sense of guilt in a woman).

According to K. Imielinsky (1986), dyspareunia, which arose during sexual intercourse with one partner, can create a predisposition for its appearance and with another partner. Prolonged dyspareunia is the starting point for the development of secondary neurotic reactions and the loss of interest in sex life.
A.I. Fedorova (2007) developed a clinical and pathogenetic classification of female dyspareunia. She identifies her three main forms:
I. Organic dyspareunia, which is caused by structural changes in the genitourinary sphere and the system innervating it, caused by various pathological processes (inflammatory, atrophic, scar-adhesive, endometrioid, traumatic, etc.).
Ii. Psychogenic dyspareunia. It is actually sexual dysfunction, in which the leading cause of pain associated with sexual intercourse is a psychogenic factor.
Iii. Mixed dyspareunia is the result of a combination of initially developed organic dyspareunia with various psychogenic factors affecting the perception of pain, the formation of pain and sexual behavior, and supporting and intensifying dyspareunic complaints.

According to A.I. Fedorova, psychogenic dyspareunia, in turn, can be divided into conversion and psychosomatic. Conversion psychogenic dyspareunia is regarded by her as a psychogenic violation of bodily function in the context of hysterical disorders. It makes sense not to accept the existing sexual partner, the very fact of sexual relations or their specific existing stereotype, embodied in the pain of sexual intercourse. Psychological conflict and its consequence (inadequate perception of sexual intercourse) are often caused by irrational attitudes regarding the sexual aspects of life, formed during the period of psychosexual development. Pain symptoms are the result of an objective or subjective inability to change the situation. It should be borne in mind that pain is the most psychologically and socially acceptable reason for a woman to abandon unwanted sex. This allows us to speak about a certain “rent” of this form of dyspareunia. Pain symptoms are localized more often in the area of ​​the entrance to the vagina or in the projection of the uterus. Since the conversion mechanisms involved are limited only to the sensory-motor sphere and lead, as a rule, to reversible functional disorders, the morphological changes in the genitalia do not appear or do not correspond to the nature and localization of pain.

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