DOCSLIB.ORG

Endometriosis-Associated Dyspareunia: the Impact on Women’S Lives Elaine Denny, Christopher H Mann

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endometriosis-Associated Dyspareunia: the Impact on Women’S Lives Elaine Denny, Christopher H Mann ARTICLE J Fam Plann Reprod Health Care: first published as 10.1783/147118907781004831 on 1 July 2007. Downloaded from Endometriosis-associated dyspareunia: the impact on women’s lives Elaine Denny, Christopher H Mann Abstract pain was found to limit sexual activity for the majority of the sample, with a minority ceasing to be sexually active. Background and methodology Endometriosis is a Lack of sexual activity resulted in a lowering of self- chronic condition in which endometrial glands and esteem and a negative effect on relationships with stroma are present outside of the uterus. Whereas partners, although the experience differed between chronic pelvic pain is the most commonly experienced younger and older women. pain of endometriosis, many women also suffer from deep dyspareunia. In order to determine how much of an Discussion and conclusions The experience of impact endometriosis-associated dyspareunia has on dyspareunia is a significant factor in the quality of life and the lives and relationships of women a qualitative study relationships for women living with endometriosis. For using semi-structured interviews, supplemented with most of the women in the study it was very severe and quantitative data on the extent of dyspareunia, was resulted in their reducing or curtailing sexual activity. conducted in a dedicated endometriosis clinic in the Qualitative research can produce salient data that West Midlands, UK with 30 women aged from 19 to 44 highlight the impact of dyspareunia on self-esteem and years. sexual relationships. Results The main outcome measures were the extent of Keywords dyspareunia, endometriosis, qualitative dyspareunia within the sample of women, and the impact research, quality of life, sexual relationships of dyspareunia on quality of life. The experience of dyspareunia was found to be higher than in previous J Fam Plann Reprod Health Care 2007; 33(3): 189–193 research. Three main themes emerged. The experience of (Accepted 12 October 2006) Introduction Endometriosis is a chronic condition in which endometrial Key message points glands and stroma are present outside of the uterus. This G Dyspareunia is a more common symptom of abnormal tissue is most commonly, but not exclusively, endometriosis than previously reported. found in the abdominal cavity. The cyclical hormonal G The experience of dyspareunia has an impact on quality influence of progesterone and oestrogen on these of life and relationships for women. endometrial deposits causes activation of the tissue, G The importance placed upon the consequent avoidance leading to the typical symptom of pain.1 The frequency of of sexual activity varies among women. diagnosis of endometriosis has increased over the last 15–20 years.2 However, this may not reflect a rise in the true incidence of the condition, rather in the methodology been a common finding in previous studies on employed in diagnosing the condition, as this increase in endometriosis and chronic pelvic pain.4–8 Ferraro et al.4 the number of cases diagnosed coincided with the used a sexual function questionnaire in order to introduction of laparoscopy for the direct confirmation of characterise sexual functioning among women, and http://jfprhc.bmj.com/ the presence of endometrial tissue in the abdomen.3 It is found that women with endometriosis experienced also thought that later and less frequent childbearing, with higher prevalence of deep dyspareunia than controls a consequent increase in menstrual cycles, theoretically (60.6% of the sample compared with 34.9% of controls), presents more opportunity for endometrial tissue to implant and women with disease of the uterosacral ligaments had outside the uterus.2 higher prevalence than those with endometriosis in other The true prevalence of this disease is unknown, but it sites. Intensity of pain in Ferraro et al.’s study was is usually estimated to be present in between 5% and assessed using a visual analogue scale. The same authors 15% of women of reproductive age.2 Whereas chronic also found that women with endometriosis have on September 27, 2021 by guest. Protected copyright. pelvic pain is the most commonly experienced type of frequently experienced deep dyspareunia throughout pain in endometriosis, many women also suffer from their entire sexually active lives. deep dyspareunia4 (deep pelvic pain associated with Fauconnier et al.5 utilised medical records and sexual intercourse). The symptom of dyspareunia has descriptions of the findings at the time of surgery in order to gauge the relationship between the anatomic location of deeply infiltrating endometriotic lesions and nature and severity of pain symptoms. The retrospective data analysis Faculty of Health, University of Central England, of Fauconnier et al.’s study found that 78.6% of women Birmingham, UK experienced dyspareunia, and it also showed that deep Elaine Denny, PhD, Head of Health Policy and Public Health dyspareunia was associated with endometriotic lesions in Division the uterosacral ligaments. This finding was also reported by Birmingham Women’s Hospital, Birmingham, UK Porpora et al.6 in their study considering the correlation Christopher H Mann, MD, Senior Lecturer in Gynaecological between endometriosis and pelvic pain, but Vercellini,7 Oncology who considered whether prevalence and severity of pain Correspondence to: Professor Elaine Denny, Department of are related to endometriosis stage and site, found that deep Community Health and Social Work, Health Policy and Public dyspareunia was associated more with vaginal Health Division, University of Central England, Perry Barr, endometriosis. Most of the current literature does not, Birmingham B42 2SU, UK. E-mail: [email protected] however, have dyspareunia as its primary focus, but ©FFPRHC J Fam Plann Reprod Health Care 2007: 33(3) 189 Denny and Mann J Fam Plann Reprod Health Care: first published as 10.1783/147118907781004831 on 1 July 2007. Downloaded from Table 1 Characteristics of the study sample the interviews. It allowed them to communicate the complexities of their lives and also enabled them to set Characteristic Value parameters around what they were prepared to reveal.10 This type of qualitative research is particularly useful if Average age in years (range) 31 (19–44) 11 Socioeconomic status experience and subjectivity are actively sought, and for Social class 1–3 27 researching sensitive issues such as sexual function. Semi- Social class 4–5 3 structured interviews took place in a location chosen by the Marital status woman, or acceptable to her, and all the interviews were Married/cohabiting 20 taped-recorded with the permission of the participants. Single 10 Sexual orientation Women were initially invited to tell their story of living Heterosexual 30 with endometriosis from the time at which they first Homosexual 0 experienced symptoms of endometriosis. Fourteen women Women with children (n) 11 (plus two pregnant spontaneously discussed painful sexual intercourse at this at interview) Parity (range) 1–3 time. Follow-up questions by the researcher expanded on Ethnicity the issues raised by participants, and introduced the White British 27 concept of dyspareunia to those women who had not Afro-Caribbean British 1 mentioned it originally. Indo-Caribbean 1 South American Indian 1 All interviews were transcribed verbatim. Rigour in the Average time from symptoms to 5.65 (1–18) research process was achieved by sending women a diagnosis in years (range) transcript of their interview and asking them to confirm its veracity, and by both researchers being involved in the interpretation and analysis of data, and in the generation of research into other aspects of endometriosis frequently key themes. finds that deep dyspareunia is a common theme in the experience of endometriosis. For example, Momoeda et Ethical approval al.8 found that the frequency of dyspareunia increased with Ethical approval for this study was obtained from the disease stage in women with endometriosis whose primary University of Central England Faculty of Health Ethics complaint was either chronic pelvic pain or infertility. Committee and South Birmingham Research Ethics All of the studies cited above used quantitative Committee. methodology to correlate dyspareunia with the site of endometriosis. One of these studies was also retrospective Analysis and utilised medical records in order to obtain data.5 The As a storytelling approach was utilised for the collection of data, narrative analysis was considered most appropriate, study reported here is primary research, and although 9 primarily qualitative in order to assess how much of an the specific model used being thematic analysis. This impact the experience of deep dyspareunia has on the began with intensive reading and re-reading of interview quality of life in women with endometriosis, it also transcripts, which was carried out independently by both gathered quantitative data to gauge the extent of the authors. It resulted in the generation of themes, and also a problem. framework by which to classify the data. Common themes and divergent cases were elicited and explored. Rigour in Methodology the analytical process was achieved by both authors Sample independently analysing the data and agreeing the The sample was recruited from women attending a emergent themes. Rigour was increased by the involvement dedicated endometriosis outpatient clinic. The sole of the women in the sample in confirming the veracity of http://jfprhc.bmj.com/ criterion for inclusion was laparoscopically diagnosed data from their own interview, and agreeing the relevance endometriosis, and this was confirmed in all 30 cases by of themes. the same surgeon macroscopically, and by histological examination of biopsy samples. It therefore constituted a Results purposive sample. Women who met the criterion were Reported incidence of dyspareunia invited to participate and given an information leaflet to It was found that dyspareunia was experienced by 23 take home. They were telephoned a week later to confirm (86%) of the valid sample (i.e. those 27 women out of the participation and written consent was obtained before total study cohort who were sexually active) (Table 2).
Load more

Recommended publications
  • Dyspareunia: an Integrated Approach to Assessment and Diagnosis
    PROBLEMS IN FAMILY PRACTICE Dyspareunia: An Integrated Approach to Assessment and Diagnosis Genell Sandberg, PhD, and Randal P. Quevillon, PhD Seattle, Washington, and Vermillion, South Dakota Dyspareunia, or painful intercourse, is frequently referred to as the most common female sexual dysfunction. It can occur singly or be manifested in combination with other psychosexual disorders. Diagnosis of dyspareunia is appropriate in cases in which the experience of pain is persistent and severe. There has been little agreement concerning the origin of dyspareunia. Or­ ganic conditions and psychological variables have alternately been pre­ sented as major factors in causality. There is a presumed high incidence of physical disease associated with dyspareunia when compared with other female sexual dysfunctions. In the majority of cases, however, organic fac­ tors are thought to be rare in contrast with sexual issues and interpersonal or intrapsychic difficulties as a cause of continuing problems. The finding of an organic basis for dyspareunia does not rule out emotional or psychogenic causes. Thorough and extensive gynecologic and psycholog­ ical evaluation is essential in cases of dyspareunia. The etiology of dys­ pareunia should be viewed on a continuum from primarily physical to primar­ ily psychological with many women falling in the middle area. recurrent pattern of genital pain during or im­ Dyspareunia and vaginismus are undeniably linked, A mediately after coitus is the basis for the diagnosis and repeated dyspareunia is likely to result in vaginis­ of dyspareunia.1 The Diagnostic and Statistical Man­ mus, as vaginismus may be the causative factor in ual of Mental Disorders (DSM-III)2 has included dys­ dyspareunia.6-7 The difference between vaginismus pareunia under the classification of psychosexual dis­ and dyspareunia is that intromission is generally pain­ orders.
    [Show full text]
  • Pelvic Inflammatory Disease (PID) PELVIC INFLAMMATORY DISEASE (PID)
    Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Pelvic Inflammatory Disease (PID) PELVIC INFLAMMATORY DISEASE (PID) SCOPE RNs (including certified practice RNs) must refer to a physician (MD) or nurse practitioner (NP) for all clients who present with suspected PID as defined by pelvic tenderness and lower abdominal pain during the bimanual exam. ETIOLOGY Pelvic inflammatory disease (PID) is an infection of the upper genital tract that involves any combination of the uterus, endometrium, ovaries, fallopian tubes, pelvic peritoneum and adjacent tissues. PID consists of ascending infection from the lower-to-upper genital tract. Prompt diagnosis and treatment is essential to prevent long-term sequelae. Most cases of PID can be categorized as sexually transmitted and are associated with more than one organism or condition, including: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) Trichomonas vaginalis Mycoplasma genitalium bacterial vaginosis (BV)-related organisms (e.g., G. vaginalis) enteric bacteria (e.g., E. coli) (rare; more common in post-menopausal people) PID may be associated with no specific identifiable pathogen. EPIDEMIOLOGY PID is a significant public health problem. Up to 2/3 of cases go unrecognized, and under reporting is common. There are approximately 100,000 cases of symptomatic PID annually in Canada; however, PID is not a reportable infection so, exact
    [Show full text]
  • 3-Year Results of Transvaginal Cystocele Repair with Transobturator Four-Arm Mesh: a Prospective Study of 105 Patients
    Arab Journal of Urology (2014) 12, 275–284 Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com ORIGINAL ARTICLE 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients Moez Kdous *, Fethi Zhioua Department of Obstetrics and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia Received 27 January 2014, Received in revised form 1 May 2014, Accepted 24 September 2014 Available online 11 November 2014 KEYWORDS Abstract Objectives: To evaluate the long-term efficacy and safety of transobtura- tor four-arm mesh for treating cystoceles. Genital prolapse; Patients and methods: In this prospective study, 105 patients had a cystocele cor- Cystocele; rected between January 2004 and December 2008. All patients had a symptomatic Transvaginal mesh; cystocele of stage P2 according to the Baden–Walker halfway stratification. We Polypropylene mesh used only the transobturator four-arm mesh kit (SurgimeshÒ, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. ABBREVIATIONS The patients’ characteristics and surgical variables were recorded prospectively. The VAS, visual analogue anatomical outcome, as measured by a physical examination and postoperative scale; stratification of prolapse, and functional outcome, as assessed by a questionnaire TOT, transobturator derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic tape; Floor Impact Questionnaire and the Pelvic Organ Prolapse–Urinary Incontinence- TVT, tension-free Sexual Questionnaire, were considered as the primary outcome measures. Peri- vaginal tape; and postoperative complications constituted the secondary outcome measures. TAPF, tendinous arch Results: At 36 months after surgery the anatomical success rate (stage 0 or 1) was of the pelvic fascia; 93%.
    [Show full text]
  • Necrotizing Fasciitis Complicating Female Genital Mutilation: Case Report Abdalla A
    EMHJ • Vol. 16 No. 5 • 2010 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale Case report Necrotizing fasciitis complicating female genital mutilation: case report Abdalla A. Mohammed 1 and Abdelazeim A. Mohammed 1 Introduction Case report On examination the she was very ill; she had a temperature of 40.2 ºC, pulse Necrotizing fasciitis is a deep-seated in- A 7-year-old girl presented to Kas- of 104 beats per minute and blood pres- fection of the subcutaneous tissue that sala New Hospital on 2 March 2005 sure of 90/60 mmHg. There was exten- results in the progressive destruction of with high fever following FGM. The sive perineal and anterior abdominal fascia and fat; it easily spreads across the procedure had been done 7 days prior wall necrosis (Figure 1). The left labium fascial plane within the subcutaneous to admission in a mass female genital majus, the lower three-quarters of the tissue [1]. It begins locally at the site of cutting in the village during the first left labium minus and most of the mons the trauma, which may be severe, minor week of the school summer vacation. pubis were eaten away. The clitoris was or even non-apparent. The affected After the cutting, a herbal powder was preserved. There was extensive loss of skin becomes very painful without any applied to the wound. No antibiotic skin and subcutaneous fat of the right grossly visible change. With progression was given. During that period she ex- inguinal region. Superficial skin ulcera- of the disease, tissues become swollen, perienced high fever and difficulty in tion reached the umbilicus.
    [Show full text]
  • Painful Sex (Dyspareunia) Labia Majora a Guide for Women Labia Minora 1
    Clitoris Painful Sex (Dyspareunia) Labia majora A Guide for Women Labia minora 1. What is dyspareunia? Perineum 2. How common is dyspareunia? 3. What causes dyspareunia? 4. How is dyspareunia diagnosed? 5. How is dyspareunia treated? These issues may start suddenly or occur gradually over a period of time and may be traced back to an event such as What is dysperunia? a previous infection. Additionally, certain disorders of the Dyspareunia, or female sexual pain, is a term used to describe urethra (the tube through which urine is emptied from the pelvic and/or vaginal pain during intercourse. The duration of bladder) can cause significant pain involving the vagina. Ex- the pain can be limited to the duration of intercourse but may last amples include urethritis (inflammation/pain in the urethra, for up to 24 hours after intercourse has finished. The duration sometimes caused by sexually transmitted diseases) and of symptoms varies widely and sometimes can be traced back urethral diverticulum (a weakness in the wall of the urethra to a specific time or event. It is often difficult to diagnose the which forms a pocket in which urine can be trapped). exact source of discomfort (muscular, vascular, foreign bodies, • Musculoskeletal issues. At times, women will describe a surgery, trauma, aging, emotional) as well as to implement the pain like being ‘stabbed in the vagina’ or chronic soreness. correct treatment options. This can be related to increased tension of the pelvic floor musculature so that it cannot properly relax. This phenom- How common is dyspareunia? enon (levator spasm) can cause constant or intermittent pain Dyspareunia is common but probably under-reported.
    [Show full text]
  • Sexually Transmitted Diseases Treatment Guidelines, 2015
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Sexually Transmitted Diseases Treatment Guidelines, 2015 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Gonococcal Infections ...................................................................................... 60 Methods ....................................................................................................................1 Diseases Characterized by Vaginal Discharge .......................................... 69 Clinical Prevention Guidance ............................................................................2 Bacterial Vaginosis .......................................................................................... 69 Special Populations ..............................................................................................9 Trichomoniasis ................................................................................................. 72 Emerging Issues .................................................................................................. 17 Vulvovaginal Candidiasis ............................................................................. 75 Hepatitis C ......................................................................................................... 17 Pelvic Inflammatory
    [Show full text]
  • Incidence and Prevalence of the Sexual Dysfunctions in Infertile Women
    Incidence and Prevalence of the Sexual Dysfunctions in Infertile Women Naeimeh Tayebi1, Seyed Mojtaba Yassini Ardakani2 1 Medical Doctor, Clinical and ABSTRACT Research Center for Infertility, Shahid Sadoughi University. Yazd, Aim: The aim of this study was to assess the degree of sexual Iran. dysfunction among infertile women and its correlation with age, duration of marriage and etiology of infertility in women. 2 Assistant Professor of Psychiatry, Research & Clinical Center for Methods: 300 infertile women who were referred to IVF center Infertility, Shahid Sadoughi University for management of their infertility problem involved in this study of Medical Science, Yazd, Iran. Eur J Gen Med 2009;6(2):74-77 after inform consent. They are asked to fill a questionnaire con- tained three part of demographic, infertility and sexual function items. Distribution of sexual dysfunction and its relationship to infertility and marriage duration were analyzed through Chi-square taest. Results: The most common sexual dysfunction was orgasm disorder (83.76%) and the rate of sexual desire disorder, dyspareunia and vaginismus were 80.7%, 67.7% and 76.7% respectively. More than of 50% of cases mentioned decreased frequency of coitus after diagnosis of infertility. Vaginismus and dyspaereunia were more common in 20-24 years age group. Conclusion: According to the high rate of sexual dysfunction in this study and almost the same rate in other studies, it is the time that gynecologists should pay more attention to this impor- tant issue and encourage the patients to have an evaluation by a psychiatrist or psychologist Keywords: Sexual dysfunction, Infertility. Corresponding author: Naeimeh Tayebi, Email: [email protected], Address: Research & Clinical Center for Infer- tility, Bouali Ave, Safayeh, Yazd, Iran 74 European Journal of General Medicine Tayebi et al.
    [Show full text]
  • Risk Profile of Qatari Women Treated for Infertility in a Tertiary Hospital: a Case- Control Study Sarah Musa1 and Sherif Osman2,3*
    Musa and Osman Fertility Research and Practice (2020) 6:12 https://doi.org/10.1186/s40738-020-00080-5 RESEARCH ARTICLE Open Access Risk profile of Qatari women treated for infertility in a tertiary hospital: a case- control study Sarah Musa1 and Sherif Osman2,3* Abstract Background: Female infertility is a multifactorial condition constituting a worldwide public health problem. The ability to reproduce is an important product of any marriage, hence infertility may exert a negative impact on physical, financial, social and emotional wellbeing of affected couples. The cornerstone to the management of any disease, including infertility, is prevention. Identifying the modifiable risk factors of female infertility will aid at prevention, early detection, and treatment of medical conditions that can threaten fertility as well as promoting healthy behaviours that can preserve it. Aim: To explore the risk profile of infertility among Qatari women and compare risk factors distribution among primary vs. secondary infertility. Methodology: A hospital-based case control study was conducted from September 17th, 2017- February 10th, 2018. Cases (n = 136) were enrolled from infertility clinic and controls (pregnant women, n = 272), were enrolled from antenatal clinic, Women Hospital, Hamad Medical Corporation (HMC). Interview questionnaire was utilized to collect data about sociodemographic, risk factors related to infertility and patient health Questionnaire (PHQ)-2. Body Mass Index (BMI) was calculated. Logistic regression was used to identify the
    [Show full text]
  • Pathogenesis of Endometriosis: the Origin of Pain and Subfertility
    cells Review Pathogenesis of Endometriosis: The Origin of Pain and Subfertility Teresa Mira Gruber 1 and Sylvia Mechsner 2,* 1 Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353 Berlin, Germany; [email protected] 2 Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Endometriosis Centre Charité, Department of Gynaecology, Augustenburger Platz 1, 13353 Berlin, Germany * Correspondence: [email protected] Abstract: Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infer- tility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions. Keywords: endometriosis; adenomyosis; pain; infertility; pathophysiology; inflammation; ovarian Citation: Gruber, T.M.; Mechsner, S. Pathogenesis of Endometriosis: The reserve Origin of Pain and Subfertility. Cells 2021, 10, 1381. https://doi.org/ 10.3390/cells10061381 1. Pathogenesis of Endometriotic Lesions Academic Editors: Domenica Lorusso EM is defined by endometrial tissue-like lesions that occur outside the uterine cavity.
    [Show full text]
  • The Perils of Penile Enhancement: Case Report of a Fulminant Penile Infection Nicole Wen Mun Khor1,2* , Ankur Dhar1 and Alistair Cameron‑Strange1,2
    Khor et al. BMC Urol (2021) 21:115 https://doi.org/10.1186/s12894-021-00878-5 CASE REPORT Open Access The perils of penile enhancement: case report of a fulminant penile infection Nicole Wen Mun Khor1,2* , Ankur Dhar1 and Alistair Cameron‑Strange1,2 Abstract Background: Penile enhancement with injectable agents is a rising trend and yet has received little scientifc atten‑ tion despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile fller insertion leading to multi‑organ failure and intensive care support. Case presentation: A 31‑year‑old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic fller injections at a cos‑ metic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superfcial abrasion on the distal ventral penile shaft. Within 24 h the patient devel‑ oped septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fllers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intra‑ operatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight.
    [Show full text]
  • Evaluation and Differential Diagnosis of Dyspareunia LORI J
    PROBLEM-ORIENTED DIAGNOSIS Evaluation and Differential Diagnosis of Dyspareunia LORI J. HEIM, LTC, USAF, MC, Eglin Air Force Base, Florida Dyspareunia is genital pain associated with sexual intercourse. Although this con- dition has historically been defined by psychologic theories, the current treatment O A patient infor- approach favors an integrated pain model. Identification of the initiating and pro- mation handout on dyspareunia, written mulgating factors is essential to reaching a successful diagnosis. The differential by the author of this diagnoses include vaginismus, inadequate lubrication, atrophy and vulvodynia article, is provided (vulvar vestibulitis). Less common etiologies are endometriosis, pelvic congestion, on page 1551. adhesions or infections, and adnexal pathology. Urethral disorders, cystitis and interstitial cystitis may also cause painful intercourse. The location of the pain may be described as entry or deep. Vulvodynia, atrophy, inadequate lubrication and vaginismus are associated with painful entry. Deep pain occurs with the other con- ditions previously noted. The physical examination may reproduce the pain, such as localized pain with vulvar vestibulitis, when the vagina is touched with a cotton swab. The involuntary spasm of vaginismus may be noted with insertion of an examining finger or speculum. Palpation of the lateral vaginal walls, uterus, adnexa and urethral structures helps identify the cause. An understanding of the present organic etiology must be integrated with an appreciation of the ongoing psycho- logic factors and negative expectations and attitudes that perpetuate the pain cycle. (Am Fam Physician 2001:63:1535-44,1551-2.) Members of various yspareunia is genital pain ex- Epidemiology family practice depart- perienced just before, during ments develop articles There are few reports of clinical trials relat- 1 for “Problem-Oriented or after sexual intercourse.
    [Show full text]
  • Female Dyspareunia
    Female dyspareunia Aldo Campana Training Course in Sexual and Reproductive Health Research Geneva, February 2009 Female dyspareunia • Terms and definitions • Prevalence • Etiology • Evaluation and differential diagnosis • Therapy • Research Terms and definitions • Dyspareunia • Vaginismus • Vulvodynia Dyspareunia - Definitions • Painful sexual intercourse. • Nonorganic (psychogenic) dyspareunia: dyspareunia (or pain during sexual intercourse) occurs in both women and men. It can often be attributed to local pathology and should then properly be categorized under the pathological condition. This category is to be used only if there is no primary nonorganic sexual dysfunction (e.g. vaginismus or vaginal dryness). Excludes: dyspareunia (organic) (ICD-101). • Genital pain experienced just before, during or after sexual intercourse (ACOG2). • Recurrent genital pain occurring during, before, or after sexual intercourse in either the male or the female (MeSH3). • Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female. The disturbance causes marked distress or interpersonal difficulty. The disturbance is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (DSM–IV-TR4). • Persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse (Basson et al, 20045). 1. World Health Organization. ICD-10: International statistical classification of diseases and related health problems. Geneva: World Health Organization; 1992. 2. American College of Obstetricians and Gynecologists. Sexual dysfunction. Technical bulletin no. 211. Washington, D.C.: ACOG,1995.
    [Show full text]