Sexuality is an action that has always been discussed throughout human history and develops as it is discussed. As a result of women gaining a place in society and questioning their rights, pleasurable, satisfying and painless intercourse has become the desire of every woman. Painful sexual intercourse has been defined as a disease.
What is Dyspareunia?
Dyspareunia can be simply expressed as 'Painful sexual intercourse' or 'Pain during sexual intercourse'. Vaginismus and dyspareunia (painful sexual intercourse) are accepted as diseases as Genital Pelvic Pain and Penetration Disorder in the classification of Female Sexual Function Disorders within the 2014 DSM-5 diagnostic criteria by the American Psychiatric Association.
Health can be defined as a person being in a state of complete physical, spiritual and sexual well-being. Therefore, lack of sexual health is a disease. This condition must be treated for the healthy, satisfactory and regular progress of female sexuality.
Dyspareunia Types
Dyspareunia is divided into two according to the time of occurrence. 'Primary dyspareunia' is a condition that exists since the first relationship and makes it difficult to continue the relationship. 'Secondary dyspareunia' is defined as when intercourse that was previously normal later becomes painful and painful. Both of these are conditions that should be investigated by consulting an experienced gynecologist.
Dyspareunia is divided into two according to the cause of occurrence. While there is no visible problem in psychological dyspareunia, pain occurs due to intense anxiety and fears, and vaginismus is the best example of this.
In dyspareunia of physical origin, there are conditions defined as diseases in the vagina and internal genital organs. These are conditions that can be detected and treated by gynecological examination, such as painful sensitive hymen, vulvar vestibulitis, vaginal infections, and ovarian cysts.
Dyspareunia is also divided into two according to where the pain is felt. In 'superficial dyspareunia', the pain is at the entrance to the vagina. 'Deep dyspareunia' is the pain felt in the groin as a result of full intercourse, mostly due to gynecological problems such as ovarian cysts and myomas.
Dyspareunia in Women Causes
Causes due to psychological and organic reasons lead to dyspareunia. While vaginismus is the most important factor of psychological origin, let's take a closer look at the organic causes.
Vulvar Vestibulitis Syndrome
Vestibulum is the remaining area at the entrance of the vagina, adjacent to the hymen. Vulvar vestibulitis syndrome is an inflammatory condition of this area. Although the cause is not fully known, HPV infection, frequent fungal infections and surgical interventions are blamed. It is considered the most common organic cause of painful sexual intercourse. By touching this area, patients feel as if 'salt has been poured into an open wound and their flesh has been cut with a razor'.
The examination is performed on the gynecological table with a cotton-tipped swab. Touching the red, erythematous areas seen with this eye with a cotton-tipped swab causes instant and serious pain, and the patient expresses this very well. There are medical and surgical methods in treatment. Although many drug treatments have been tried, success is very high with surgical removal of the problematic area.
Vulvovaginitis
The female externalgenital organ is called 'vulva'. is called. 'Vagina' is the tube-shaped, flexible and curved canal that connects the external genital area and the internal genital organs, through which sexual intercourse is performed. Infectious conditions in both areas may cause painful sexual intercourse and sometimes the inability to have sexual intercourse at all.
Lichen Sclerosis Disease
Non-infectious lesions of the vulva. It is an inflammatory disease that is among the inflammatory pathologies. This disease, which can be diagnosed by experienced physicians, causes thinning, atrophy and abrasions on the skin in the vulva area. The inability to have sexual intercourse may be observed due to the pain caused by the inflammatory reaction. Medical treatments and alternative applications are available.
Vaginal Canal Abnormalities
Narrow or short vaginal canal due to birth or subsequent operations. is the situation. In the congenital disease called Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS), the vagina is short or blind and sexual intercourse is impossible. Intercourse may occur after the operation to surgically create a new vagina. Also previous vaginal Dyspareunia develops due to the narrowing of the vaginal canal after genital canal operations and episiotomy repairs in normal births, causing problems in having sexual intercourse.
Inability to Have Sexual Intercourse Due to Menopause
Menopause is one of the most special periods of a woman's life, like adolescence. As the epithelium in the vulva and vagina area atrophy as a result of the decrease in estrogen hormone in the years approaching menopause, vaginal stenosis and dryness begin to occur. The most comfortable period of sexual life, when family planning methods will not be used, may become painful due to this dryness and narrowing. This epithelial loss can be prevented and painful sexual intercourse can be avoided by using an appropriate amount of hormonal therapy during the peri-menopausal period.
Inability to Have Sexual Intercourse Due to Hymen Problems
Hymen. There are structural types of the membrane. They are classified as annular, high-sided, septate, crescent-shaped, sieve-like and fully closed. Imperforate hymen, that is, completely closed hymen, manifests itself in adolescence with amenorrhoea, abdominal swelling and pain, and is surgically opened. Hymens, which have a hard structure with high edges and partitions, may cause painful sexual intercourse.
Ovarian Cysts and Endometriosis Disease
In this case, which is a cause of deep dyspareunia, the diagnosis is usually made by ultrasonography and the complaints regress after treatment. While simple ovarian cysts cause temporary complaints, there are widespread intra-abdominal implants and adhesions in the disease called endometriosis. It forms nodules and causes pain during deep intercourse. Its treatment is surgical and medical approaches.
Pelvic Inflammatory Disease
It is an inflammatory disease of the internal genital organs, namely the uterus, ovaries and tubes. The condition, which is characterized by widespread pain and fever, is recognized and treated by gynecological examination.
Differential Diagnosis of Dyspareunia
The patient who presents with dyspareunia complains of psychological and It is important to make a diagnosis by performing a detailed physical evaluation. After the definitive diagnosis of this multifactorial disease is made, the treatment plan to be applied will be selected. Specialized in this field � The best step to take is to consult a gynecologist and obstetrician.
Treatment of Painful Sexual Intercourse
Treatment methods to be chosen in dyspareunia due to its etiological cause. It is changing. There is a wide range of treatments available, from simple medical treatment to psychotherapy combined with surgery. However, whatever the cause, it should be known that it is a situation that can be overcome with appropriate treatment.
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