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Dryness Of Vagina During Intercourse

Sexual aversion disorder & female sexual arousal disorder are: Lack of enjoyment during intercourse
Dryness of vagina during coitus is also called female sexual excitation & arousal disorder, there is minimal vaginal lubrication or no lubrication at all during sexual excitation as well as absence of feeling of excitation. This absence of lubrication/absence of secretion can lead to sexual aversion disorder & female sexual arousal disorder and to painful intercourse.  Many women complain of difficulty in getting excited. Many of such women complain of absence of orgasm & sex may be even be painful. It can be from beginning of sexual life or may start later in life. In some females it is observed that sexual arousal is absent with one partner whereas it is normal with other partner.

VARIOUS CAUSES OF DRYNESS OF VAGINA DURING INTERCOURSE
Arrow Hormones Disorder: Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies), Hypogonadisms, Hypothyroidisms, Testosterone deficiency, Hyperprolactinemias, Hypogonadotropics states: Hypothalamic – pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Ovarian Dysfunctions. Untreated endocrinopathies & Diabetics, Glucocorticoids excess, Cushings disease, Addisons disease

Arrow Chronic infection like vulvo-vaginitis  and chronic urethritis.
Arrow It may also occur following any previous painful penetration of penis i.e. painful sexual intercourse or painful entry of some other object as painful examination of vagina by doctor with some instrument or by some trauma.
Arrow Alcohol or drug addiction, chronic smoker, heroin or cannabis use can lead to this
Arrow Some medication like Sedatives: Narcotics, tranquillizers, amphetamine, cocaine, many antidepressant and anti-psychotics, anti -hypertensives, some anti diabetics.
Arrow Psychiatric diseases like  depression, anxiety neurosis, &  other psychiatric disorders.
Arrow Any sexual dysfunction in man can also lead to non-enjoyment of sexual act by female.
Arrow Any cause of painful sexual intercourse (as due to vaginismus or dyspaerunia) will also lead to secondary loss of excitation in women whether married or unmarried.
Arrow Various medical conditions can lead to decreased blood supply to vagina due to which there is decreased vaginal lubrication and lead to pain during intercourse
Arrow Infections: in genital tract or vulvae vestibule, vulvo-vaginitis
Arrow Less lubrication due to various reasons as hormone deficiency
ArrowSome connective tissue disorders lead to vaginal dryness
Arrow Sicca syndrome
Arrow Idiopathic
Arrow Any ulcerative lesions of vagina as chronic lichen planus, herpese genitals, Pemphigus vulgaris of vagina
Arrow Vulvar vestibulitis
ArrowInadequate sexual information, Restrictive upbringing, early insecurity in psychosexual role
Arrow Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum
Arrow Idiopathic vulvodynia
Arrow Disorders of sex centre: In the brain there is a particular center in the hippocampus part of fore brain, which regulates the desire of sex. Sex center has some well-defined portion, which control different component of normal sexuality These are as follows as one part of sex center controls sexual desire other parts controls excitation i.e. lubrication in response to sexual excitation, time taken in orgasm & enjoyment of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to dryness of vagina during intercourse in response to sexual stimuli. This occurs due to arousal & excitation-controlling portions of sex center does not work properly so that inspite of \not having any physical or mental disorders the patient does not gets sexually excited. Beside absent excitation patient may be sexually otherwise be fit or may be suffering with some other sexual disorder.
The causes of sex centre dysfunction can be divided into two groups:
Arrow Immediate Cause
Arrow Remote Causes.
Such a classification is helpful in the treatment of absent excitation. If the absent excitation & arousal is due to immediate causes, a removal of these factors results in adequate excitation & lubrication & enjoyment by women. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure.

DIAGNOSIS OF CAUSE
Onset: Detailed history is taken, for duration of absence of sexual excitation & arousal whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. Response of previous treatment! Response to previous therapy, pain during sex. Any history of stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

EXAMINATION OF GENITALS
We examine whether any Sexual Development defect is present or not. The vagina is examined for some local problem. If the vaginal examination is very painful with accompanied spasm is proof of the some local cause. Female hormone level is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of vagina is assessed by, palpating texture of vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes. Then other systems of body are also examined.

DIAGNOSTIC TESTS
The various diagnostic tests needed/performed are as follows: – 
Arrow Complete sex hormones profile like Estradiol, SHBG etc.
Arrow Thyroids function test
Arrow Serum prolactins
Arrow Androgen levels
Arrow Investigation for systemic diseases
Arrow Other tests
Arrow Detailed Sex Counseling: Talking in detail resulting in detection of primary cause leading to absence of sexual excitation & arousal.
Arrow Biochemistry Tests as liver function or kidney function tests may be required.

TREATMENT
Arrow Hormone therapy: When female sex hormone deficiency is found or disorder of other glands, correction of hormone dysfunction is done. Hormone therapy is very effective in curing dryness of vagina during intercourse, when hormone is the cause for absence of sexual excitation & arousal. It is given in the form of oral tablets. Skin cream, local application of gels. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sexual excitation in many patients in whom no hormone disorder is found,
Arrow Sex therapy is offered in which we teach the patient about the various techniques in such a way that it increase the enjoyment of body touch better excitation & arousal in female. This leads to good lubrication of vagina thus women enjoys the sex more pleasurable. Due to this more enjoyment of sex leads to women getting orgasm more often. All this improves the dryness of vagina during intercourse as well as enjoyment of sex.
Arrow Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results.
Arrow Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in sexual excitation & arousal.
Arrow Treatment of psychiatric disorder are diagnosed & treated.
Arrow Oral supplement of DHEAS is also effective.
Arrow Treat other systemic disease when they are detected.

RESPONSE OF TREATMENT
After appropriate drug therapy, sex education & sex therapy patient recover almost in two months time. The dryness of vagina during intercourse of patient recovers. After return of dryness of vagina during intercourse to normal her family relationship also normalizes.

SIDE EFFECTS
It has no side effects if given in proper doses and in-patients when it is really indicated. This it is absolutely safe when given by our qualified doctors, in proper doses.

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