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Pain During Intercourse

THE CAUSES OF PAIN DURING INTERCOURSE MAY BE DUE TO
Dyspaerunia
Vaginismus

DYSPAERUNIA
The pain due to Dyspaerunia may occur repeatedly either before, during, or after sexual intercourse. It is one of the common problems in women. It can be primary or secondary, it may also be classified superficial or deep, or as diffuse with every partner or situational i.e. with particular partner. In one study approximately 9% women suffer with pain during sex. In many cases it disturbs the family life also. This vaginal/ genital pain may occur due to various below mentioned causes.

HOW COMMON ERECTILE DISORDER IS?
In a survey in USA (1994) 39% of 40 Yr. old men, 67% of 70 Yr. old men complained of some degree of impotency. Complete erectile failures were present in 5% at age of 40 Yr., 15% at age 70 Yr. In India 1 in every 10 men suffers from some degree of impotence.

CAUSES MAY BE
arrow Hormone disorder: In which female hormones are less some other sex stimulating hormone are disturbed. These hormone disorders may be due to any of the following causes: Hypothalmic idiopathic hypogonadotropic hypogonadism, Prolactinomas, Empty sella, Sheehan syndrome, Panhypopituitarism, Inflammatory /infiltrative
arrow Ovarian lesions : Granulosa-theca cell, Brenner, mucinous/serous cystadenomas, Krukenberg. mumps oophoritis, Resistant ovary (Savage syndrome), Autoimmune disease.
arrow Infections: in genital tract or vulvae vestibule, vulvo-vaginitis.
arrow Less lubrication due to various reasons as hormone deficiency.

VAGINISMUS
painful involuntary contraction of vaginal introitus i.e. opening & vaginal all.
Sexual aversion disorder.
Connective tissue diseases leading to dryness.
Psychological problems: as depression & other psychiatry disorders.
Sex centre disorders so that proper signal of sexual excitation does not comes from the sex centres so that pre sex secretion does not occurs..
Idiopathic.
Neoplasm’s of vagina.
Any ulcerative lesions of vagina as chronic lichen planus, herpese genitals.
Decreased blood supply to vagina due to various medical conditions can lead to diminish vaginal lubrication, pain during intercourse.
Vulvar vestibulitis.
Restrictive upbringing, Inadequate sexual information, early insecurity in psychosexual role.
Vaginal stenosis, vaginal scarring, post surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum.
Idiopathic vulvodynia.
Atrophic vaginal mucosal atrophy.
Sexual aversion disorder & female sexual arousal disorder.

PRIMARY CAUSE OF PAIN DURING SEXUAL INTERCOURSE
Due to any of the above causes patient may first time feel pain during sexual act. Once a women get pain due to any of the above causes as hormone disorder or decreased pelvic blood supply or any other cause virtually all woman develop following three things, these three factors further worsen the pain during sexual activity, and these are called secondary factors. These secondary factors are as follows:
arrow Fear of pain: In this the moment lady thinks of going for sex, She starts fearing that, I may get pain again thus she start getting anxious about pain during sex. This fear decreases her confidence leading to further worsening of the pain. Many times due to this fear patient starts avoiding sex & his desire for intercourse decreases.
arrow Anxiety due to anticipation of pain: Woman develops severe anxiety before real sex. Patient develops obsessive concern for pain during sex i.e. whether or not She can do the sexual activity without pain & can keep his partner satisfied. This performance anxiety can be cured by sex therapy in few sittings.
arrow So by sex therapy, the patient is taught how to avoid fearing and become free of fear of failure & performance anxiety.
arrow So above secondary problems hinder into normal recovery of sexual function even if the original cause may have been cured.
After correcting primary cause also sometimes pain during se does not disappears, because these secondary factors interfere with normal sexual functioning. If these factors are also removed by sex therapy, sexual functioning soon becomes normal. The new, intensive team treatment of sexual dysfunction has revolutionized sex therapy. In most cases, for cure of pain during sexual intercourse detailed sex counseling & sex therapy is necessary.

DIAGNOSIS OF CAUSE OF PAIN DURING SEX
First step in proper treatment of pain during sex is accurate diagnosis of cause of her pain during sex. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

DETAILED HISTORY
Onset: We take detailed history, as for quality of pain whether is at the introitus, superficial or deep inside, whether it is mild, moderate or severe pain. Then we decide whether it occurs all the time only during sexual activity. How is the response of previous treatment. Response to previous therapy, Libido, Stress (physical or mental), History of precipitation by some drugs.
Presence of hypertension, heart problems, claudication, trauma, diabetes, Secondary. Sexual Characters, Hypothyroidisms / Hyperthyroidisms & Galactorrhoeas, Symptoms of sensory loss.

EXAMINATION OF GENITALS
We examine whether any Sexual Development defect is present or not. For this vaginal size is measured by vaginometer or Genitometer (if patient is outstation then by radiological tests). The vagina is examined for some local problem. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of penis is assessed by, palpating dorsal penile artery of penis. Nerves supplying the female genitals examined by sensation testing, Deep Tendon reflexes. Then other systems are examined.

INVESTIGATIONS I.E. DIAGNOSTIC TESTS
At our centre we have all the facility for complete investigation of cause of pain during coitus & other difficulties. So we perform following tests, step by step depending on their need based on history & examination.

The various diagnostic tests needed/performed are as follows:
HORMONE TESTING Various Female sex hormones & other associated Hormones are tested by latest-immunoassay techniques. These hormones includes total Estradiol, Estriol, Prolactin, LH, FSH, T3, T4, TSH others as Cortical, E2, Free testosterone SHBG etc. Among above tests relevant hormones are tested in that particular patient. Results are available in 36 hours. When we find out any of above hormones disorder simply correction of these hormone disorder corrects the pain problems in two months time. Blood glucose & other systemic tests are also done.
ULTRASOUND SCANNING Ultrasound scanning is done to decide whether any type of local problem is present or not, accordingly treatment is prescribed.
SEX COUNSELING After detail discussion with our female sex therapist, we try to finds out the root cause of pain problem then we treat accordingly. For counseling we take detail history of sexual development, her thoughts, her misconception about sex, her old experience in sex, her unconscious fears about sex. This counseling session unravels all the hidden psychological causes of sexual pain disorder.
OTHER TESTS (If required)
Pelvic Nerve Testing: By conduction and sensory testing (NCV, EMG).
Psychoanalysis: To find different factor leading to psychogenic pain disorder.
Detailed Sex Counseling

TREATMENT OF PAINFUL INTERCOURSE
After diagnosing the cause of pain during sexual intercourse, we prescribe medicines that patient has to purchase herself from any medical store & give the sex therapy session. The success of various drugs we use depends on accurate diagnosis of cause.
The various treatment options for patient with impotence are:
Hormone Therapy.
Anti-in-effective drugs.
Sex Therapy.

HORMONES THERAPY
Hormones therapy is given to cure the hormone problem.
arrow Hormones Therapy: Estrogen treatment is given when deficiency of hormones are found. Hormone therapy usually cures the Hormone problem in 2 to 3 months time and they do not have any adverse effects as they given to only those patients in whom some hormone disorder is found.
Anti-in-effective drugs: The anti-microbial treatment is indicated whenever the infection is found.
Sex Therapy: The various sex therapy is offered by sex therapist leading to permanent sex therapy.
Other drugs found effective are anti-inflammatory, serotonin reuptake inhibitors.

RESPONSE OF TREATMENT
As we have fully dedicated team of highly qualified, experienced, doctors, sex counselors, sex therapist, who are expert in field of sexual problems, we get cure in almost all cases. After finding the cause of pain during sexual intercourse by above tests it is cured in most patients by two months treatment.

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