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8 Cards in this Set
- Front
- Back
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Define dyspareunia |
Pain during intercourse, impaired arousal, impaired ability to climax, lack of sexual desire |
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What are the types of sexual pain disorder? |
Primary - pain with first sexual encounter Secondary - no pain with first encounter but pain occurs later Situational - with some encounters or partners but not others Complete - wit each sexual encounter |
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What is the neuroanatomic pathophysiology of dyspareunia? |
Vestibule,urethra and bladder have the same embriologic origins and sometimes areaffected by pain syndrome together – interstitial cystitis will sometimes alsogive vestibular pain
Alllower genital structures have estrogen receptors-by-room/living-room/scatter-cushions.html |
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What is the pathophysiology of dyspareunia? |
Pudendalnerve innervates vulva and vestibule
Autonomicnerves from inferior hypogastric plexus and caudal sympathetic chain alsoinvolved in genital sensation Afferentgenital and visceral share the same roots as muscle and skin and thus sometimes referred pain |
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What are the types of sexual pain? |
Nociceptive– related to ongoing disease
Neuropathic– resulting from abnormal neural activity that may result from neural injurybut may persist without ongoing disease Transmittedby myelinated A-delta fibers that gives sharp pain UnmyelinatedC fibers – dull pain Interplaybetween systems with sensitization in dorsal horn |
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How is sexual pain classified? |
Dyspareunia –Pain associated with sexual intercourse
Vaginismus –Involuntary contraction of outer 1/3 of vagina that interferes with vaginalpenetration Non-coital sexual pain disorder –genital pain induced by non-coital sexual stimulation |
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What are the risk factors for sexual pain? |
History of PID - 10x increased
Depression Anxiety Historyof sexual abuse Blackrace Peri/postmenopausal Age<50 years |
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What is the differential diagnosis in sexual pain? |
Localizedvulvodynia
–Provokedby touching vestibule –Topicalanalgesics Generalvulvodynia –Unprovoked Urogenitalatrophy –Dry,burning, pruritis, bladder symptoms –Pale,thin, petechiae –Breastfeeding, progestogens, menopauseTreatedwith lubricants + estrogens Vaginismus –Involuntaryspasm of perineal and levator muscles –Physio,dilators, sex therapy, Botox Urinarytract disease –Interstitialcystitis - Associatedwith urge, nocturia, IBS, dysmenorrhea, fibromyalgia –UTI –Urethraldiverticulum Vulvovaginitis Hypertonicityof pelvic floor with trigger points Post-partum Endometriosis Uterineretroversion POP Adnexalpathology |
