As dyspareunia pain during attempted or completed vaginal penetration are called.
Dyspareunia may be during penetration to occur (superficial or introital) with progressive penetration, with penile movements or after coitus. A certain increase in tone of the pelvic floor muscles, which manifests itself both as arbitrary as well as involuntary guarding and strong muscle tension, is common in all types of chronic dyspareunia.
As dyspareunia pain during attempted or completed vaginal penetration are called. Dyspareunia may be during penetration to occur (superficial or introital) with progressive penetration, with penile movements or after coitus. A certain increase in tone of the pelvic floor muscles, which manifests itself both as arbitrary as well as involuntary guarding and strong muscle tension, is common in all types of chronic dyspareunia. Etiology causes can psychological as physical nature (overview of sexual function and sexual disorders of women: Etiology). Causes of superficial dyspareunia are provoked Vestibulodynie (PVD), atrophic vaginitis, disorders of the vulva (z. B. lichen sclerosus, Vulvadystrophien), congenital malformations, genital herpes simplex, fibrosis after radiation therapy, surgery-related narrowing of the vaginal orifice or recurrent rupture of the posterior commissure. Deep dyspareunia may be from a hypertension of the pelvic muscles or diseases of the uterus or the ovary (z. B. fibroids, chronic pelvic inflammatory disease, endometriosis). The penis size and penetration depth influence the occurrence and severity of symptoms. Women with dyspareunia by PVD (Provoked Vestibulodynie (vulvar vestibulitis; PVD)) tend to have high self-expectation, fear of negative evaluation by others, increased somatization, catastrophizing (gross exaggeration of the possible consequences), generally lower pain threshold, hypervigilance to pain and often other chronic pain syndromes (eg. as irritable bowel syndrome, temporomandibular joint disease, interstitial cystitis). Diagnosis Clinical Investigation The diagnosis is made clinically and due to a pelvic exam. On a superficial dyspareunia, the investigation and the wrinkles between the small and large labia (typical cracks z. B. on for chronic candidiasis), and the clitoris, urethra, hymen and openings of large vestibular gland ducts (focused on the inspection of the vulvar skin on atrophy, signs of inflammation and abnormal lesions that require a biopsy). PVD can with a cotton swab (pain from a non-injurious stimulus) are diagnosed triggers a allodynia; First, non-painful outer and then the typical painful areas (i. e., the outer edge of the Hymenalrings, columns next to the urethra) contacts. Suspicion of hypertonicity of the pelvic floor muscles arises when by palpation of the deep levator ani muscles, v. a. the spines ischiadicae around a pain can be induced, which is similar to the pain occurring during sexual intercourse. By palpation of the urethra and bladder is an abnormal sensitivity to pressure can be observed. The evaluation of deep dyspareunia requires careful bimanual palpation to determine whether the pain caused by moving the cervix or palpation of the uterus and appendages; also searching for nodules in the Douglas space or into the vaginal vault. A rectovaginal examination is usually indexed to study the rectovaginal septum and the posterior surface of the uterus and appendages. In cases of suspected diseases of uterus and ovaries imaging techniques are, if clinically indicated, carried out. Treatment If possible treatment of the cause (. For example, local estrogen in atrophic vaginitis, pelvic floor physiotherapy at elevated tone of the pelvic floor muscles) clarification of chronic pain, and their effects on sexuality Psychotherapien Treatment often includes the steps of: encouragement and elucidation of the pair, so that they develop satisfactory, nichtpenetrative sexual techniques meeting psychological factors that contribute to the development of chronic pain and are triggered by this, if possible treatment of primary physical disorders that lead to pain (eg. as endometriosis, lichen sclerosus, Vulvadystrophien, vaginal infections, congenital malformations , radiation fibrosis;. s corresponding locations in the MSD Manual). Treatment of the accompanying increase in tone of the pelvic floor muscles treating the accompanying disorder of sexual desire and interest or sexual arousal local helps-applied estrogen in atrophic vaginitis (Menopause: Hormone) and recurrent fissures on the posterior commissure. A local anesthetic or sitz baths can relieve superficial dyspareunia. Psychotherapies such as cognitive behavioral therapy, mindfulness, and mindfulness-based cognitive therapy (treatment) are often helpful. Women with an increased tone of the pelvic floor muscles as well as some women with PVD can benefit from targeted pelvic floor physical therapy, supported perhaps by biofeedback to learn the pelvic floor relaxation.