Pain during intercourse
Introduction
Introduction to sexual intercourse pain Sexual intercourse pain means that couples are not happy when they are sexual intercourse, but feel uncomfortable or even painful, and they have painful sexual intercourse. Some occur shortly after marriage, some have occurred for a long time, and some have been discovered by women during menopause. The painful part is sometimes only in the genital area, sometimes in the vagina, and affects the abdomen, waist, and back. Sexual intercourse pain can occur during sexual intercourse, or can occur after sexual intercourse or even continue until a few hours or a few after sexual intercourse. day. If this happens, but it cannot be corrected and cured in time, it will not only affect the normal sex life between husband and wife, but also affect each other's feelings. basic knowledge Sickness ratio: 8% Susceptible people: no special people Mode of infection: non-infectious Complications: cold sex
Cause
Sexual pain
(1) Causes of the disease
Physiological causes:
There are many causes of pain in sexual intercourse, such as various diseases of the reproductive organs and urinary system, congenital malformations, etc. The typical lesions are endometriotic nodules on the humeral ligament close to the vaginal fornix, inflammation and peritoneum in the disc cavity. The viscera is stuck, and the penis is inserted into the nodule. During the friction with the vaginal mucosa, the peritoneum is shaken to cause pain in the organ. In addition, vaginal specific allergies, such as contraceptive use, may cause pain. For the first time, the new marriage will tear the hymen and expand the vaginal opening. It will also cause pain and confusion in the first few days. The excitement of the newlywed spirit and the busyness of the marriage will also make the delivery not completely satisfactory. Therefore, after the marriage Generally, after 3-4 weeks, the degree of satisfactory intercourse can be reached, and the rush is rushed, that is, before the female sexual excitement is not fully evoked, the yin lacks expansion and lubrication, then the penis is inserted, or the action is inserted slightly, often Pain that causes temporary discomfort, then sexual excitement will love inhibition. As the penis is pulled and rubbed, the pain may be aggravated, especially highly sensitive. Pedicle part, because it is rich in blood vessels and nerve tissue, in the absence of sexual excitement and dry conditions will not only cause pain, but also produce a sense of disgust one kind of psychologically unbearable.
In the absence of organic lesions, sexual intercourse pain is mainly caused by insufficient vaginal lubrication. There are two main reasons for insufficient sexual arousal: First, the preparation for coordinating is not sufficient, that is, the hug, kissing, caress, etc. mentioned above. The flirting action is not enough; the second is the anxiety, fear, lack of concentration, and depression caused by work and life.
Psychological causes:
1. Improper education. As far as the current situation is concerned, whether it is family, school or society, sex education is very scarce. Moreover, in the limited sex education, women are often indoctrinated with some sexual health. Such as "the most precious woman's shackles", "sexual intercourse is a man's pleasure, a woman is guilty", etc. Some people are more seriously influenced by this kind of thinking, especially in areas with relatively backward culture, especially before marriage, anxiety, fear, The feelings of sin are filled with the brain. When you are married, you will be anxious, fearful, shy, and the emotions and absurd thoughts of self-sin will grow and become stronger, thus hindering the enjoyment of sexual excitement and sexual pleasure. In this case, pain or difficulty in intercourse is inevitable.
2, psychological trauma, women before marriage, if there is experience closely related to the pain of cross-talking, or direct experience of painful misunderstanding, or due to the exchange of memory that is difficult to eliminate, it is easy to form conditioned reflexes, such as before marriage Once raped, or the first marriage to the husband is not enough, or the violent action, etc., such people once again face the situation of coexistence, the relationship between the exchange and pain pain, and build a psychological barrier of defense, if the actual exchange It is very likely that pain symptoms actually occur.
3, stimulation inhibition, the inhibition of stimulation mentioned here does not refer to the inhibition of the direct mutual stimulation of the genital organs, but refers to the inhibition of the external, human factors on the impulse stimulation of sexual desire before the exchange, from this perspective, mainly Several factors like this:
First, it belongs to the couple's emotional aspects. The most important thing about sexual urge is to have an emotional foundation. Without this one, no matter how excited it is, the wife has no feelings for her husband, and she regards it as a burden and pain. This will inevitably lead to discomfort and pain.
The second is to pay attention to the environment. At present, many people in China, especially in cities and towns, have poor living conditions. Some of them live in the same room for the second or even three generations. When the children are slightly older, the husband and wife can live under such environmental conditions. Influence, it often does not have the conditions to fully flirt, and there is no possibility of playing under the dark light. The whole process of intercourse is carried out under the tacit agreement, and it is worried that the elders and children will be aware when the action is too large, so these will be suppressed. Sexual excitement, unpleasant situation.
Third, in terms of sexual perversion, sometimes women with homosexuality or homosexuality tend to have sexual excitement when dealing with men. Even if it is difficult to achieve sexual harmony, it is common to cause pain or difficulty in intercourse.
In practice life, we observe that sexual intercourse pain is rarely caused by a single factor, often many factors are intertwined, psychological factors and organic lesions may also be related to each other, cross each other, and coexist.
(two) pathogenesis
With the deepening of research on female sexual dysfunction, people gradually realize that sexual intercourse pain is not only a simple psychological disorder, but also its physiological and pathological basis. Hormone has an important regulatory effect on female sexual function. Estradiol level directly affects the central nervous system. And the function of peripheral nerve cells and the transmission of nerve signals, with the arrival of aging and menopause, blood estrogen levels decline, most women will experience varying degrees of sexual function changes, mainly characterized by lack of sexual desire, frequency of sexual activity, sexual intercourse Pain, decreased sexual responsiveness, difficulty in orgasm, and genital dysfunction, studies have shown that non-adrenergic/non-cholinergic (NANC) neurotransmitter nitric oxide (NO) participates in the physiological mechanisms of female sexual response, increasing the vagina Blood flow, lubrication and secretion; while NANC nerve may regulate the relaxation of clitoris and vaginal smooth muscle, lowering estrogen levels in menopausal and surgical castration or hyperglycemia women, reducing vaginal nitric oxide synthase (NOS) Expression, reduce vaginal NO levels, increase vaginal wall fibrosis, cause vaginal mucosal cell apoptosis, leading to vaginal mucosa Decreased secretion function, insufficient vaginal lubrication, dryness; in addition, vaginal wall fibrosis reduces vaginal compliance and diastolic response, vaginal reactive hyperemia during sexual intercourse, decreased ductility, penile insertion difficulties, resulting in female sexual intercourse pain, animal experiments It is shown that estradiol can widen the receptors of the pudendal nerve and reduce the sensory threshold of the pudendal nerve region. For postmenopausal women, estrogen supplementation can restore the functional characteristics of the clitoris and vagina, and is close to the premenopausal level. Estrogen can also improve blood supply to the vagina, clitoris and urethra through vasodilation. In 1966, Masters et al first reported the physiological changes related to sexual function in menopausal women, recognizing the changes in sexual function and estrogen levels. Decreased, directly related to estradiol below 50pg / ml, supplementation of estrogen can significantly improve symptoms, similar to NO, NANC neurotransmitter vasoactive peptide (VIP) can cause vasodilation of blood vessels and non-vascular smooth muscle, increase pelvic and vaginal The blood flow and the lubrication and secretion of the vagina, but the mechanism of its regulation is still unclear.
Different parts of the female genitalia are distributed with different receptors, such as tactile bodies and cilia, pressure and vibration sensation bodies, pain sensation free ends, temperature sensation sensilla and Dougall sensation body, human haze, labia majora, clitoris and The distribution of the hymen is rich in painful free nerve endings. In the case of vulvar infectious diseases, the local inflammatory reaction itself has red, swollen, hot, painful discomfort, and the release of painful inflammatory mediators such as prostaglandin E (PGE) stimulates local painful free nerves. The tip causes the perineum to increase the sensitivity to pain, and the contact, friction and even collision during sexual life will undoubtedly aggravate the local pain, and the female sexual intercourse pain will manifest as burning pain, stinging (shade, labia majora and vagina). Mouth), pulling pain (cary), etc.; In addition, inflammation, vulva, vaginal tissue damage and surface ulceration, inflammatory secretions increase the local pH of the vagina, vaginal lubrication fluid properties change, resulting in insufficient vaginal lubrication, dryness, Plus sexual intercourse further aggravates local damage, causing burning pain and pain in the vagina and vulva.
Jensen reported that 86% of 322 vulvovaginal infections had vulvar pain, 71% had sexual intercourse pain, and 66% improved after treatment.
Chronic pelvic inflammatory adhesions, endometriosis, painful nodules of the posterior vagina and disease limit the cervix, the uterus moves up, reducing the vaginal extensibility, sexual intercourse and / or after sexual intercourse Local or diffuse traction or blunt pain in the deep and/or pelvic cavity of the vagina, and can last for several hours to one day. The pain is mainly caused by pelvic congestion caused by pelvic congestion and inflammatory reaction caused by traction and sexual excitement. Caused.
For psychogenic pain, the pathogenesis is mainly central and peripheral nervous system reflex and information transmission or abnormal release of neurotransmitters, such as fear of sexual intercourse or high mental stress during sexual intercourse, inhibition of central nervous system function and information Conduction, thereby inhibiting the production of physiological sexual excitement, vaginal reactive hyperemia, insufficient lubrication, leading to pain in sexual intercourse; in addition, due to women's lack of understanding of the anatomy and physiology of sexual organs, coupled with the lack of sexual life knowledge and experience, the woman's asexual excitatory response The vagina does not contain diastolic relaxation, no synovial secretion, the penis is forcibly inserted into the cervix neck and ligaments, or causes damage to the vaginal opening and the vaginal wall, stimulating nerve endings or aggravating pain or discomfort.
Vaginal fistula, also known as sexual phobia, is caused by the patient's extreme fear of penis and "injury" to the genitals. In fact, the vagina is a smooth muscle organ, which has great expansion and containment. It can be used to prove the delivery of the fetal head during childbirth. Tension, fear, will increase the release of noradrenaline (NA) in the genital adrenergic neurotransmitter, causing contraction or even paralysis of the smooth muscle of the vaginal wall. The skeletal muscle of the external vaginal orifice is also released by the pudendal nerve to release acetylcholine (Ach). Spastic contraction occurs, hindering the smooth insertion of the penis or the inserted penis cannot exit and cause pain.
Prevention
Sexual pain prevention
1. The man avoids rudeness during sexual intercourse.
2. Strengthen physical exercise, pay attention to sexual hygiene, and maintain a happy mood.
3. Early treatment of the primary disease.
Complication
Sexual pain complications Complications are cold
Vaginal dryness is a common complication of women with diabetes. Low levels of sex hormones can cause vaginal dryness and are prone to irritation, which can cause pain in sexual intercourse.
Sexual intercourse pain can induce sexual arousal and orgasm dysfunction and sexual intercourse difficulties, etc., can also lead to male erectile dysfunction and impotence.
Symptom
Symptoms of Sexual Intercourse Pain Symptoms Symptoms Anxiety Urinary Pain Herpes Herpes Itching Wet Endometriosis Urinary Frequency Menopausal Cyst
The most important and obvious symptoms of female sexual intercourse pain are the different degrees of sexual life, and the pain of different nature is also the main reason for patients to see a doctor.
1. The nature and location of pain
Congenital genital dysplasia, such as hymen hypertrophy, hymen umbrella, vaginal atresia, stenosis or short, vaginal mediastinum or diaphragm, pain for superficial blunt impact pain, often accompanied by vaginal insertion difficulties; labia and vaginal adhesions, scars , vulvitis, vestibular gland inflammation, cysts, etc. are often localized burning pain, pain during sharp pain or impact; when the clitoris or clitoris foreskin is allergic, the pain is traction or contact pain, anal rectal disease, pain often Diffuse; vaginal infection or vaginal trauma and vaginal atrophy, due to lack of estrogen and other factors caused by the vagina, the pH of the mucus in the cervix changes, the pain is more in the vaginal opening, the vagina, sharp pain or mild pain, The uterus is retrograde or accompanied by uterine fibroids, which is characterized by deep intercourse pain in the early menstrual period. Endometriosis often causes premenstrual sexual intercourse pain, deep pain with sexual intercourse, and chronic pelvic inflammatory disease and other pelvic lesions are mostly deep intercourse pain. And cystitis often has vaginal anterior wall pain with sexual intercourse; fat bulging can also cause pain in the anterior wall of the vagina during sexual intercourse, vulvar skin due to sexual transmission The herpes genital genital inflammation can cause external or internal burning of the vagina during sexual intercourse; genital warts cause pain in the vulva or vaginal opening during sexual intercourse; others such as herpes simplex, herpes zoster, pubic lice, hemorrhoids, dermatitis, etc. Causes shallow pain in sexual intercourse.
2. Associated symptoms of organic diseases
Such as endometriosis, a typical history of menstrual lower abdominal pain, pain is progressively worse, pelvic examination often has tenderness of the posterior vagina, tenderness of the uterus or attachment, cervical pain, swing pain, etc., sometimes Touches the chocolate cyst formed by ectopic endometrial; congenital absence of vagina, short or narrow vagina, vaginal diaphragm, hymen atresia or hypertrophy, etc., can be clearly diagnosed during gynecological examination; external genital atrophy caused by various reasons, vaginal dryness, Vulvar itching, leucorrhea, urinary frequency, urgency, dysuria and other symptoms of urinary tract infection; see vulvovaginal skin during examination, mucous membrane thinning, lack of elasticity, vaginal discharge reduction or trait changes, often recurrent urinary History of genital tract infection; vulvovaginal inflammation including spirochete-like sexually transmitted diseases (STDs), often vaginal discharge abnormalities, genital itching, gynecological examination of local congestion, redness and ulceration and STDs typical vulvar herpes or sputum biological proliferation and other pathological damage; Typical manifestations of other diseases such as mental illness, such as childbirth, breastfeeding or the presence of special physiological events in menopause.
3. Mental emotional performance
The patient may say "I don't want to have sex, just do the duty of the wife", "Fear or hate the house", "Husband only cares about his feelings, his actions are rude, and he is not good to tell him", "that is to say, it is not clear." Sometimes, it is misunderstood to deliberately find reasons to avoid sex life, and similar complaints, negative treatment of couple sex life; patient mood or low, irritated, or excited, sensitive; husband and wife relationship is not harmonious, psychological pressure; generally do not actively talk about Sexual life problems, but after inquiry, you may find that there may be a lack of sexual knowledge and sexual experience or lack of sexual dysfunction. Some patients involuntarily appear nervous anxiety during the gynecological examination, the body moves backwards, the legs are adducted or by hand Block the voyeur or hand touch and resist the check.
Sexual intercourse pain is usually accompanied by a clear gynecological disease, so the doctor should ask in detail about the medical history and various psychosocial factors, understand the cause, location, duration and complications of the pain, etc., detailed gynecological examination, including speculum examination, vagina Examination and necessary triad examinations can only consider psychosocial factors after gynecological and systemic related diseases are excluded.
Examine
Sexual pain check
Endocrine hormone test: The regulation of sex hormones on female sexual physiological response is very important. Many diseases or drugs can affect the secretion and regulation of sex hormones, which may cause female sexual dysfunction. Thyroid hormone directly affects the body's metabolism and nerve reactivity, or because of Interfering with the function of the gland axis, or causing female sexual intercourse pain due to emotional factors, taking blood to detect sex hormone follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estrogen (E), testosterone (T) And thyroid hormone thyroid stimulating hormone (TSH), free three-point iodothyronine (FT3), free tetraiodothyronine (FT4), can help diagnose endocrine women with sexual pain.
1.B ultra-uterine and accessory defects, malformations, uterine fibroids, adenomyosis, accessory masses, etc. can be diagnosed by B-ultrasound, if necessary, with special examinations such as endometriosis anti-endometrial antibodies Check and further confirm the diagnosis.
2. Specific physiological examination mainly includes measuring the blood flow of female genital tract before and after stimulation, vaginal pH value, vaginal compliance and the sensation of female genital vibration.
Ultrasound Doppler can be used to measure the maximum contraction blood flow velocity and end-diastolic velocity of the clitoris, labia, urethra, vagina and uterus, and to understand the sexual physiology of the external genitalia.
Vaginal pH can indirectly reflect the degree of vaginal slip and cleanliness and can be measured with a digital pH meter.
The clitoris and labia stun are indicators that reflect the sensitivity of the clitoris and labia to sexual stimuli and can be measured using a bioseismic threshold measurer.
Vaginal pressure/flow changes, ie vaginal compliance, are measured using a compliance meter.
Other somatic diseases are diagnosed and treated in the corresponding specialists.
Diagnosis
Diagnosis of sexual intercourse pain
diagnosis
Diagnosis should be consistent with the diagnostic criteria for non-organic sexual dysfunction. Men feel pain or discomfort during sexual life. Women's pain during vaginal intercourse or when the penis is inserted deeply cannot be attributed to vaginal fistula. Or poor vaginal moisturization.
Differential diagnosis
It is often necessary to distinguish it from the urology or obstetrics and gynecology diseases. Clinically, the above two subjects can be diagnosed.
