Vaginismus
Introduction
Introduction to vaginal fistula Vaginal fistula is a sexual psychophysiological disorder syndrome, also known as sexual intercourse phobia. Refers to the 1/3 of the muscles surrounding the vagina, including the perineal superficial transverse muscle, the deep transverse muscle, the levator ani muscle, and the thigh adductor muscles in severe cases when the penis or a substitute is inserted into the vagina. Involuntary spasmodic contraction, resulting in pain or sexual intercourse. Vaginal fistula can occur in any woman who has sexual intercourse, adolescents, childbearing age, and older women. Vaginal fistula is divided into four types: primary, secondary, complete and circumstantial. basic knowledge The proportion of illness: 3% Susceptible people: women Mode of infection: non-infectious Complications: depression, social phobia
Cause
Cause of vaginal fistula
(1) Causes of the disease
Vaginal fistula is divided into four types: primary, secondary, complete and circumstantial. Primary vaginal fistula is the majority, which means that since the establishment of sexual intercourse, vaginal fistula occurs when sexual intercourse, they have never experienced success. Sexual intercourse, secondary vaginal fistula has a normal history of sexual intercourse, followed by vaginal fistula and sexual intercourse can not, complete vaginal fistula can not be inserted under any circumstances, can not complete sexual intercourse, and the situation can sometimes be inserted, sometimes Can not be inserted, such as a doctor can successfully carry out gynecological examination, but sexual intercourse can not be inserted.
The causes of vaginal fistula include two aspects: psychosocial factors and organic causes:
Psychological factor
(1) Factors of family education: Patients may have been influenced by the traditional concepts of feudalism, religion and other imprisonment during childhood or adolescence. They regard sexual life as inferior, evil and obscene behavior, and think that the daughter's most important thing is to be vigilant. A lost child is ruined. If women are interested in sexual activity, they are considered to be unfair, thus intentionally or unintentionally linking sexual activity with shame, shame, anxiety, fear and guilt. A study in Ireland pointed out that Among the 53 patients with vaginal fistula, 18 had negative sex education, accounting for 34%; while the control group was 66, accounting for only 29%.
(2) Traumatic factors: I have suffered from sexual intercourse, leaving an irreparable memory of fear, forming a negative conditional reflex. When I feel that sexual intercourse is coming or sexual intercourse, my vaginal fistula is caused by fear. According to the aforementioned Irish data, in 53 cases of vaginal fistula, 24 cases were sexually violent, accounting for 27%, 66 cases in the control group, and 6 cases were violent, accounting for 9%, with significant differences.
(3) Disharmony between husband and wife: The husbands sexual behavior is rude at the first marriage, causing severe pain and trauma, causing the woman to have fear of sexual intercourse. In addition, the husbands relationship is not the same or the sexual skill is wrong, causing the womans irritability, anger or fear to produce the vagina. Hey.
2. Organic factors Any gynecological disease that can cause pain in sexual intercourse can lead to vaginal fistula, such as hymen hypertrophy, vaginal scar stenosis, vulvitis with vulva or vaginal vestibular ulcer, endometriosis and senile atrophy Vaginitis and so on.
(two) pathogenesis
Vaginal fistula and female sexual intercourse pain often cause each other, so the estrogen (E2)-NOS-cGMP theory that causes female sexual intercourse pain also causes vaginal fistula: E2 level is lowered, resulting in decreased expression of nitric oxide synthase (NOS) in female genitalia Non-adrenergic/non-cholinergic (NANC) neurotransmitter nitric oxide (NO) release decreased, causing perineal vasodilation, decreased perineal blood flow, insufficient vaginal vascular filling, reduced vaginal exudate In addition, the reduction of NO, increased vaginal wall fibrosis, vaginal mucosal damage and apoptosis, vaginal mucosa and vestibular gland secretion decreased, on the one hand vaginal dryness, insufficient lubrication, causing female sexual intercourse pain, and then reflexively caused vaginal fistula; On the other hand, vaginal ductility and compliance are reduced, penile insertion is difficult, leading to vaginal fistula, another NANC neurotransmitter vasoactive peptide (VIP) can cause vasodilation of blood vessels and non-vascular smooth muscle, increase blood flow of the pelvis and vagina and vaginal Lubrication and secretion may also be involved in the pathogenesis of vaginal fistula, but the specific regulatory mechanisms are still unclear.
The vaginal fistula is essentially a painful protective tendon. The pain is transmitted to the central nervous system of the brain via local pain receptors or pain nerve endings. The nerve reflex causes the perineum and/or pelvic cavity and even the buttocks, and the thigh muscles are reflexively contracted, resulting in The occurrence of vaginal fistula.
Through special molecular probes and RNase protein analysis, 2 and 2 receptors were found in human clitoris and vaginal smooth muscle cells. Exogenous norepinephrine (1 and 2 agonists) produced dose-dependent contraction of vaginal smooth muscle. While 1 and 2 selective antagonists inhibit this contraction, adrenergic neurons can be seen to regulate genital contractile responses.
Vaginal fistula, the patient believes that the erect penis will damage the vulva, vagina or hymen and cause severe pain. 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. High tension, fear Exciting the local sympathetic nerves of the genitals, the release of noradrenaline (NA) in the adrenergic neurotransmitter, causing the vaginal wall and even the entire pelvic floor smooth muscle to contract or even paralyzed, so that the vaginal volume shrinks when sexual intercourse, fear and tension can not reach orgasm The vestibular gland does not secrete mucus, and the vaginal vasoconstriction does not ooze. At the same time, the vaginal external ring skeletal muscle also undergoes sacral contraction under the action of acetylcholine (ACh) released from the pudendal nerve, hindering the smooth insertion of the penis, or the inserted penis. Can not quit, resulting in vaginal fistula.
Prevention
Vaginal fistula prevention
(1) Learn about sexual knowledge and eliminate misconceptions and concepts about sexual life.
(2) As soon as possible to go to the hospital for examination, you should go to a more formal hospital for gynecological examination.
(3) If you are suffering from vaginal diseases, you should receive regular treatment. If it is congenital malformation of the reproductive organs, after surgery, you can avoid the occurrence of convulsions.
(4) Pay attention to the living and living conditions. If the body is not full of yang, usually take more warm medicine and food, eat less cold, and sit warmer, especially during menstruation and postpartum, to prevent the evil of wind and cold from invading from the lower part.
Complication
Vaginal fistula complications Complications depression social phobia
Although vaginal fistula is not life-threatening, it seriously affects the quality of sexual life of couples, leading to the deterioration of husband-wife relationship and even family relationships. The patient is very painful inside, often with a sense of guilty to her husband but unable to overcome it, and the cause is difficult to explain. Women cause tremendous mental stress, which seriously affects women's daily life and physical health. If they are not treated in time, they often last for several years. In severe cases, they may cause depression and social terror syndrome, which will bring great pain to both couples. Disharmony with marriage, and even caused family breakdown.
Symptom
Symptoms of vaginal fistula Common symptoms Sexual intercourse, painful intercourse, difficulty in lower abdominal abdomen, endometriosis
Mainly for sexual intercourse when the penis can not be inserted into the vagina or the inserted vagina can not be pulled out, resulting in painful intercourse, sexual intercourse can not be or penile incarcerated sexual intercourse emergency.
Vaginal fistula is often accompanied by varying degrees of vulvovaginal or lower abdominal pain. The pain is characterized by sharp pain, blunt pain, pulling pain or tingling. The pain lasts for tens of minutes to 1 day; the pain can be superficial. It can also be deep pain, which can be limited to local or diffuse. Patients often have muscle contraction of the perineum or inner thigh muscles, high muscle tone, fear or even refuse gynecological examination.
If vaginal fistula is caused by organic lesions, there are clinical manifestations of organic diseases, such as genitourinary infections, congenital genital dysplasia, and endometriosis.
Because the degree of vaginal fistula can vary greatly, the symptoms are not necessarily the same for each person. The symptoms are still barely sexual intercourse, but both sides feel uncomfortable, the woman shows symptoms of pain, and some even insert the vagina into the vagina. When the waist is painful or the lower abdomen is swelled; not only does the woman feel extremely uncomfortable or painful, but the male penis cannot be inserted into the vagina at all. This kind of severe pain will affect the normal husband and wife sex life.
Upon inquiry, you may find some abnormalities such as mental and emotional manifestations, such as severe pain, guilt, inferiority, depression, or nervousness. Depending on the doctor's conversation skills and keen insight, you can induce and discover Potential factors of vaginal fistula.
Examine
Vaginal fistula examination
(1) The doctor first looks at the patient's vulva, which often reveals vaginal fistula and leg muscles or perineal muscles that are stiff or have convulsions. At this time, it is necessary to determine whether the muscle contraction is a random contraction, because the doctor will not be able to determine the presence or absence of random sputum when there is voluntary contraction. The method is to let the patient fully relax, take a deep breath, talk with them to transfer the tension brought about by the high concentration of the spirit, and the muscle tension caused by the random contraction of the patient after full relaxation will disappear. The reasons for the patient's voluntary contraction include nervousness, adduction of the legs or attempting to leave the examination table.
(2) The palpation of the vulva should be followed. The gloved finger is first presented to the patient, telling the patient that the doctor will separate her labia during the examination and examine her external structure such as the vestibule and urethra. Then slowly separate the labia, remind the patient at all times without nervousness and fear, pay attention to check the labia, clitoris, urethra, vaginal opening, and pay attention to the occurrence of paralysis.
(3) The next step is to check the shallow part of the vagina, which is 1/3 of the outer section of the vaginal canal. First, show the finger with the lubricant on the patient, then gently put the finger on the vaginal opening, apply a little pressure, ask Whether the patient has discomfort or not, can bear it. Talking while talking can help the patient's relaxation and freedom, and slowly insert the finger into the vagina 2-5 cm when the patient is not nervous or has obvious discomfort. When inserting a finger, apply a little pressure to the back, rather than directly squatting forward. If you find that there is an involuntary contraction or narrowing of the ring around the vaginal opening, you can make a diagnosis. This finding will surprise the patient because she may not have realized it in the past or mistakenly believe that her hymen is too hypertrophic. Such an examination confirms to both partners in a visible and dynamic form what the essence of the vaginal closure is. For example, the young woman mentioned earlier learned that she suffered from vaginal fistula after physical examination and felt deeply guilty. She felt that the mans yangshuo was too ignorant in the past, and the mans doubts were no longer nervous.
Diagnostic pelvic examination, palpation of the vulva, deep palpation, speculum examination, Pap smear smear examination, vaginal secretion culture, etc.
Diagnosis
Diagnosis of vaginal fistula
diagnosis
Diagnosis of vaginal fistula is not difficult. Any persistent incontinence of vaginal contractions before or during sexual intercourse can be diagnosed.
The vaginal fistula is divided into 4 levels according to the degree of sputum:
Grade I: Vaginal fistula occurs only under certain conditions, such as too short a caregiver before sexual intercourse, violent sexual intercourse, or unsafe sexual intercourse. The muscles that cause vaginal fistula are limited to the perineal muscles and levator ani muscles. Sometimes, the penis can be included during sexual intercourse, but there is a feeling of pain. Such patients can fully relax and relieve themselves through psychological counseling.
Grade II: The muscles of the sputum are not limited to the perineal muscles, but also affect the muscles of the entire pelvis, or vaginal fistula can occur in a variety of situations, so that they can not have sexual intercourse, and can insert two little fingers into the gynecological examination. vaginal.
Grade III: When the vaginal vault occurs, not only the pelvic muscles are paralyzed, but also the entire buttocks are involuntarily raised. This is due to the frequent spasm of the hip muscles. Because the hip muscles are frequently paralyzed, sexual intercourse cannot be performed at all. Gynecological examination can only accommodate one little finger.
Grade IV: When the sputum occurs, not only the buttocks muscles contract, but also the hips are involuntarily raised, and the patient's legs are adducted and try to withdraw the whole body backwards, even shouting and panicking. This reaction is not actual. Due to sexual intercourse or gynaecological examination, it is a reaction to the closeness and premonition of a sexual partner or examiner. Whenever there is a sexual activity or examination, a panic reaction occurs. Doctors must use an anesthetic to be successful.
Patients with grade II to IV vaginal fistula should receive regular sexy concentration training and system desensitization treatment to eliminate reflexive paralysis and fear, so that the symptoms can be relieved and cured. These patients must first receive sexual physiology and sexual psychology consultation. Services, combined with behavioral and device therapy for comprehensive treatment.
Differential diagnosis
1. Mainly differentiated from sexual intercourse pain, both have vaginal pain during sexual intercourse, but vaginal fistula pain is mild, mainly because the penis can not be included in the vagina for sexual intercourse, sexual intercourse pain is mainly pain, and can have abdominal pain, pain occurs Hours or days after sexual intercourse, and the erect penis can still be inserted into the vagina for sexual intercourse.
2. It should be differentiated from simple fearful sexual intercourse and sputum caused by organic factors such as endometriosis or vaginal inflammation.
