Sexual intercourse pain

　　Dyspareunia is usually caused by clear gynecological diseases or systemic organic diseases. Some patients may have psychological factors as the main cause, but in clinical practice, organic diseases and psychological factors often coexist.
　　1. Organic causes
　　Gynecological inflammation is one of the main causes of dyspareunia, including vulvitis, vaginitis, and pelvic inflammatory disease. Vulvitis and ulcers in the labia majora, labia minora, and vaginal vestibule caused by vulvitis can lead to severe dyspareunia, with pain in the vulvar orifice and vestibule. Acute and chronic pelvic inflammatory disease often cause deep pelvic pain and lower abdominal pain during sexual intercourse, with varying degrees of inflammation leading to different pain intensity and duration. Atrophic vaginitis, the most common cause of dyspareunia, can occur in women entering the perimenopausal period, postmenopausal period, or after bilateral ovarian surgery, or due to a decrease or deficiency of estrogen levels in the body caused by drugs [such as gonadotropin-releasing hormone agonists (GNRH-a)]. The thinning of vaginal epithelium, reduction or disappearance of rugae, decreased elasticity, insufficient vaginal expansion capacity, and reduced lubrication can all cause pain in the vaginal orifice, vaginal canal, and even lower abdominal pain during sexual intercourse. Ovarian dysfunction, vaginal fibrosis, and narrowing caused by radiotherapy can also produce dyspareunia and sexual difficulties.
　　In the middle and late stages of chronic vulvar dystrophy and leukoplakia, local skin atrophy and thinning, reduced or absent elasticity, often leads to unavoidable, stubborn, and severe dyspareunia during sexual intercourse. Often, superficial fissures appear on the upper part of the perineum below the vaginal orifice after sexual intercourse or mere contact with the vaginal orifice, causing constant pain upon contact, slow healing, and eventually leading to refusal of sexual intercourse or long-term cessation of sexual life. Chronic vulvar dystrophy is one of the important causes of dyspareunia.
　　Congenital hymen hypertrophy, rigidity, or postpartum, as well as post-traumatic perineal laceration with abnormal healing, large scars can also cause dyspareunia. Poor healing of the vaginal stump after total hysterectomy, with hard scars, can also cause deep vaginal pain in the near postoperative period.
　　Endometriosis is a common cause of dyspareunia, mainly characterized by tumors or thickened nodules in the bilateral uterosacral ligaments, which reduce elasticity, leading to deep pelvic pain with varying duration. Patients often avoid sexual intercourse or deep penetration.
　　Acute and chronic urethritis or postmenopausal senile chronic urethritis can cause recurrent pain in the urethra and lower abdomen during sexual intercourse, often lingering and not healing for a long time, affecting health.
　　Pelvic congestion syndrome is mainly caused by varicose veins and congestion in the broad ligament, with sexual intercourse pain presenting as deep and diffused persistent dull pain in the pelvis. Diabetes and lower limb skeletal diseases can also be accompanied by sexual intercourse pain.
　　2. Psychological reasons
　　Feudal, religious, and traditional sex education, as well as traumatic sexual experiences, can cause fear, anxiety, and inhibition of sexual life, leading to low libido, sexual arousal disorders, sexual intercourse pain, and vaginal spasm. Disagreements in marital relationships and incorrect sexual behavior can also cause sexual intercourse pain. When libido is low and sexual arousal is poor, the vaginal extension, expansion, and sufficient lubrication during the normal sexual response process are insufficient, resulting in discomfort or lower abdominal pain during sexual intercourse.
　　The occurrence of sexual intercourse pain is closely related to the spousal relationship, such as improper posture, lack of pre-coital language or non-verbal communication, rough actions, etc., which can cause sexual intercourse pain. Conversely, if the spouse is too accommodating, and the female partner lacks confidence due to slight discomfort, she may yield and retreat, which may also strengthen the female partner's pain sensation, causing difficulty in sexual intercourse.

　　Common complications of sexual intercourse pain:
　　1. Sexual intercourse pain can trigger sexual arousal and climax dysfunction, sexual intercourse difficulty, and can also lead to poor male erection function and impotence.
　　2. Lower abdominal pain: Often occurs with severe vaginal pain, and the pain after sexual intercourse does not disappear for several hours, leading to the refusal of sexual intercourse due to pain.

　　The most obvious symptoms of female sexual intercourse pain include the following 3 points:

　　1. Nature and location of pain

　　Congenital reproductive organ developmental abnormalities, such as thickened hymen, hymenopexy, vaginal atresia, stenosis, or shortness, vaginal septum or transverse septum, are accompanied by superficial dull impact pain, often with difficulty in vaginal insertion. Adhesions, scars, vulvitis, Bartholin's gland inflammation, cysts, and other local symptoms are usually burning pain, sharp pain, or pain during impact. Allodynia of the clitoris or prepuce can cause pulling or contact pain. Anal-rectal diseases often present with diffuse pain; vaginal infectious diseases or vaginal trauma and atrophy, due to changes in the acidity and alkalinity of vaginal and cervical mucus caused by the lack of estrogen and other factors, often cause sharp or mild pain at the vaginal orifice and inside the vagina. Deep sexual intercourse pain may occur before menstruation in women with retroverted uterus or uterine fibroids. Endometriosis often causes premenstrual sexual intercourse pain, which deepens with sexual intercourse. Deep sexual intercourse pain is common in chronic pelvic inflammatory disease and other pelvic lesions, while cystitis often causes anterior vaginal wall sexual intercourse pain during sexual intercourse. Fat prolapse can also cause pain in the anterior vaginal wall during sexual intercourse. Vaginal external or internal burning pain can be caused by sexually transmitted herpesvirus inflammation of the external genitalia. Genital warts can cause burning pain in the vulva or vaginal orifice during sexual intercourse. Other conditions such as herpes simplex, herpes zoster, pubic lice, scabies, dermatitis, and others can also cause superficial pain during sexual intercourse.

　　2. Symptoms of Associated Organic Diseases

　　For example, in the case of endometriosis, there is a typical history of lower abdominal pain during menstruation, with the pain progressively worsening. During pelvic examination, there are often symptoms such as tenderness of the posterior fornix of the vagina, tenderness of the uterus or adnexa, cervical pain on palpation, and pain on movement. Sometimes, chocolate cysts formed by endometriosis can be palpated. Congenital absence of the vagina, short or narrow vagina, vaginal septum, hymen imperforate or hypertrophic, and other conditions can be diagnosed during gynecological examination. Various causes of atrophy of the external genitalia may result in symptoms such as vaginal dryness, pruritus vulvae, and reduced leukorrhea. There are often symptoms of urinary tract infection such as frequent urination, urgency, and dysuria. During examination, the skin and mucosa of the vulva and vagina are found to be thin, lack elasticity, and the vaginal secretion is reduced or changed in character. There is often a history of recurrent urinary and reproductive tract infections. In cases of vulvovaginal inflammation, including sexually transmitted diseases (STDs) caused by spirochetes, there are often abnormal leukorrhea, pruritus vulvae, and local congestion, redness, ulceration, and typical vulvar herpes or hyperplasia of lesions. The presence of special physiological events such as childbirth, lactation, or menopause, as well as typical manifestations of other diseases such as mental illness, etc.

　　3. Manifestations of Mental and Emotional States

　　Patients may complain about not wanting to have sexual intercourse, but only fulfilling the duties of a wife, being afraid or讨厌 having sex, the husband only caring about his own feelings, and being rough and not good at expressing his feelings, and sometimes being misunderstood as deliberately finding reasons to avoid sexual intercourse. They may have negative attitudes towards conjugal sexual life; their emotions may be low or irritable, or they may be excited and sensitive. The relationship between husband and wife may not be harmonious, and they generally do not actively discuss sexual issues due to psychological pressure. However, upon inquiry, it may be found that there may be a lack of sexual knowledge and experience, or hidden potential for sexual dysfunction. Some patients may involuntarily experience tension, anxiety, body withdrawal, legs being drawn together, or using hands to block the speculum or the touch of hands during gynecological examination.

　　Some measures for the prevention of sexual pain are as follows:

　　1. Overcome the fear of psychological

　　2. Establish an equal psychological attitude between men and women. Many sexual pain and difficulties in women are caused by psychological inequality.

　　3. Create a good sexual environment atmosphere. The environment can most influence a person's psychological reactions, and the suitability of the love-making environment is an essential condition for treating coital disorders.

　　4. Reasonably perform foreplay. This is not something that can be ignored for men. Many sexual difficulties and pain in women are due to the husband's rough entry during the first time. Foreplay can cause women to have a high level of sexual excitement, and in this situation, slight pain is often not noticeable.

　　5. Practice vaginal muscle relaxation techniques. This behavioral treatment is particularly effective for sexual pain caused by vaginal spasm.

　　6. Avoid excessive sexual activity and reduce the frequency of sexual activity. For example, some people have very frequent sexual activity, and some people have sexual activity two to three times a day, which is particularly prone to over-congestion or chronic inflammation that cannot be relieved, leading to sexual pain during intercourse.

　　7. To avoid sexual pain during intercourse, we also need to pay attention to hygiene, avoid infection caused by unclean sexual activity, and we know that urinary system inflammation is very common. In recent years, there has been an increasing trend in sexually transmitted diseases, such as non-gonococcal urethritis and prostatitis, which can cause congestion and also cause sexual pain during intercourse.

　　Therefore, we need to prevent, so we should pay attention to sexual hygiene in sexual life to avoid infection and the occurrence of sexually transmitted diseases.

　　The examinations needed for sexual pain include laboratory tests and other tests such as the following:

　　Endocrine hormone examination

　　The regulatory role of sex hormones in female sexual physiological reactivity is very important. Many diseases or drugs can affect the secretion and regulation of sex hormones, leading to female sexual dysfunction; thyroid hormones directly affect the metabolism and reactivity of the nervous system, or due to interference with the function of the gonadal axis, or due to emotional factors causing female sexual pain during intercourse. Blood tests for sex hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estrogen (E), testosterone (T), and thyroid hormones such as thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) can assist in diagnosing endocrine-derived female sexual pain during intercourse.

　　Other auxiliary examinations

　　1. Ultrasound: B-ultrasound can clearly diagnose conditions such as the absence or malformation of the uterus and its adnexa, uterine fibroids, adenomyosis, adnexal masses, etc. Necessary special examinations such as anti-endometrial antibody tests for endometriosis can be performed in conjunction with further diagnosis.

　　2. Specific physiological examination: mainly includes the measurement of blood flow in the female reproductive tract before and after sexual stimulation, vaginal pH value, vaginal compliance, and the threshold of the vibration sensation of female reproductive organs.

　　3. By using Doppler ultrasound: it can measure the maximum systolic blood flow velocity and venous diastolic velocity of the arteries in the clitoris, labia, urethra, vagina, and uterus, and understand the sexual physiological reactivity of the external genitalia.

　　4. Vaginal pH value: It can indirectly reflect the vaginal smoothness and cleanliness, which can be measured by a digital pH meter.

　　5. Clitoris and labial vibration degree: It is an indicator reflecting the sensitivity of the clitoris and labia to sexual stimulation, which can be measured by the bio-oscillation threshold meter.

　　6. Vaginal pressure/flow change: that is, vaginal compliance, which is measured by the compliance meter.

　　7. Other: For somatic diseases, go to the corresponding speciality department for diagnosis and treatment.

　　Patients with sexual intercourse pain should pay attention to the following content in their diet:

　　Eat foods rich in protein, such as various beans, milk, lean pork, eggs, etc.;

　　Eat vegetables rich in vitamins, such as cabbage, chives, spinach, carrots, etc.;

　　Eat foods with the effects of regulating qi and promoting blood circulation, such as mutton, hawthorn, fennel, etc.;

　　Eat foods with warming and nourishing effects, such as beef, pork liver, mutton, longan, hen, etc.

　　Avoid eating spicy, greasy and other刺激性 foods, such as chili, pepper, garlic, fried spareribs, etc.;

　　Avoid eating cold and cool foods, such as cucumbers, winter melon, etc.;

　　Avoid alcohol, and do not drink tonics containing alcohol, such as ginseng wine, deer antler wine, etc.;

　　Avoid eating too salty foods, such as salted meat, salted soup, pickled vegetables, etc.

　　The treatment of sexual intercourse pain varies according to the cause. For women with situational sexual intercourse pain, it is sufficient to change to a suitable sexual environment. For those with organic diseases, surgical or drug treatment should be adopted according to the condition. Generally speaking, premarital sex education and sexual consultation and diagnosis for patients are necessary.

　　Treatment of organic diseases:Sexual intercourse pain caused by organic lesions should be treated for the primary disease, and the sexual intercourse pain can naturally be cured after the primary disease is cured.

　　Congenital absence or maldevelopment of reproductive organs is often treated surgically. Vaginoplasty can be performed for congenital absence of the vagina or a short vagina, and the surgical method should be selected according to the patient's condition, such as whether there is a normally developed internal reproductive organ, whether there is cervical atresia, etc., and select the surgical method accordingly.

　　Antimicrobial therapy should be targeted at the pathogen or disease type for urinary生殖系 infections.