Causes of dyspareunia
Hypertonus of pelvic muscles and their high rigidity are characteristic for all types of chronic dyspareunia. The most characteristic cause of superficial dyspareunia is vestibulitis. Vestibulitis (inflammation of the vulva) is the most common form of chronic pelvic pain syndrome, with incoming impulses to the nervous system from the peripheral receptors and the cerebral cortex remodulated for unknown reasons. As a result of this sensitization, the patient perceives this stimulus not as an ordinary contact, but as a significant pain (allodynia). Many women have concomitant genitourinary disorders (for example, vulvovaginal candidiasis, hyperoxaluria), but the etiological role of these disorders is unproven. Some women also have other pain disorders (for example, irritable bowel syndrome.) The appearance of pain in vestibulitis occurs immediately after the introduction of the penis into the vagina, during movement and during ejaculation in men.With vestibulitis, burning and dysuric disorders may occur after sexual contact. There is pain in the introduction of the penis into the vagina, but the pain stops when the movements of the penis stop and again resumes, the pain can persist with vaginismus, when the movement of the polo th member shall be terminated; the pain may disappear during sexual intercourse, despite the continuing movement of the penis.
Other causes of superficial dyspareunia include atrophic vaginitis, vulvar damage or disorders (eg sclerosing lichen, vulvar dystrophy), congenital malformations, fibrosis after radiation therapy, postoperative narrowing of the vestibule, and rupture of the posterior adhesion of the labia.
The causes of deep dyspareunia are hypertonic pelvic muscles and uterine or ovarian disorders (eg, fibroids, endometriosis). The size and depth of the introduction of the penis affect the appearance and severity of the symptoms. Damage to sexual sensory or vegetative bundles of nerve fibers, as well as the use of selective serotonin inhibitors, can lead to acquired disruption of orgasm.
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