[Sexual pain disorders in females and males].
ABSTRACT The occurrence of pain during sex is one of the most common complaints in gynecological and sexological practice but nonetheless one of the most difficult problems to deal with and treat effectively.
A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men.
The different descriptions of painful intercourse (dyspareunia, vestibulo-vulvodynies, vaginismus) are not separate entities but the result of the interaction of many factors including genital pain, emotional and behavioral responses to penetration, caresses, desire and excitement, in a context of possible organic pathology (infection, endometriosis, inflammatory or dermatological disease, morphological or pelvic abnormality, hormonal deficiency) sometimes associated with chronic pain phenomena self-sustained by neurogenic inflammation. The clinical expression of sexual pain is as variable as its causes are many. The etiological investigation is essential but should not omit the sexological context and the need for appropriate management. The neurogenic inflammation and hypersensitivity impose an algological approach associated to etiological and sexological treatment.
Chronic sexual pains, whether they are superficial or deep, can be the sign of organic or psycho-sexual (primary or secondary) disorders. The development of a "therapeutic program" helps patients, allows them to restore self-confidence and leads to the disappearance of the symptom in more than half cases.
[Show abstract] [Hide abstract]
ABSTRACT: In order to obtain a description of the innervation of the vaginal wall we employed an antiserum against the general neuronal marker, protein gene product 9.5, on normal human vaginal mucosa. Specimens were taken from the anterior and posterior fornices, from the anterior vaginal wall at the bladder neck level and from the introitus vaginae region, and then processed for indirect immunohistochemistry. All regions studied revealed a profound innervation, although regional differences were noted. The more distal areas of the vaginal wall had more nerve fibers compared to the more proximal parts. Also, biopsies from the anterior wall generally were more densely innervated than the posterior wall. Some large nerve coils were observed in lamina propria of the anterior wall as well as gatherings of thick-walled medium-sized blood vessels. Free intraepithelial nerve endings were only detected in the introitus vaginae region. These fibers were very thin, always varicose and could be observed just a few cell layers from the surface. In this part of the vagina, protein gene product 9.5 antibodies also stained cells within the basal parts of the epithelium. These cells were also neurone-specific enolase positive and resembled, from a morphological point of view, Merkel cells.Acta Anatomica 02/1995; 153(2):119-26. DOI:10.1159/000147722
[Show abstract] [Hide abstract]
ABSTRACT: This study examines the frequency and duration of pain in same-sex anal intercourse in a sample of 277 adult men who have engaged in, or attempted to engage in, anal intercourse during their lifetime. Whereas estimates of frequency of pain appeared blocked distributed across a 7-point Likert scale, severity of pain appeared positively skewed, with 12% rating it as too painful to continue. Participants rated inadequate lubrication, psychological factors such as not feeling relaxed, and lack of digitoproctic stimulation prior to penetration as the three most important psychophysiological factors predicting pain. Factors associated with a greater amount of pain experienced in anal intercourse were depth and rate of thrusting, lack of social comfort with gay men, being more "closeted," and less concern over becoming old or unattractive as a gay or bisexual man. Pain was also positively related to anxiety. The use of condoms was not rated highly as a factor in receptive anal pain. Based on these findings, the authors define anodyspareunia to denote painful receptive anal intercourse, and suggest clinical criteria similar to that used for other sexual pain disorders.Journal of Sex and Marital Therapy 10/1998; 24(4):281-92. DOI:10.1080/00926239808403963 · 1.27 Impact Factor
Article: Epidemiology of chronic pelvic pain.[Show abstract] [Hide abstract]
ABSTRACT: An overview is given of the current knowledge of the epidemiology of chronic pelvic pain (CPP) in terms of prevalence, incidence, and associated risk factors. However, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Although data are limited, the prevalence of CPP in the general population appears to be high. A single study found a 3-month prevalence (pelvic pain of at least 6 months' duration) of 15% in women aged 18-50 in the general US population. In the UK, an annual prevalence in primary care of 38/1000 was found in women aged 15-73, a rate comparable to that of asthma (37/1000) and back pain (41/1000). The monthly incidence in primary care was 1.6/1000. No incidence figures exist for the general population. Analysis of risk factors for CPP is highly complicated owing to its multifactorial aetiology. At present, it is only of some value using women with CPP identified at community level, since those in primary, secondary or tertiary care are likely to constitute highly selected sub-groups.Bailliè re s Best Practice and Research in Clinical Obstetrics and Gynaecology 07/2000; 14(3):403-14. · 3.00 Impact Factor