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How Is the Cause of Painful Intercourse (Sex) Diagnosed?

Date: Oct 20,2018   Read: 
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A health-care professional should ask about a woman's history of pain during intercourse. A thorough history and an extensive physical examination often reveal the most probable cause of this pain.

· A medical history identifying pain at the vaginal opening may suggest one of the following:
. Inadequate lubrication during the arousal phase (may be associated with hormonal changes or medications)
. Inflammation at the opening into the vagina
. Painful spasms of the vagina that prevent intercourse
· Pain located in the entire vaginal area may indicate conditions such as vulvar muscle degeneration, chronic vulvar pain, or a vaginal infection (fungal, parasitic, or bacterial).
o At times, a specific area of discomfort may be identified that might suggest another cause for the pain, such as inflammation of the urethra (the tube through which urine exits the body).
. Deep thrust dyspareunia refers to pain which occurs with deep repetitive vaginal penetration by her partner. A common complaint is that it feels as though her partner is "bumping" into something which causes pain with pelvic thrusting. This type of pain may suggest abnormalities of the pelvic organs, such as endometriosisadhesions, or uterine prolapse.
. Pain in the middle of the pelvis may suggest a uterine origin. Pain on one or both sides of the pelvis is more suggestive of pathology involving the fallopian tubes, ovaries, and ligaments.
· A health-care professional may perform an extensive physical examination of the woman's pelvis, abdomen, and lower back to better understand both her anatomy and the location of her pain. The exam may also allow the woman to better guide the doctor to the location of the discomfort. Part of this exam should include a rectal exam or rectovaginal exam. The exam may include a Pap smear, the collection of vaginal or cervical fluids for culture, an analysis of the urine (urinalysis), and other laboratory tests.
· A health care professional may recommend special radiological tests, such as a pelvic ultrasound or a CT scan or an MRI of the pelvis.
· The doctor may perform a urethrogram (an X-ray procedure to provide an image of the urinary tract), a cystogram (an x-ray exam that images the urinary bladder), or both, or the woman may be referred to a specialist (urologist) for these procedures. Another diagnostic procedure that may be used to look for urinary abnormalities is a cystoscopy, in which the doctor uses a thin, lighted probe to see the interior lining of the bladder and urethra. Frequently, referral to a urologist may be necessary to accomplish these procedures.

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