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494:. Criteria for genito-pelvic pain/penetration disorder include multiple episodes of difficulty with vaginal penetration, pain associated with intercourse attempts, anticipation of pain due to attempted intercourse, and tensing of the pelvis in response to attempted penetration. To meet criteria for this disorder, a patient must experience the symptoms for at least six months and experience "significant distress".
395:. Most vaginal pain disorders were officially discovered or coined during a time when rape was more normalized than it is now (marital rape was only recognized as non-consensual by all 50 US states in 1993). Some in the medical community are now starting to take into account factors like rape/sexual assault/ fear of rape/sexual harassment as strong enough psychological stressors to cause such pain disorders.
166:
more superficial or deep is important in understanding what may be causing the pain. Some patients have always experienced pain with intercourse from their very first attempt, while others begin to feel pain with intercourse after an injury or infection or cyclically with menstruation. Sometimes the pain increases over time.
177:
Physical examination of the vulva (external genitalia) may reveal clear reasons for pain including lesions, thin skin, ulcerations or discharge associated with vulvovaginal infections or vaginal atrophy. An internal pelvic exam may also reveal physical reasons for pain including lesions on the cervix
165:
Some describe superficial pain at the opening of the vagina or surface of the genitalia when penetration is initiated. Others feel deeper pain in the vault of the vagina or deep within the pelvis upon deeper penetration. Some feel pain in more than one of these places. Determining whether the pain is
497:
The differential diagnosis for dyspareunia is long because of its complicated and multifactorial nature. Often there are physiologic conditions underlying the pain, as well as psychosocial components that must be assessed to find appropriate treatment. A differential diagnosis of underlying physical
344:
pain and discomfort during or after sex. For an IC patient with a penis, pain occurs at the moment of ejaculation and is focused at the tip of the penis. If the IC patient has a vagina, pain usually occurs the following day and is the result of painful, spasming pelvic floor muscles. Interstitial
173:
and vaginal dilation decrease. When the vagina is dry and undilated, penetration is more painful. Fear of being in pain can make the discomfort worse. Pain may continue despite the original source being removed, due to the learned expectation of pain. Fear, avoidance, and psychological distress
468:
procedure may be recommended. Frenuloplasty is an effective procedure, with a high chance of avoiding circumcision, giving good functional results and patient satisfaction. The psychological effects of these conditions, while little understood, are real, and are visible in literature and art.
355:
involving either generalized or localized vulvar pain most often described as burning without physical evidence of other causes on exam. Pain can be constant or only when provoked (as with intercourse). Localized provoked vulvodynia is the most recent terminology for what used to be called
315:
inadequacy, which can lead to painful friction during intercourse. Vaginal dryness is often also reported alongside lactation. Patients undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to
123:. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.
153:
Those who experience pelvic pain upon attempted vaginal intercourse describe their pain in many ways. This reflects how many different and overlapping causes there are for dyspareunia. The location, nature, and time course of the pain help to understand potential causes and treatments.
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Clearly explain to the patient what has happened, including identifying sites and causes of pain. Make clear that the pain, in almost all cases, disappears over time, or at least greatly lessens. If there is a partner, explain the causes and treatment and encourage them to be
505:
Superficial dyspareunia without visible exam findings: When no other physical cause is found the diagnosis of vulvodynia should be considered. Vaginal atrophy may also not be seen clearly on exam but commonly affects postmenopausal patients and is generally associated with
202:, urinary tract infection, lack of lubrication, scar tissue, abnormal growths, or tender pelvic sites. Some cases may be psychosomatic, which can include fear of pain or injury, feelings of guilt or shame, ignorance of sexual anatomy and physiology, and fear of pregnancy.
563:
Encourage the couple to add pleasant, sexually exciting experiences to their regular interactions, such as bathing together (in which the primary goal is not cleanliness), or mutual caressing without intercourse. Such activities tend to increase both natural
460:, as the foreskin retracts on entry to the vagina irrespective of lubrication. In one study frenulum breve was found in 50% of patients who presented with dyspareunia. During vigorous or deep or tight intercourse or masturbation, small tears may occur in the
114:
covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the
541:
For pain due to yeast or fungal infections, a clinician may prescribe mycogen cream (nystatin and triamcinolone acetonide), which treats both a yeast infection and associated painful inflammation and itching because it contains both an antifungal and a
1965:
1946:
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657:, a physician, arguing for the removal of dyspareunia from the manual altogether. The most recent version, the DSM 5, has grouped dyspareunia under the diagnosis of Genito-Pelvic Pain/Penetration Disorder.
126:
Numerous physical, psychological, and social or relationship causes can contribute to pain during sexual encounters. Commonly, multiple underlying causes contribute to the pain. The pain can be acquired or
648:, stated that the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of
652:
or by vaginal spasm (vaginismus). After the text revision of the fourth edition of the DSM, a debate arose, with arguments to recategorize dyspareunia as a pain disorder instead of a sex disorder, with
1656:
Kompanje, EJ (October 2006). "Painful sexual intercourse caused by a disproportionately long penis: an historical note on a remarkable treatment devised by
Guilhelmius Fabricius Hildanus (1560-1634)".
726:
Basson R, Berman J, Burnett A, et al. Report of the international consensus development conference on female sexual dysfunction: definitions and clas-sifications. J Sex
Marital Ther. 2001;27(2):83–94
181:
When there are no visible findings on vulvar exam that would suggest a cause for superficial dyspareunia, a cotton-swab test may be performed. This is a test to assess for localized provoked
2866:
594:. Lubricant should be liberally applied (two tablespoons full) to both the penis and the orifice. A folded bath towel under the receiving partner's hips helps prevent spillage on bedclothes.
1617:"Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: effect on sexual functioning, psychological status and health-related quality of life"
464:
and can bleed and be very painful and induce anxiety, which can become chronic if left unresolved. If stretching fails to ease the condition, and uncomfortable levels of tension remain, a
2047:
1370:"Vulvodynia: A Common and Under-Recognized Pain Disorder in Women and Female Adolescents -- Integrating Current Knowledge into Clinical Practice | Dannemiller Education Center"
568:
and vaginal dilation, both of which decrease friction and pain. Prior to intercourse, oral sex may relax and lubricate the vagina (provided both partners are comfortable with it).
644:
936:
Flanagan, E; Herron, KA; O'Driscoll, C; Williams, AC (20 October 2014). "Psychological
Treatment for Vaginal Pain: Does Etiology Matter? A Systematic Review and Meta-Analysis".
2040:
597:
Instruct the receiving partner to take the penis of the penetrating partner in their hand and control insertion themselves, rather than let the penetrating partner do it.
1456:
735:
Gorniak G, Conrad W. An anatomical and functional perspective of the pelvic floor and urogenital organ support system. J Womenʼs Health Phys Ther. 2015;39(2):65–82
534:
The treatment for pain with intercourse depends on what is causing the pain. After proper diagnosis one or more treatments for specific causes may be necessary.
311:
among postmenopausal patients, and may be a result of similar changes in menstruating patients on hormonal birth control. Estrogen deficiency is associated with
1407:
McLean SA, Soward AC, Ballina LE, Rossi C, Rotolo S, Wheeler R, Foley KA, Batts J, Casto T, Collette R, Holbrook D, Goodman E, Rauch SA, Liberzon I (2012).
761:
Banaei, Mojdeh; Kariman, Nourossadat; Ozgoli, Giti; Nasiri, Maliheh; Ghasemi, Vida; Khiabani, Azam; Dashti, Sareh; Mohamadkhani Shahri, Leila (2020-12-27).
1291:
Bachmann GA, Leiblum SR, Kemmann E, Colburn DW, Swartzman L, Shelden R (July 1984). "Sexual expression and its determinants in the post-menopausal woman".
1878:
185:. A cotton tip applicator is applied at several points around the opening of the vagina; the patient reports the resulting pain on a scale from 0–10.
502:
Superficial dyspareunia or vulvar pain: infection, inflammation, anatomic causes, tissue destruction, psychosocial factors, muscular dysfunction
729:
Vegunta S, Kling JM, Faubion SS. Sexual health matters: management of female sexual dysfunction. J Womens Health (Larchmt). 2016;25(9):952–954.
720:
JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet
Gynecol. 2014;123(1):141–148.
1914:
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Yong, Paul J.; Williams, Christina; Yosef, Ali; Wong, Fontayne; Bedaiwy, Mohamed A.; Lisonkova, Sarka; Allaire, Catherine (2017-08-01).
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Happel-Parkins A., Azim K.A., Moses A. "i just beared through it": Southern US christian women's experiences of chronic dyspareunia.
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2174:
1483:
Dockray J, Finlayson A, Muir GH (May 2012). "Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring".
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Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunc-tion. Obstet
Gynecol Clin North Am. 1998;25(4):723–746.
101:
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following inflammation or local infection. Another cause of painful intercourse is due to tension in a short and slender frenulum,
1750:
Binik, YM (February 2005). "Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision".
2269:
1256:
Smith, NK; Jozkowski, KN; Sanders, SA (February 2014). "Hormonal contraception and female pain, orgasm and sexual pleasure".
487:
364:
878:
525:, inflammatory diseases (interstitial cystitis, pelvic inflammatory disease), infections, congestion, psychosocial factors,
560:
Encourage the patient to learn about her body, explore her own anatomy and learn how she likes to be caressed and touched.
448:, may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight
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Underlying causes determine treatment. Many patients experience relief when physical causes are identified and treated.
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Latif EZ, Diamond MP. Arriving at the diagnosis of female sexual dysfunction. Fertil Steril. 2013;100(4):898–904.
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There are a number of physical factors that may cause sexual discomfort. Pain is sometimes experienced in the
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can make genital stimulation painful or uncomfortable. Anatomic deformities of the penis, such as exist in
379:, an autoimmune disorder that characteristically attacks the exocrine glands that produce saliva and tears.
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The cause of the pain may be anatomic or physiologic, including but not limited to lesions of the vagina,
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For those who have pain on deep penetration because of pelvic injury or disease, recommend a change in
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Dyspareunia is a condition that has many causes and is not a diagnosis of itself. It is combined with
145:
In 2020, dyspareunia has been estimated to globally affect 35% of women at some point in their lives.
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2130:
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For patients with diagnostic criteria for endometriosis, medications or surgery are possible options.
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For pain that is likely due to post-menopausal vaginal dryness, estrogen treatment can be used.
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infections are sometimes associated with burning or sharp penile pains during ejaculation.
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452:, occurring either during the first attempt at intercourse or subsequent to tightening or
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330:
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Whelan. "Male dyspareunia due to short frenulum: an indication for adult circumcision".
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Binik YM, Bergeron S, Khalifé S (2000). "Dyspareunia". In
Leiblum SR, Rosen RC (eds.).
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can lead to intense burning or itching sensations following ejaculation. Patients with
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around attempting intercourse can become large parts of the experience of dyspareunia.
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131:. Symptoms of dyspareunia may also occur after menopause. Diagnosis is typically by
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Cancer of the reproductive tract, including the ovaries, cervix, uterus, or vagina.
1985:
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Krychman, ML (March 2011). "Vaginal estrogens for the treatment of dyspareunia".
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deficiency is a particularly common cause of sexual pain complaints related to
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2015:
1996:
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cystitis patients also struggle with urinary frequency and/or urinary urgency.
274:
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182:
46:
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1031:
786:
763:"Prevalence of postpartum dyspareunia: A systematic review and meta-analysis"
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2020:
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on the site of the
Applied Research Forum, National Electronic Network on
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507:
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421:
405:
304:
1729:(4th ed.). Washington, DC: American Psychiatric Association. 1994.
762:
1803:
Moser, C (February 2005). "Dyspareunia: Another argument for removal".
778:
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341:
258:
Tissue Injury. Pain after trauma to the pelvis from injury, surgery or
1938:
1269:
949:
825:
2472:
2243:
1950:
1008:"Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia"
241:
237:
213:
120:
1615:
Vercellini P, Frattaruolo MP, Somigliana E, et al. (May 2013).
1161:
1159:
1157:
1155:
971:
Boardman, Lori A.; Stockdale, Colleen K. (Dec 2009). "Sexual pain".
1559:(5th ed.). Washington: American Psychiatric Publishing. 2013.
1217:"Endometriosis-associated dyspareunia: the impact on women's lives"
552:
In addition, the following may reduce discomfort with intercourse:
491:
326:
266:
156:
816:
Boyer, SC; Goldfinger, C; Thibault-Gagnon, S; Pukall, CF (2011).
498:
causes can be guided by whether the pain is deep or superficial:
453:
432:
may experience intense penis pain at the moment of ejaculation.
2036:
84:
1116:
879:"Painful Sex (Dyspareunia) Treatment | Women's Therapy Center"
1726:
Diagnostic and
Statistical Manual of Mental Disorders: DSM-IV
1409:"Acute severe pain is a common consequence of sexual assault"
1110:
McDonald, Ea; Gartland, D; Small, R; Brown, Sj (2015-04-01).
205:
Common causes for discomfort on vaginal penetration include:
169:
Pain may distract from feeling pleasure and excitement. Both
1555:
Diagnostic and
Statistical Manual of Mental Disorders: DSM-5
579:. A device has also been described for limiting penetration.
1221:
The Journal of Family Planning and Reproductive Health Care
93:
90:
75:
1397:. Article dated March 1999. (Retrieved September 3, 2020.)
363:
Conditions that affect the surface of the vulva including
336:
Pain from bladder irritation: Dyspareunia is a symptom of
119:, or deeper in the pelvis upon deep pressure against the
66:
1853:. Arlington, VA: American Psychiatric Publishing. 2013.
1112:"Dyspareunia and childbirth: a prospective cohort study"
1905:(3rd ed.). New York: The Guilford Press. pp.
240:
tend to cause more superficial pain. Infections of the
1067:. Philadelphia, PA: F. A. Davis Company. p. 166.
640:
Diagnostic and Statistical Manual of Mental Disorders
102:
87:
69:
1928:
767:
International Journal of Gynecology & Obstetrics
78:
72:
63:
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2006:
1932:
1873:The original text for this article is taken from a
1849:
Diagnostic and Statistic Manual of Mental Disorders
81:
40:
35:
1846:
1552:
1348:(2nd ed.). Edinburgh: Churchill Livingstone.
1095:familydoctor.org editorial staff (25 April 2019).
1090:
1088:
1086:
1084:
360:when the pain is localized to the vaginal opening.
2867:Noninflammatory disorders of female genital tract
110:due to medical or psychological causes. The term
2048:
1339:
1337:
8:
1455:: CS1 maint: multiple names: authors list (
931:
929:
212:. Infections that mostly affect the labia,
1168:"Surgery in the alleviation of dyspareunia"
2799:
2576:
2257:
2248:
2091:
2082:
2055:
2041:
2033:
1929:
818:Management of female sexual pain disorders
161:Pain due to a long penis or a small vagina
32:
1763:
1632:
1432:
1232:
1191:
1127:
1065:Fifth Edition: Diseases of the Human Body
1039:
375:). Vaginal dryness is sometimes seen in
691:Tayyeb, Muhammad; Gupta, Vikas (2023).
683:
488:genito-pelvic pain/penetration disorder
1902:Principles and Practice of Sex Therapy
1448:
898:Boardman, Lori (2009). "Sexual Pain".
859:
849:
575:to one with less penetration, such as
1811:(1): 44–6, 57–61, author reply 63–7.
367:(lichen sclerosus et atrophicus), or
7:
1097:"Dyspareunia: Painful Sex for Women"
630:"bedfellow", meaning "badly mated".
2842:Persistent genital arousal disorder
1894:Sexual Pain Disorders - Dyspareunia
1328:"Painful intercourse (dyspareunia)"
382:Muscular dysfunction: For example,
900:Clinical Obstetrics and Gynecology
611:The word "dyspareunia" comes from
25:
2656:Hypoactive sexual desire disorder
2175:Ovarian hyperstimulation syndrome
820:. Vol. 31. pp. 83–104.
513:Deep dyspareunia or pelvic pain:
340:(IC). Patients may struggle with
1594:10.1111/j.1743-6109.2010.02114.x
1497:10.1111/j.1464-410X.2011.10678.x
1346:Human sexuality and its problems
1326:David Delvin (23 October 2019).
59:
590:during intercourse. Discourage
371:(dryness, especially after the
273:, thickened undilatable hymen,
2270:Dysfunctional uterine bleeding
1582:The Journal of Sexual Medicine
1258:The Journal of Sexual Medicine
1215:Denny E, Mann CH (July 2007).
938:The Journal of Sexual Medicine
740:J. Women's Health Phys. Ther..
27:Pain during sexual intercourse
1:
289:can contribute to discomfort.
2366:Menorrhagia (hypermenorrhea)
2337:Polymenorrhea (epimenorrhea)
1305:10.1016/0378-5122(84)90062-8
985:10.1097/GRF.0b013e3181bf4a7e
912:10.1097/GRF.0b013e3181bf4a7e
748:10.1097/JWH.0000000000000158
2783:Pelvic inflammatory disease
1805:Archives of Sexual Behavior
1752:Archives of Sexual Behavior
1658:Archives of Sexual Behavior
1425:10.1016/j.jpain.2012.04.008
250:pelvic inflammatory disease
2893:
2778:Pelvic congestion syndrome
2208:Fallopian tube obstruction
1234:10.1783/147118907781004831
1024:10.1016/j.esxm.2017.07.001
252:tend to cause deeper pain.
200:retroversion of the uterus
2827:Vestibular papillomatosis
2746:
2679:
2579:
2406:
2396:Metropathia haemorrhagica
2260:
1817:10.1007/s10508-005-7473-z
1774:10.1007/s10508-005-0998-4
1670:10.1007/s10508-006-9057-z
699:. StatPearls Publishing.
321:Pelvic masses, including
2163:Follicular cyst of ovary
1382:Bergen, Raquel Kennedy,
582:Recommend water-soluble
234:urinary tract infections
2661:Sexual arousal disorder
2617:Candidal vulvovaginitis
2275:Endometrial hyperplasia
1184:10.1136/bmj.1.5136.1510
1172:British Medical Journal
1129:10.1111/1471-0528.13263
1063:Tamparo, Carol (2011).
391:Psychological, such as
178:or anatomic variation.
2104:Endometriosis of ovary
1395:Violence Against Women
1166:Agnew AM (June 1959).
478:Differential diagnosis
353:diagnosis of exclusion
162:
2548:Vesicouterine fistula
2491:Cervical incompetence
2416:Recurrent miscarriage
2354:Premenstrual syndrome
2215:Fallopian tube cancer
1634:10.1093/humrep/det041
430:interstitial cystitis
338:interstitial cystitis
265:Anatomic variations.
160:
2706:Rectovaginal fistula
2131:Poor ovarian reserve
1892:Sandra Risa Leiblum
877:Katz, Ditza (2020).
420:. Infections of the
333:can cause deep pain.
194:Dyspareunia in women
133:physical examination
2872:Sexual dysfunctions
2756:Postcoital bleeding
2684:Urogenital fistulas
2612:Bacterial vaginosis
2265:Asherman's syndrome
1473:1977; 24–31: 1633-4
1344:Bancroft J (1989).
973:Clin Obstet Gynecol
655:Charles Allen Moser
577:missionary position
358:vulvar vestibulitis
218:lower urinary tract
171:vaginal lubrication
2641:Sexual dysfunction
2607:Atrophic vaginitis
2543:Retroverted uterus
2506:Female infertility
2486:Cervical dysplasia
2411:Female infertility
2203:Female infertility
2158:Corpus luteum cyst
2114:Ovulatory disorder
2109:Female infertility
2007:External resources
1621:Human Reproduction
1389:2011-10-06 at the
779:10.1002/ijgo.13523
742:2020;44(2):72-86.
717:Multiple sources:
588:surgical lubricant
462:preputial frenulum
446:Peyronie's disease
416:immediately after
400:Dyspareunia in men
377:Sjögren's syndrome
351:: Vulvodynia is a
283:retroverted uterus
163:
149:Signs and symptoms
108:sexual intercourse
2854:
2853:
2850:
2849:
2791:
2790:
2766:
2765:
2699:Obstetric fistula
2597:Vaginal discharge
2566:
2565:
2511:Cervical stenosis
2426:
2425:
2280:Endometrial polyp
2238:
2237:
2168:Theca lutein cyst
2030:
2029:
1916:978-1-57230-574-8
1860:978-0-89042-554-1
1736:978-0-89042-062-1
1566:978-0-89042-555-8
1485:BJU International
1355:978-0-443-03455-8
1270:10.1111/jsm.12409
1074:978-0-8036-2505-1
950:10.1111/jsm.12717
835:978-3-8055-9825-5
826:10.1159/000328810
292:Hormonal causes:
52:
51:
30:Medical condition
16:(Redirected from
2884:
2822:Kraurosis vulvae
2817:Bartholin's cyst
2800:
2751:Vaginal bleeding
2644:
2577:
2553:Uterine prolapse
2381:Menometrorrhagia
2305:
2258:
2249:
2148:Ovarian apoplexy
2092:
2083:
2057:
2050:
2043:
2034:
1930:
1920:
1865:
1864:
1852:
1843:
1837:
1836:
1800:
1794:
1793:
1767:
1747:
1741:
1740:
1721:
1715:
1696:
1690:
1689:
1653:
1647:
1646:
1636:
1612:
1606:
1605:
1577:
1571:
1570:
1558:
1549:
1543:
1542:
1540:
1539:
1530:. Archived from
1523:
1517:
1516:
1480:
1474:
1467:
1461:
1460:
1454:
1446:
1436:
1404:
1398:
1380:
1374:
1373:
1366:
1360:
1359:
1341:
1332:
1331:
1323:
1317:
1316:
1288:
1282:
1281:
1253:
1247:
1246:
1236:
1212:
1206:
1205:
1195:
1178:(5136): 1510–2.
1163:
1150:
1149:
1131:
1107:
1101:
1100:
1092:
1079:
1078:
1060:
1054:
1053:
1043:
1018:(3): e184–e195.
1003:
997:
996:
968:
962:
961:
933:
924:
923:
895:
889:
888:
886:
885:
874:
868:
867:
861:
857:
855:
847:
813:
807:
806:
758:
752:
715:
709:
708:
688:
426:seminal vesicles
331:uterine fibroids
287:uterine prolapse
222:yeast infections
103:dis-pər-OO-nee-ə
100:
99:
96:
95:
92:
89:
86:
83:
80:
77:
74:
71:
68:
65:
33:
21:
2892:
2891:
2887:
2886:
2885:
2883:
2882:
2881:
2857:
2856:
2855:
2846:
2787:
2762:
2742:
2675:
2638:
2633:
2629:Vaginal atresia
2562:
2522:
2481:Cervical cancer
2467:
2449:
2445:Uterine fibroid
2422:
2402:
2386:Polymenorrhagia
2327:Oligoamenorrhea
2299:
2294:
2234:
2189:
2185:Ovarian torsion
2074:
2064:Female diseases
2061:
2031:
2026:
2025:
2002:
2001:
1941:
1927:
1917:
1898:
1889:
1887:Further reading
1869:
1868:
1861:
1845:
1844:
1840:
1802:
1801:
1797:
1749:
1748:
1744:
1737:
1723:
1722:
1718:
1697:
1693:
1655:
1654:
1650:
1614:
1613:
1609:
1579:
1578:
1574:
1567:
1551:
1550:
1546:
1537:
1535:
1525:
1524:
1520:
1491:(10): 1546–50.
1482:
1481:
1477:
1468:
1464:
1447:
1406:
1405:
1401:
1391:Wayback Machine
1381:
1377:
1368:
1367:
1363:
1356:
1343:
1342:
1335:
1325:
1324:
1320:
1290:
1289:
1285:
1255:
1254:
1250:
1214:
1213:
1209:
1165:
1164:
1153:
1109:
1108:
1104:
1094:
1093:
1082:
1075:
1062:
1061:
1057:
1012:Sexual Medicine
1005:
1004:
1000:
970:
969:
965:
935:
934:
927:
897:
896:
892:
883:
881:
876:
875:
871:
858:
848:
836:
815:
814:
810:
760:
759:
755:
716:
712:
690:
689:
685:
680:
672:Sexual headache
663:
636:
609:
604:
592:petroleum jelly
573:coital position
532:
480:
475:
402:
309:vaginal atrophy
246:fallopian tubes
196:
191:
151:
137:medical history
62:
58:
31:
28:
23:
22:
15:
12:
11:
5:
2890:
2888:
2880:
2879:
2874:
2869:
2859:
2858:
2852:
2851:
2848:
2847:
2845:
2844:
2839:
2834:
2829:
2824:
2819:
2814:
2808:
2806:
2797:
2793:
2792:
2789:
2788:
2786:
2785:
2780:
2774:
2772:
2768:
2767:
2764:
2763:
2761:
2760:
2759:
2758:
2747:
2744:
2743:
2741:
2740:
2739:
2738:
2733:
2728:
2723:
2718:
2708:
2703:
2702:
2701:
2696:
2691:
2689:Ureterovaginal
2680:
2677:
2676:
2674:
2673:
2668:
2666:Vaginal cancer
2663:
2658:
2653:
2647:
2645:
2635:
2634:
2632:
2631:
2626:
2621:
2620:
2619:
2614:
2609:
2599:
2590:
2580:
2574:
2568:
2567:
2564:
2563:
2561:
2560:
2558:Uterine cancer
2555:
2550:
2545:
2540:
2530:
2528:
2524:
2523:
2521:
2520:
2518:Nabothian cyst
2515:
2514:
2513:
2503:
2498:
2496:Cervical polyp
2493:
2488:
2483:
2477:
2475:
2469:
2468:
2466:
2465:
2459:
2457:
2451:
2450:
2448:
2447:
2442:
2436:
2434:
2428:
2427:
2424:
2423:
2421:
2420:
2419:
2418:
2407:
2404:
2403:
2401:
2400:
2399:
2398:
2390:
2389:
2388:
2383:
2375:
2374:
2373:
2368:
2358:
2357:
2356:
2351:
2341:
2340:
2339:
2334:
2332:Oligomenorrhea
2329:
2324:
2319:
2308:
2306:
2296:
2295:
2293:
2292:
2287:
2282:
2277:
2272:
2267:
2261:
2255:
2246:
2240:
2239:
2236:
2235:
2233:
2232:
2227:
2222:
2217:
2212:
2211:
2210:
2199:
2197:
2195:Fallopian tube
2191:
2190:
2188:
2187:
2182:
2180:Ovarian cancer
2177:
2172:
2171:
2170:
2165:
2160:
2150:
2145:
2140:
2135:
2134:
2133:
2128:
2127:
2126:
2124:Oligoovulation
2121:
2106:
2100:
2098:
2089:
2080:
2076:
2075:
2062:
2060:
2059:
2052:
2045:
2037:
2028:
2027:
2024:
2023:
2011:
2010:
2008:
2004:
2003:
2000:
1999:
1988:
1977:
1962:
1942:
1937:
1936:
1934:
1933:Classification
1926:
1925:External links
1923:
1922:
1921:
1915:
1896:
1888:
1885:
1884:
1883:
1867:
1866:
1859:
1838:
1795:
1765:10.1.1.528.189
1742:
1735:
1716:
1691:
1648:
1627:(5): 1221–30.
1607:
1572:
1565:
1544:
1518:
1475:
1462:
1399:
1384:"Marital Rape"
1375:
1361:
1354:
1333:
1318:
1283:
1248:
1207:
1151:
1122:(5): 672–679.
1102:
1080:
1073:
1055:
998:
963:
925:
890:
869:
860:|journal=
834:
808:
753:
751:
750:
736:
733:
730:
727:
724:
721:
710:
682:
681:
679:
676:
675:
674:
669:
662:
659:
635:
634:Classification
632:
608:
605:
603:
600:
599:
598:
595:
580:
569:
561:
558:
550:
549:
546:
543:
531:
528:
527:
526:
511:
503:
479:
476:
474:
471:
458:frenulum breve
424:, bladder, or
401:
398:
397:
396:
389:
380:
361:
346:
334:
319:
318:
317:
302:
290:
263:
256:
253:
230:trichomoniasis
195:
192:
190:
187:
150:
147:
50:
49:
44:
38:
37:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
2889:
2878:
2875:
2873:
2870:
2868:
2865:
2864:
2862:
2843:
2840:
2838:
2835:
2833:
2830:
2828:
2825:
2823:
2820:
2818:
2815:
2813:
2812:Vulvar cancer
2810:
2809:
2807:
2805:
2801:
2798:
2794:
2784:
2781:
2779:
2776:
2775:
2773:
2769:
2757:
2754:
2753:
2752:
2749:
2748:
2745:
2737:
2734:
2732:
2729:
2727:
2724:
2722:
2719:
2717:
2714:
2713:
2712:
2709:
2707:
2704:
2700:
2697:
2695:
2694:Vesicovaginal
2692:
2690:
2687:
2686:
2685:
2682:
2681:
2678:
2672:
2669:
2667:
2664:
2662:
2659:
2657:
2654:
2652:
2649:
2648:
2646:
2643:
2642:
2636:
2630:
2627:
2625:
2622:
2618:
2615:
2613:
2610:
2608:
2605:
2604:
2603:
2600:
2598:
2594:
2591:
2589:
2585:
2582:
2581:
2578:
2575:
2573:
2569:
2559:
2556:
2554:
2551:
2549:
2546:
2544:
2541:
2539:
2535:
2532:
2531:
2529:
2525:
2519:
2516:
2512:
2509:
2508:
2507:
2504:
2502:
2499:
2497:
2494:
2492:
2489:
2487:
2484:
2482:
2479:
2478:
2476:
2474:
2470:
2464:
2461:
2460:
2458:
2456:
2452:
2446:
2443:
2441:
2438:
2437:
2435:
2433:
2429:
2417:
2414:
2413:
2412:
2409:
2408:
2405:
2397:
2394:
2393:
2391:
2387:
2384:
2382:
2379:
2378:
2376:
2372:
2369:
2367:
2364:
2363:
2362:
2359:
2355:
2352:
2350:
2347:
2346:
2345:
2342:
2338:
2335:
2333:
2330:
2328:
2325:
2323:
2322:Hypomenorrhea
2320:
2318:
2315:
2314:
2313:
2310:
2309:
2307:
2304:
2303:
2297:
2291:
2288:
2286:
2285:Endometriosis
2283:
2281:
2278:
2276:
2273:
2271:
2268:
2266:
2263:
2262:
2259:
2256:
2254:
2250:
2247:
2245:
2241:
2231:
2228:
2226:
2223:
2221:
2220:Hematosalpinx
2218:
2216:
2213:
2209:
2206:
2205:
2204:
2201:
2200:
2198:
2196:
2192:
2186:
2183:
2181:
2178:
2176:
2173:
2169:
2166:
2164:
2161:
2159:
2156:
2155:
2154:
2151:
2149:
2146:
2144:
2141:
2139:
2138:Mittelschmerz
2136:
2132:
2129:
2125:
2122:
2120:
2117:
2116:
2115:
2112:
2111:
2110:
2107:
2105:
2102:
2101:
2099:
2097:
2093:
2090:
2088:
2084:
2081:
2077:
2073:
2069:
2065:
2058:
2053:
2051:
2046:
2044:
2039:
2038:
2035:
2022:
2018:
2017:
2013:
2012:
2009:
2005:
1998:
1994:
1993:
1989:
1987:
1983:
1982:
1978:
1976:
1972:
1971:
1967:
1963:
1961:
1957:
1953:
1952:
1948:
1944:
1943:
1940:
1935:
1931:
1924:
1918:
1912:
1908:
1904:
1903:
1897:
1895:
1891:
1890:
1886:
1882:
1880:
1877:CDC document
1876:
1875:public domain
1871:
1870:
1862:
1856:
1851:
1850:
1842:
1839:
1834:
1830:
1826:
1822:
1818:
1814:
1810:
1806:
1799:
1796:
1791:
1787:
1783:
1779:
1775:
1771:
1766:
1761:
1757:
1753:
1746:
1743:
1738:
1732:
1728:
1727:
1720:
1717:
1713:
1709:
1705:
1701:
1695:
1692:
1687:
1683:
1679:
1675:
1671:
1667:
1663:
1659:
1652:
1649:
1644:
1640:
1635:
1630:
1626:
1622:
1618:
1611:
1608:
1603:
1599:
1595:
1591:
1588:(3): 666–74.
1587:
1583:
1576:
1573:
1568:
1562:
1557:
1556:
1548:
1545:
1534:on 2018-08-31
1533:
1529:
1522:
1519:
1514:
1510:
1506:
1502:
1498:
1494:
1490:
1486:
1479:
1476:
1472:
1466:
1463:
1458:
1452:
1444:
1440:
1435:
1430:
1426:
1422:
1419:(8): 736–41.
1418:
1414:
1410:
1403:
1400:
1396:
1392:
1388:
1385:
1379:
1376:
1371:
1365:
1362:
1357:
1351:
1347:
1340:
1338:
1334:
1329:
1322:
1319:
1314:
1310:
1306:
1302:
1298:
1294:
1287:
1284:
1279:
1275:
1271:
1267:
1264:(2): 462–70.
1263:
1259:
1252:
1249:
1244:
1240:
1235:
1230:
1227:(3): 189–93.
1226:
1222:
1218:
1211:
1208:
1203:
1199:
1194:
1189:
1185:
1181:
1177:
1173:
1169:
1162:
1160:
1158:
1156:
1152:
1147:
1143:
1139:
1135:
1130:
1125:
1121:
1117:
1113:
1106:
1103:
1098:
1091:
1089:
1087:
1085:
1081:
1076:
1070:
1066:
1059:
1056:
1051:
1047:
1042:
1037:
1033:
1029:
1025:
1021:
1017:
1013:
1009:
1002:
999:
994:
990:
986:
982:
979:(4): 682–90.
978:
974:
967:
964:
959:
955:
951:
947:
943:
939:
932:
930:
926:
921:
917:
913:
909:
906:(4): 682–90.
905:
901:
894:
891:
880:
873:
870:
865:
853:
845:
841:
837:
831:
827:
823:
819:
812:
809:
804:
800:
796:
792:
788:
784:
780:
776:
772:
768:
764:
757:
754:
749:
745:
741:
737:
734:
731:
728:
725:
722:
719:
718:
714:
711:
706:
702:
698:
694:
693:"Dyspareunia"
687:
684:
677:
673:
670:
668:
665:
664:
660:
658:
656:
651:
647:
646:
641:
638:The previous
633:
631:
629:
625:
621:
617:
614:
606:
601:
596:
593:
589:
585:
581:
578:
574:
570:
567:
562:
559:
555:
554:
553:
547:
544:
540:
539:
538:
537:For example:
535:
529:
524:
520:
519:ovarian cysts
516:
515:endometriosis
512:
509:
504:
501:
500:
499:
495:
493:
489:
485:
477:
472:
470:
467:
466:frenuloplasty
463:
459:
455:
451:
447:
443:
439:
435:
431:
427:
423:
419:
415:
411:
407:
399:
394:
390:
388:
385:
381:
378:
374:
370:
366:
362:
359:
354:
350:
347:
343:
339:
335:
332:
328:
324:
323:ovarian cysts
320:
314:
310:
306:
303:
301:
297:
296:Endometriosis
294:
293:
291:
288:
284:
280:
276:
272:
271:vaginal septa
268:
264:
261:
257:
254:
251:
247:
243:
239:
235:
231:
227:
223:
219:
215:
211:
208:
207:
206:
203:
201:
193:
188:
186:
184:
179:
175:
172:
167:
159:
155:
148:
146:
143:
140:
138:
134:
130:
124:
122:
118:
113:
109:
106:) is painful
105:
104:
98:
56:
48:
45:
43:
39:
34:
19:
2731:Sigmoidocele
2650:
2639:
2584:Hematocolpos
2463:Parametritis
2371:Metrorrhagia
2349:Dysmenorrhea
2302:Menstruation
2300:
2290:Endometritis
2225:Hydrosalpinx
2153:Ovarian cyst
2014:
1990:
1979:
1964:
1945:
1901:
1872:
1848:
1841:
1808:
1804:
1798:
1758:(1): 11–21.
1755:
1751:
1745:
1725:
1719:
1714:"bedfellow".
1711:
1703:
1694:
1664:(5): 603–5.
1661:
1657:
1651:
1624:
1620:
1610:
1585:
1581:
1575:
1554:
1547:
1536:. Retrieved
1532:the original
1521:
1488:
1484:
1478:
1470:
1465:
1451:cite journal
1416:
1412:
1402:
1378:
1364:
1345:
1321:
1299:(1): 19–29.
1296:
1292:
1286:
1261:
1257:
1251:
1224:
1220:
1210:
1175:
1171:
1119:
1115:
1105:
1064:
1058:
1015:
1011:
1001:
976:
972:
966:
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2736:Urethrocele
2651:Dyspareunia
2624:Hydrocolpos
2588:Hydrocolpos
2534:Hematometra
2455:Parametrium
2440:Adenomyosis
2253:Endometrium
2230:Salpingitis
2119:Anovulation
2021:Dyspareunia
1526:Douglas E.
944:(1): 3–16.
667:Dysorgasmia
650:lubrication
566:lubrication
557:supportive.
510:deficiency.
442:prostatitis
418:ejaculation
384:levator ani
313:lubrication
300:adenomyosis
112:dyspareunia
55:Dyspareunia
36:Dyspareunia
18:Painful sex
2861:Categories
2837:Vulvodynia
2721:Enterocele
2671:Vaginismus
2593:Leukorrhea
2501:Cervicitis
2432:Myometrium
2317:Amenorrhea
2143:Oophoritis
2016:Patient UK
1992:DiseasesDB
1706:"bad" and
1538:2014-09-23
884:2021-01-22
697:StatPearls
678:References
622:"bad" and
484:vaginismus
438:Urethritis
434:Gonorrheal
406:testicular
393:vaginismus
349:Vulvodynia
275:hypoplasia
269:remnants,
260:childbirth
210:Infections
183:vulvodynia
129:congenital
47:Gynecology
2726:Rectocele
2716:Cystocele
2602:Vaginitis
1760:CiteSeerX
1293:Maturitas
1138:1471-0528
1032:2050-1161
862:ignored (
852:cite book
803:228088155
787:0020-7292
607:Etymology
530:Treatment
523:adhesions
521:, pelvic
473:Diagnosis
373:menopause
279:introitus
226:chlamydia
117:genitalia
42:Specialty
2832:Vulvitis
2796:External
2711:Prolapse
2538:Pyometra
2079:Internal
2072:genitals
1833:12297902
1825:16092029
1790:28497075
1782:15772767
1712:pareunos
1708:πάρευνος
1686:37484326
1678:17031589
1643:23442755
1602:21091878
1513:42381244
1505:22176714
1443:22698980
1387:Archived
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1243:17609078
1202:13651780
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1050:28778678
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920:20393420
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795:33300122
705:32965830
661:See also
628:pareunos
624:πάρευνος
542:steroid.
508:estrogen
454:scarring
450:foreskin
422:prostate
305:Estrogen
2527:General
2066:of the
1986:D004414
1528:"JQuad"
1434:3437775
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1193:1993727
1041:5562494
602:History
490:in the
387:myalgia
369:xerosis
342:bladder
316:trauma.
277:of the
267:Hymenal
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2377:Mixed
2361:Timing
2244:Uterus
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2068:pelvis
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329:, and
327:tumors
242:cervix
238:herpes
214:vagina
189:Causes
121:cervix
2804:Vulva
2771:Other
2096:Ovary
1975:625.0
1960:N94.1
1956:F52.6
1829:S2CID
1786:S2CID
1698:From
1682:S2CID
1509:S2CID
799:S2CID
613:Greek
492:DSM-5
486:into
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410:glans
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2877:Pain
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1879:PDF
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