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Sexual pain disorders: dyspareunia and vaginismus

09/06/2008

Sexual pain disorders: dyspareunia and vaginismus
in: Porst H. Buvat J. (Eds), ISSM (International Society of Sexual Medicine) Standard Committee Book, Standard practice in Sexual Medicine, Blackwell, Oxford, UK, 2006, p. 342-350
Pain is almost never “psychogenic,” except for pain from grieving. Pain has biological basis, when it is the alerting signal of an impending or current tissue damage from which the body should withdraw it is defined as “nociceptive”. When pain becomes a disease per se, i.e. it is generated within the nerves and nervous centers, it is called “neuropathic”. It is a complex perceptive experience, involving psychological and relational meanings, which may become increasingly important with the chronicity of pain.
Sexual pain disorders – dyspareunia and vaginismus – are very sensitive issues, as the pain involves emotionally charged behaviors: sexual intimacy and vaginal intercourse. Most patients have been denied for years that their pain was real and feel enormously relieved when they finally meet a clinician who trusts their symptoms and commits him/herself to a thorough understanding of the complex etiology of their sexual pain.
Talking with patients about sexual pain disorders requires special attention to the sensitivity of the issue and an empathic attitude to the biological “truth” of pain. This is the basis of a very rewarding clinician-patient relationship and is the basis of an effective therapeutic alliance.

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Parole chiave:
Abuso sessuale Adolescenza Aliamidi Amenorrea Anamnesi Androgeni Candida / Micosi Carcinoma mammario Cistite recidivante Classificazione Comorbilità Compliance Depressione Desiderio sessuale Disfunzioni ormonali Dispareunia femminile / Dolore ai rapporti Distrofia vulvare Disturbi del desiderio Disturbi dell'eccitazione Disturbi dell'orgasmo Disturbi sessuali con dolore Disturbi sessuali femminili Dolore cronico Eccitazione Endometriosi Esame obiettivo medico Estradiolo Estrogeni Farmaci Fattori biologici Fattori di rischio Fattori predittivi Fattori psicosessuali Fattori relazionali Fobia Funzione sessuale femminile Ginecologia Identità sessuale Incontinenza urinaria Intimità Invecchiamento Malattie sessualmente trasmesse Mastociti Matrimonio non consumato Menopausa / Premenopausa Menopausa precoce iatrogena Ormoni sessuali Pavimento pelvico pH Progesterone / Progestinici Prolattina Psicoterapia Puerperio Radioterapia Rapporto medico-paziente Riabilitazione uro-ginecologica Secchezza vaginale Semeiotica medica Sessuologia medica Terapia sessuale Testosterone Tossina botulinica Uroginecologia Vagina Vaginismo Vestibolite vulvare / Vestibolodinia provocata / Vulvodinia Vulva Vulvo-vaginite

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