Symptoms and signs of painful sexual intercourse in women

　　female The most important and obvious symptom of painful sexual intercourse is the varying degrees and nature of pain during sexual intercourse, which is also the main reason for patients to seek medical treatment.

　　1. The nature and location of the pain. Congenital genital development abnormalities, such as hymen hypertrophy, hymenal umbrella, vaginal atresia, stenosis or shortness, vaginal mediastinum or transverse septum. The pain is superficial blunt impact pain, often accompanied by difficulty in vaginal penetration.； Adhesions and scars on the labia and vaginal opening, vulvitis , Bartholinitis, cysts, etc. often cause local burning pain, sharp pain or pain upon impact.； When the clitoris or clitoral foreskin is allergic, the pain is traction or contact pain. anorectum disease When the time comes, pain and sadness are often full of； In cases of vaginal infectious diseases, vaginal trauma and vaginal atrophy, the lack of estrogen and other factors causes changes in the pH of the mucus in the vagina and cervix. The pain is mostly at the vaginal opening and inside the vagina, presenting as sharp pain or mild pain. Retroversion of the uterus or with uterine fibroids , suggesting deep sexual intercourse pain in the early stages of menstruation. Endometriosis often causes sexual intercourse pain during premenstrual period and deep pain during sexual intercourse. Chronic pelvic inflammatory disease Pelvic lesions often present with deep sexual intercourse pain, while cystitis often causes sexual intercourse pain on the anterior vaginal wall following sexual intercourse.； Fat bulging can also cause pain in the front vaginal wall during sexual intercourse. vulva skin Because of sexually transmitted herpetic inflammation of the external genitalia, it can cause burning pain on the outside or inside of the vagina during sexual intercourse.； Genital warts cause burning pain in the vulva or vaginal opening during sexual intercourse ； Others such as herpes simplex, herpes zoster, pubic lice, scabies , dermatitis, etc. can all cause superficial pain during sexual intercourse.

　　2. Symptoms of associated organic diseases such as endometriosis, with a typical history of lower abdominal pain during menstruation, which is progressively worse. During pelvic examination, there is often tenderness in the posterior vaginal fornix, tenderness in the uterus or appendages, cervical lifting pain, twisting pain, etc. Sometimes chocolate cysts formed by endometriosis can be touched.； Congenital absence of vagina, short or narrow vagina, vaginal septum, atresia or hypertrophy of hymen, etc. The diagnosis can be clearly understood during gynecological examination ； External genital atrophy caused by various reasons, including vaginal dryness, Itching of the vulva , less leucorrhea and more urinary tract infection symptoms such as frequent urination, urgency, and painful urination.； During the examination, it was found that the skin and mucosa of the vulva and vagina became thinner and lacked elasticity, the vaginal secretions decreased or their properties changed, and there was often a history of frequent urogenital tract infections. ； vulva Vaginitis When the symptoms include spirochete sexually transmitted diseases (STDs), abnormal leucorrhea and vulvar itching are common. Gynecological examination shows local congestion, redness, swelling and ulceration, as well as pathological lesions such as vulvar herpes or vegetation hyperplasia typical of STDs.； Childbirth, breastfeeding or menopause, the presence of special psychological issues and other typical symptoms of other diseases such as neurosis.

　　3. Patients with mental symptoms may report similar complaints such as "do not want to have sex, just fulfill the duties of a wife", "fear or hate sexual intercourse", "the husband only cares about his own feelings, behaves rashly, and is difficult to tell him", "can't explain clearly, and is sometimes misunderstood as deliberately looking for reasons to avoid sexual life", and treats the sexual life of couples negatively.； The patient's mood may be reduced, agitated, or moved and sensitive. ； The relationship between husband and wife is not harmonious and the psychological pressure is high ； Generally, people do not take the initiative to talk about sexual life issues, but after questioning, they can find out the hidden dangers of sexual dysfunction that may be due to lack of sexual knowledge and experience. ； Some patients involuntarily experience severe anxiety during gynecological examination, move their body backward, retract their legs, or resist the examination by using their hands to resist the touch of the speculum or hands.

　　Pain during sexual intercourse is usually accompanied by obvious gynecological diseases. Therefore, doctors should inquire about the medical history and various social and psychological related factors in detail to understand the cause, location, duration and complications of the pain. It is necessary to carry out specific gynecological examination, including speculum examination, vaginal examination and necessary triadic examination. Only after gynecological and systemic organic related diseases are ruled out can psychological factors be considered.

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