Monforte M, Mimoun S, Droupy S
Service de gynécologie-obstétrique et médecine de la reproduction, CHU Arnaud-de-Villeneuve, 34000 Montpellier, France.
Prog Urol. 2013 Jul;23(9):761-70. doi: 10.1016/j.purol.2013.01.018. Epub 2013 Apr 4.
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.
性交时疼痛是妇科和性学实践中最常见的主诉之一,但却是最难处理和有效治疗的问题之一。
在Medline上进行文献综述,考虑截至2012年1月列出的关于男性和女性性交疼痛的文章。
性交疼痛(性交困难、前庭大腺炎、阴道痉挛)的不同描述并非独立的实体,而是多种因素相互作用的结果,这些因素包括生殖器疼痛、对插入、抚摸、欲望和兴奋的情绪及行为反应,在可能存在的器质性病变(感染、子宫内膜异位症、炎症或皮肤病、形态或盆腔异常、激素缺乏)的背景下,有时与神经源性炎症自我维持的慢性疼痛现象相关。性交疼痛的临床表现与其病因一样多样。病因调查至关重要,但不应忽略性学背景以及适当管理的必要性。神经源性炎症和超敏反应需要采用与病因及性学治疗相关的疼痛学方法。
慢性性交疼痛,无论是浅表性还是深部性的,都可能是器质性或心理性(原发性或继发性)障碍的迹象。制定“治疗方案”对患者有帮助,能使他们恢复自信,并在超过半数的病例中使症状消失。