Steege J F, Ling F W
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill.
Obstet Gynecol Clin North Am. 1993 Dec;20(4):779-93.
The presence of dyspareunia as a specific complaint should be a routine part of the gynecologic history. Even if the patient does not present with this as a chief complaint, the regular inclusion of the question of whether the patient has pain during intercourse can address emotional and physical concerns the patient may leave unspoken unless given the opportunity. Once identified, the symptoms should be dealt with by the clinician potentially as both an organic and as a sexual problem. This will allow the clinician to keep in mind that secondary sexual dysfunction can arise from initially simple organic problems. Patients should be advised at the onset that the process is ongoing and that therapy may be more than just one single treatment approach. Dyspareunia that occurs after a period of good sexual adjustment may be more amenable to an office-based counseling and educational approach, assuming that the patient and her partner are comfortable and cooperative in approaching the problem. Dyspareunia of long standing or in a more complicated relationship may require skills possessed by more highly trained professionals.
性交困难作为一项具体主诉，应成为妇科病史常规内容的一部分。即便患者未将此作为主要诉求，常规询问患者性交时是否疼痛，也能够解决一些患者可能因未得到询问机会而未提及的情感及身体方面的担忧。一旦确诊，临床医生应将这些症状视为器质性问题和性问题来处理。这会让临床医生记住，继发性性功能障碍可能最初源于简单的器质性问题。应在一开始就告知患者，整个治疗过程是持续的，治疗方法可能不止一种。若患者及其伴侣在面对问题时感到自在且配合，那么在经历一段良好性适应期后出现的性交困难，可能更适合采用基于门诊咨询和教育的方法。长期存在的性交困难或情况更复杂的性交困难，可能需要训练有素的专业人员具备的技能。
