Management of Normal and Altered Female Reproductive Function
Dyspareunia (difficult or painful intercourse) is increasing in incidence and can be superficial, deep, primary, or secondary. This problem can be embarrassing for women to discuss be-cause they may believe that it is their problem if their partner is not experiencing discomfort. Dyspareunia may occur at the be-ginning of, during, or after intercourse and may be related to injury during childbirth, lack of lubrication, a history of incest, sexual abuse, or assault, endometriosis, pelvic infection, vaginal atrophy with menopause, gastrointestinal disorders, fibroids, urinary tract infection, STDs, or vulvodynia (vulvar pain that affects women of all ages without any discernible physical cause). Because dyspareunia is often due to lack of vaginal lu-brication, use of vaginal lubricants can be suggested. Depending on the cause of dyspareunia, antidepressants may be prescribed in selected patients, and surgery to expand or repair the vaginal opening is occasionally needed.
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