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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dyspareunia, or painful intercourse, is frequently referred to as the most common female sexual dysfunction. It can occur singly or be manifested in combination with other psychosexual disorders. Diagnosis of dyspareunia is appropriate in cases in which the experience of pain is persistent and severe. There has been little agreement concerning the origin of dyspareunia. Organic conditions and psychological variables have alternately been presented as major factors in causality. There is a presumed high incidence of physical disease associated with dyspareunia when compared with other female sexual dysfunctions. In the majority of cases, however, organic factors are thought to be rare in contrast with sexual issues and interpersonal or intrapsychic difficulties as a cause of continuing problems. The finding of an organic basis for dyspareunia does not rule out emotional or psychogenic causes. Thorough and extensive gynecologic and psychological evaluation is essential in cases of dyspareunia. The etiology of dyspareunia should be viewed on a continuum from primarily physical to primarily psychological with many women falling in the middle area.
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PMID:Dyspareunia: an integrated approach to assessment and diagnosis. 354 Jan 80

A computerized study of past infectious events and neurological parameters revealed the existence of a history of repeated respiratory-tract infections (RRI) beginning in childhood, in 52% of 251 multiple sclerosis (MS) patients studied. The 251 MS patients were divided into two groups: those without a past history of RRI were designated as "MS type I", and those with a history of infectious problems before the onset of MS as "MS type II". Significant differences in the neurological symptoms, the treatment received and some general parameters were found between the groups, which suggested a correlation between the evolution of MS and the presence or not of RRI in these patients. When compared to the MS type I group, a significantly higher percentage of MS type II patients reported visual problems (P less than or equal to 0.01), paresthesia (P less than or equal to 0.01), loss of sensitivity (P less than or equal to 0.03), pain (P less than or equal to 0.004), motor problems (P less than or equal to 0.016) and sexual dysfunction in males (P less than or equal to 0.02). The mean number of attacks in the first 5 years of the disease was significantly more frequent in MS type II patients, 6.2 compared to 2.9 (P less than or equal to 0.02). A significantly higher percentage of MS type II patients also received oral corticosteroids (P less than or equal to 0.02) or ACTH (P less than or equal to 0.003). Although the age of onset of MS was the same for both groups, MS type II patients were significantly younger than MS type I patients, the mean age being 36 years compared to 41 years (P less than or equal to 0.001). Only 12% of patients in the MS type II group compared to 30% in the MS type I group had the disease for more than 15 years (P less than or equal to 0.001). As is usual with MS, the majority of the patients in both groups were females, 79.3% in the MS type II compared to 63.4% in the MS type I group. These findings suggest that MS patients with a past history of RRI (MS type II) have a different evolution of their disease from MS type I patients and that in general the disease is more severe. The past infectious history of patients would thus appear of putative value, in addition to neurological criteria, in assessing the probable future evolution of the disease.
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PMID:Past infectious events and disease evolution in multiple sclerosis. 619 63

Sexuality was investigated in 35 males and 25 females with chronic back pain. Prior to onset of pain orgasmic dysfunction was common in 60 per cent of the females with relatively lower level of sexual frustration. Markedly less sexual dysfunction characterized the males. With back pain sexual dysfunction increased in both sexes. Frequency of coitus was reduced in half the subjects and about 50 per cent also had altered coital positions. Fatigue and pain were common and sexual enjoyment was reduced for most subjects. In many females back pain may serve to legalize previously latent sexual dysfunction. However, for both sexes back pain per se causes sexual maladaptation. Therefore, sexual counselling should be part of the rehabilitation of the back pain sufferer.
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PMID:Chronic back pain and sexuality. 645 10

The understanding and treatment of vaginismus and dyspareunia have been greatly advanced by discoveries in sexual physiology and by the integration of the psychological sciences into clinical medicine. Historical evaluation of these problems should attend to their chronology, the impact on the individual and her relationships, and prior attempts at solution; and one should keep in mind common theories of etiology of sexual dysfunction. Physical examination, both as an educational instrument for the patient and as a means of localizing pain, can be most informative when undertaken with a thorough knowledge of the physiology of sexual response. Particular foci of dyspareunia may be amenable to various combinations of physical and psychological treatment.
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PMID:Dyspareunia and vaginismus. 648 16

This article discusses the current and potential use of paradoxical interventions in behavioral medicine. Paradoxical interventions are considered to be of two types: intra-individual and interpersonal. Treatment indications differ for the two types of interventions. Intraindividual paradoxical interventions have been successful in the treatment of insomnia, psychogenic urinary retention and constipation. Interpersonal paradoxical interventions have been subjected to less empirical research, but have been useful in the treatment of anorexia nervosa and in family based interventions where medical patients maladaptively cope with their rehabilitation. Paradoxical procedures are also used in the treatment of sexual dysfunction and may be of value in pain management. Further possible applications as well as limitations of paradoxical interventions in behavioral medicine are discussed.
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PMID:Paradoxical interventions in behavioral medicine. 649 Sep 30

Some efforts have been made to investigate sexual functioning in obstetric patients, and these are considered in 3 areas: pregnancy, the postpartum period, and the sequelae of episiotomy. Most research in the area of pregnancy suggests that sexual activity and libido decline steadily during pregnancy, but some studies such as that of Masters and Johnson (1966) report that sexual functioning varies during pregnancy. In this study, 101 North American women were interviewed in each trimester of pregnancy and again 3 months after delivery. In primiparous women there was, compared with preconception levels, a marked reduction of sexual activity and libido during the 1st and 3rd trimesters of pregnancy, but an increase during the 2nd trimester. Multiparous women showed a similar pattern. The finding of an improvement in sexual performance during the 2nd trimester has not been supported by subsequent research. Studies in which sexual functioning was assessed during pregnancy and retrospectively during the puerperium have reported a steady decline in libido and coital frequency throughout the 3 trimesters. Childbirth appears to be associated with diminished frequency and enjoyment of sexual intercourse for at least a year after delivery, but there is a gradual improvement in sexual functioning during this period. The level of sexual functioning before conception appears to determine sexual behavior in the year after delivery. Available findings cannot provide a basis for determining whether episiotomy is a specific cause of dyspareunia, but Beischer's (1967) findings suggest that there is little relation between the anatomical results of episiotomy and subsequent development of pain on intercourse. Sexual problems encountered in gynecology may be of 2 main types: those accompanying gynecological disorders and those arising from gynecological treatments. Research has focused mainly on sexual problems in 2 gynecological conditions--the menopause and infertility. In contrast to previous findings, recent studies have suggested that there is little sexual disturbance at the time of menopause. It seems likely that the loss of libido and orgasmic dysfunction are not specifically associated with the menopause, but vaginal dryness is not an uncommon feature of ovarian failure and may give rise to dyspareunia. Infertility is reported to be associated with a substantial prevalence of sexual dysfunction, some of which may be a direct cause of the failure to conceive. Certain sexual problems have no etiological relation to infertility but are nevertheless distressing to the patients involved. Sexual dysfunction has been studied in relation to surgical procedures and oral contraceptive use.
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PMID:Sexual problems in obstetrics and gynaecology. 668 51

Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of the absence of abnormal physical findings among such patients, vulvodynia was long thought to be solely a psychosomatic syndrome. The incidence or prevalence of vulvodynia has not been well studied. The recognition of specific subtypes of vulvodynia is important in the management of patients with vulvodynia. The most common subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis and dysesthetic vulvodynia. Simple practice guidelines can be developed to facilitate the evaluation and management of such patients. Systematic epidemiological, etiological and therapeutic studies of vulvodynia are urgently needed.
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PMID:Diagnosis and treatment of vulvodynia. 763 10

Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.
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PMID:The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. 764 55

Vulvodynia is a syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. The incidence of prevalence of this condition is not known. Several subtypes of vulvodynia have been recognized. Recognition of the distinct subsets of vulvodynia is a pre-requisite for successful management. Vulvar vestibulitis syndrome, cyclic vulvovaginitis, and dysesthetic vulvodynia are the most common subtypes. Other frequently misdiagnosed vulvar or vaginal conditions which can also cause culvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent cause of differential diagnostic problems. In conclusion, vulvodynia is a complex multifactorial underdiagnosed clinical syndrome. Systematic epidemiologic, etiologic, and therapeutic studies of vulvodynia should be undertaken.
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PMID:Vulvodynia--a complex syndrome of vulvar pain. 773 94

Hypnosis has many applications in the field of reproductive health care. This paper describes its use in the treatment of sexual dysfunction, urinary incontinence, chronic pelvic pain, hyperemesis gravidarum, and pain relief in labor and delivery. Four case reports are used for illustration. Misconceptions about the risks and benefits of hypnosis are discussed. Information about training for clinicians in hypnosis is described.
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PMID:Hypnosis in reproductive health care: a review and case reports. 774 49


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