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         Dyspareunia:     more books (25)
  1. Completely Overcome Vaginismus: The Practical Approach to Pain-Free Intercourse, Book 1 and 2 by Mark & Lisa Carter, 2004
  2. Vaginal Pain: An entry from Gale's <i>Gale Encyclopedia of Medicine, 3rd ed.</i> by Laith, M.D. Gulli, Kathleen, MSW, CSW Berrisford, 2006
  3. Negative affect and somatically focused anxiety in young women reporting pain with intercourse.(Report): An article from: The Journal of Sex Research by Marta Meana, Amy Lykins, 2009-01-01
  4. Gale Encyclopedia of Medicine: Female sexual arousal disorder by Debra Gordon, 2002-01-01
  5. Female Sexual Arousal Disorder: An entry from Gale's <i>Gale Encyclopedia of Medicine, 3rd ed.</i> by Debra Gordon, 2006
  6. Gale Encyclopedia of Medicine: Vaginal pain by MSW, CSW M.D. Kathleen Farid Berrisford, 2002-01-01
  7. Hypoactive sexual desire disorder: An entry from Thomson Gale's <i>Gale Encyclopedia of Mental Disorders</i> by Ralph, M.D. Myerson, 2003
  8. A Woman's Guide to Overcoming Sexual Fear & Pain by Aurelie Jones Goodwin, Marc E., M.D. Agronin, 1997-12
  9. When Sex Hurts: A Woman's Guide to Banishing Sexual Pain by Andrew Goldstein MD, Caroline Pukall PhD, 2011-01-11
  10. Female Sexual Pain Disorders: Evaluation and Management
  11. Spasm of Vagina or Vaginismus. (Understanding Sexual Dysfunction.) by Andrew Rynne, 2010-08-24

21. Painful Intercourse (dyspareunia)
Are you experiencing pain during intercourse? If so, then the odds are that you re a woman though at the end of this feature, you ll find advice for the
http://www.netdoctor.co.uk/sex_relationships/facts/painfulintercourse.htm
Search: All NetDoctor Diseases Medicines NetDoctor.co.uk Home News and features News News archive Newsletter Features Encyclopaedia Diseases Examinations Medicines Premium services SMS services StayQuit thediet Health centres ADHD Allergy and asthma Children's health Depression ... All health centres Discussion and support Discussion forums Support groups Services Ask the doctor Find a hospital Search Medline Test yourself Information About NetDoctor Commercial opportunities NetDoctor.com Painful intercourse (dyspareunia) Written by Dr David Delvin , GP and family planning specialist and Christine Webber , psychotherapist
Not much fun is it?
Are you experiencing pain during intercourse? If so, then the odds are that you're a woman - though at the end of this feature, you'll find advice for the small number of men who get intercourse pain.
It's not much fun having pain during sex, is it? After all, sexual intercourse is meant to be great fun, and a really happy experience. And if you get pain, then it isn't.
Don't put up with it
You can safely disregard just one isolated episode of intercourse pain. After all, it's very easy to feel pain when a sensitive part of you is being prodded quite hard.

22. Painful Intercourse (dyspareunia)
Privacy policy. NetDoctor.com. Painful intercourse (dyspareunia) look at the possible cause of intercourse pain (or 'dyspareunia', to give it
http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

23. Dyspareunia
I have recently started to experience pain in my vagina when having sexual intercourse. I also feel the pain if I sit up straight on a hard surface. I
http://www.netdoctor.co.uk/ate/womenshealth/207363.html
Search: All NetDoctor Diseases Medicines NetDoctor.co.uk Home News and features News News archive Newsletter Features Encyclopaedia Diseases Examinations Medicines Premium services SMS services StayQuit thediet Health centres ADHD Allergy and asthma Children's health Depression ... All health centres Discussion and support Discussion forums Support groups Services Ask the doctor Find a hospital Search Medline Test yourself Information About NetDoctor Commercial opportunities NetDoctor.com Dyspareunia Question
I have recently started to experience pain in my vagina when having sexual intercourse. I also feel the pain if I sit up straight on a hard surface. It feels as though there maybe a lump on the inside wall of my vagina.
Answer
Thank you for your enquiry, and I am sorry to hear of your discomfort. This problem is called dyspareunia and there are many possible causes including infection, vaginal dryness, prolapses, bladder or vaginal inflammation or problems outside the womb such as constipation.
You do not mention your age but I always feel that any women with new dyspareunia should be properly assessed. In your case, the fact that you can feel a lump vaginally means especially you should be examined by your own doctor (similar to when you have a cervical smear taken) and the cause of your dyspareunia found. Once this is known, treatment is usually effective but the first thing to do here is to get the answer as to what is going on. Do not be embarrassed about asking for help with this problem - it is extremely common.

24. Discovery Health :: Dyspareunia
dyspareunia is the clinical name for painful intercourse.
http://health.discovery.com/centers/sex/sexpedia/dyspareunia.html
var oasPositionArray = "x21,x24,TopLeft,Top3,x29,x12"; OAS_RICH("TopLeft");
September 09, 2005 Dyspareunia More Sex Return to Dyspareunia Dyspareunia is the clinical name for painful intercourse. The pain can be felt as burning, sharp, searing or cramping. It can be external, within the vagina, or deep in the pelvic region or abdomen. Causes of Dyspareunia Are Multiple
The causes of dyspareunia, as with most sexual dysfunction, can be classified as either organic (physical or medical factors such as illness, injury or drug effects) or psychosocial (including psychological, interpersonal, environmental and cultural factors). The cause of a sexual dysfunction in a given person may be a combination of several factors, and in some cases, the precise cause may not be identifiable at all. Female dyspareunia can be caused by dozens of physical conditions. Any condition that results in poor vaginal lubrication can cause discomfort during intercourse. Among the more common culprits are drugs that have a drying effect (antihistamines, certain tranquilizers, marijuana) and disorders such as diabetes, vaginal infections, and estrogen deficiencies. Other causes of female dyspareunia include:
  • blisters, rashes and inflammation around the vaginal opening or the vulva

25. Discovery Health :: Dyspareunia
dyspareunia is the clinical name for painful intercourse.
http://health.discovery.com/centers/sex/sexpedia/dyspareunia_02.html
var oasPositionArray = "x21,x24,TopLeft,Top3,x29,x12"; OAS_RICH("TopLeft");
September 09, 2005 Dyspareunia More Sex Return to Dyspareunia ( cont'd Developmental Problems May Contribute to Dyspareunia Many authorities believe that developmental factors such as troubled parent-child relationships, negative family attitudes toward sex, traumatic childhood or adolescent sexual experiences, and gender identity conflicts may all predispose one toward developing a sexual dysfunction. In cases of dyspareunia, if a child has been brought up to believe that sex is wrong and will cause pain, that person as an adult may well feel pain with intercourse. Similarly, a painful previous sexual experience can create an expectation of painful intercourse in future experiences. Personal factors such as anxiety, fears of pregnancy, intimacy and rejection, to name a few, may block the pathways of sexual response and lead to pain. Relationship problems or interpersonal conflicts such as power struggles, hostility toward a partner, preference for another partner, distrust, poor communication and lack of attraction to a partner can all emerge as pain during intercourse. Other feelings and psychological conflicts may also affect sexual responsiveness, inhibiting or reducing vaginal lubrication, which can result in painful intercourse. Guilt, depression and poor self-esteem are commonly encountered in association with sexual dysfunctions.

26. Dyspareunia - Wikipedia, The Free Encyclopedia
dyspareunia is painful sexual intercourse, due to medical or psychological causes. dyspareunia is considered to be primarily a physical, rather than an
http://en.wikipedia.org/wiki/Dyspareunia
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Dyspareunia
From Wikipedia, the free encyclopedia.
Dyspareunia is painful sexual intercourse , due to medical or psychological causes. The term is used almost exclusively in women, although the problem may occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus
Contents
edit
Symptoms
When pain occurs, the woman may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, penile thrusting is painful. Even after the original source of pain (a healing episiotomy , for example) has disappeared, a woman may feel pain simply because she expects pain. In brief, dyspareunia can be classified by the time elapsed since the woman first felt it:

27. Dyspareunia
SF Bay Area sex therapists, gynecologist, and physical therapists explain sexual pain, dyspareunia, vulvodynia, and pelvic pain.
http://www.sexwithoutpain.com/dyspareunia.htm
What is Dyspareunia
Dyspareunia is a broad term referring to any recurrent genital pain with sexual intercourse. When a woman experiences pain, a cycle can develop in which the anticipation of pain causes physical tension that maintains or increases pain. Then avoidance begins — the woman avoids sex to avoid the pain. Possible causes of dypsareunia include functional medical , and psychological conditions.
Functional Causes of Sexual Pain (Dyspareunia)
" Functional" means that there is nothing structurally wrong with the organs. Functional causes of sexual pain and discomfort are often easily understood and treated. For example, if a woman is not sexually aroused, she may lack adequate vaginal lubrication. This can cause friction or burning that is uncomfortable. Often this pain disappears after the woman becomes aroused and lubricated. It is usually an indicator that more sex play is needed before intercourse is started. Some women may find that use of a lubricant makes genital contact more pleasurable. Others may feel fully aroused and yet have inadequate amounts of natural lubrication.

28. All About Painful Sex, Dyspareunia, & Vulvodynia
SF Bay Area sex therapists, gynecologist, and physical therapists explain sexual pain, dyspareunia, vulvodynia, and pelvic pain.
http://www.sexwithoutpain.com/
Dyspareunia (painful sex)...
It’s hard to talk about, and often misdiagnosed. It’s not all in your head! You don't have to live with painful sex. Proper diagnosis and multidisciplinary treatment can help you reduce or eliminate pain. What information do you need
Vulvar pain, vulvodynia, and vulvar vestibulitis l Physical and emotional causes of vulvar pain. Methods of treatment.
Vaginal pain
l Physical and emotional causes of vaginal pain. Methods of treatment.
Vaginismus
l Tight vaginal muscles that prevent intercourse. Approaches to treatment.
Pelvic pain
l Endometriosis, fibroids, and other causes of pelvic pain.
Fear of sex
l Fear and negative feelings can dramatically interfere with sex. Fortunately, it can be treated.
Consequences
of sexual trauma l Trauma can leave physical and emotional scars.
Unconsummated marriage
l Learn what can be done for couples who have been unable to have intercourse.

29. Psych Central: Dyspareunia Symptoms
General symptoms of dyspareunia. dyspareunia. SYMPTOMS. Recurrent or persistent genital pain associated with sexual intercourse in either a male or a
http://psychcentral.com/disorders/sx49.htm
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Dyspareunia
SYMPTOMS
Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female. The disturbance causes marked distress or interpersonal difficulty. The disturbance is not caused exclusively by Vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder (except another Sexual Dysfunction), and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
    Criteria summarized from:
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition . Washington, DC: American Psychiatric Association.

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30. Dyspareunia
dyspareunia (dispa-roon-ia) is defined as pain during intercourse. Pain during intercourse can be caused by a number of conditions.
http://uuhsc.utah.edu/obgyn/rei/ISdyspareunia.html
REI Home Mission Organization Services ... UUHSC Home
Dyspareunia
Dyspareunia (dis-pa-roon-ia) is defined as pain during intercourse. Pain during intercourse can be caused by a number of conditions. Examples include endometriosis, ovarian enlargement, congenital or acquired anatomic abnormalities of the reproductive tract, vulvar vestibulitis, an allergic reaction to a personal hygiene product, hormonal changes related to aging.
Sometimes, emotional issues may also play a role. Your reproductive endocrinologist will obtain a history of your pain and then perform a physical examination in order to determine the cause and suggest treatment options. Department of Obstetrics and Gynecology
University of Utah Health Sciences Center
Salt Lake City, Utah. 84132-2209
E-mail: erika.lindley@hsc.utah.edu Phone: 801-581-7647
Fax: 801-585-5146
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31. Dyspareunia
dyspareunia may be due to organic, emotional or psychogenic causes. Most women who are sexually active will experience dyspareunia at some time in their
http://www.5mcc.com/Assets/SUMMARY/TP0284.html
Dyspareunia
DESCRIPTION: Recurrent and persistent genital pain associated with sexual activity, in either the male or female. Dyspareunia may be due to organic, emotional or psychogenic causes.
  • Primary: Present throughout one's sexual history
  • Secondary: Arising from some specific event or condition, e.g., menopause, drugs
  • Superficial: Difficulty or pain at or near the introitus or vaginal barrel associated with penetration
  • Deep: Pain after penetration located at the cervix or lower abdominal area
  • Complete: Present under all circumstances
  • Situational: Occurring selectively with specific situations

System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA:
  • Most women who are sexually active will experience dyspareunia at some time in their lives. Approximately 15% (4-40%) of adult women will have dyspareunia on a few occasions during a year. About 1-2% of women will have painful intercourse on a more than occasional basis.
  • Male prevalence unknown

Predominant age: All ages
Predominant sex:
CAUSES:

  • Disorders of vaginal outlet
    • Hymenal ring abnormalities
    • Postmenopausal atrophy
    • Decreased lubrication
    • Episiotomy scars
    • Vulvar vestibulitis/vulvodynia
    • Infections
    • Trauma
    • Adhesions
    • Clitoral irritation
    • Vulvar papillomatosis
  • Disorders of vagina
    • Infections
    • Masses or tumors
    • Decreased lubrication
    • Pelvic relaxation resulting in rectocele, uterine prolapse or cystocele

32. Painful Intercourse D.Hill, MD
Painful sexual intercourse, called dyspareunia in medical terminology Some of these causes of deepthrust dyspareunia are difficult to diagnose,
http://www.obgyn.net/women/articles/dyspar_dah.htm
Issues and Procedures in Women's Health
Painful Intercourse
by D. Ashley Hill, MD OBGYN.net Editorial Advisor,
Associate Director - Department of Obstetrics and Gynecology,
Florida Hospital Family Practice Residency, Orlando, Florida Painful sexual intercourse, called dyspareunia in medical terminology (pronounced "dis-pair-une-ee-ah"), is a common complaint among women seeking gynecologic care. Many women report occasional pain with intercourse, but some women have pain with every episode of sexual relations. Although it may take a few visits to a gynecologist or other health care provider experienced in women's health, the cause of dyspareunia can usually be identified and treated. There are three main types of painful intercourse. Perhaps the least common is pain that occurs only after intercourse or orgasm. This can be due to uterine contractions from orgasm. Women with this problem may get relief by taking medications like ibuprofen before intercourse, which can block pain from uterine contractions. Another source of this type of pain is an allergy to semen, which is actually quite uncommon. After her partner ejaculates there can be an intense burning sensation and redness around the vagina and vulva (the outer "lips" of the vagina). There have actually been a few reported cases of women going into shock after sexual intercourse due to an allergy to semen. A third cause of pain after intercourse is a vaginal infection, such as a yeast infection, which can cause a burning sensation within the vagina due to irritation.

33. OBGYN.net - OBGYN.net Broadcasting - "A New Procedure For Diagnosing Dyspareunia
A new procedure for diagnosing dyspareunia Dr. James Carter with us today, who has been instrumental in developing a newer procedure for dyspareunia.
http://www.obgyn.net/displaytranscript.asp?page=/avtranscripts/smith_carter_dysp

34. Dyspareunia (painful Intercourse)
Sex should never be painful. If you are having pain during sex, stop. Sex is supposed to be pleasurable, and pain indicates that something is wrong.
http://www.sexhealth.org/problems/painful.shtml
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Dyspareunia (painful intercourse)
In Women Why do I experience pain during intercourse? Sex should never be painful. If you are having pain during sex, stop. Sex is supposed to be pleasurable, and pain indicates that something is wrong. In many cases, your partner's actions can cause pain, such as going too fast or penetrating from an awkward position. Never hesitate to ask your partner to slow down or move to make you more comfortable. Another common cause of pain during sex is the lack of natural lubrication in the vagina. Antihistamines or other medication may be the cause of this problem. Additionally, natural changes in the vagina during menopause may cause a reduction in natural lubrication. Or, in some cases, more foreplay may be required to produce a sufficient amount of vaginal lubrication. Adding a water-based lubricant to the proceedings may help alleviate this problem. We recommend Astroglide . It's a wonderful lubricant with a consistency that most couples truly enjoy. Failure of the vagina and uterus to respond to sexual arousal can also cause discomfort. The vagina may be too snug for intercourse or the uterus may not be raised so that the penis comes in contact with the cervix during penetration. Use manual penetration to explore the level of arousal before engaging in intercourse.

35. Introduction: Dyspareunia - WrongDiagnosis.com
Introduction to dyspareunia as a medical condition including symptoms, diagnosis, misdiagnosis, treatment, prevention, and prognosis.
http://www.wrongdiagnosis.com/d/dyspareunia/intro.htm
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Dyspareunia
Next sections Basic Summary for Dyspareunia Causes of Dyspareunia Symptoms of Dyspareunia Misdiagnosis of Dyspareunia ... Misdiagnosis of Underlying Causes of Dyspareunia Next chapters: Menarche Perimenopause Placenta previa Morning sickness ... Feedback
Introduction: Dyspareunia
Dyspareunia: Vaginal pain after sexual intercourse Researching symptoms of Dyspareunia: Further information about the symptoms of Dyspareunia is available including a list of symptoms of Dyspareunia , other diseases that might have similar symptoms in differential diagnosis of Dyspareunia , or alternatively return to research other symptoms in the symptom center Misdiagnosis and Dyspareunia: Research more detailed information about misdiagnosis of Dyspareunia underlying causes of Dyspareunia (possibly misdiagnosed), or research misdiagnosis of other diseases Causes of Dyspareunia: Research more detailed information about the causes of Dyspareunia , other possibly hidden causes of Dyspareunia , or other general information about Dyspareunia Contents for Dyspareunia: Diseases Did we miss something? Please provide

36. Symptoms Of Dyspareunia - WrongDiagnosis.com
Symptoms of dyspareunia including signs, symptoms, incubation period, duration, and correct diagnosis.
http://www.wrongdiagnosis.com/d/dyspareunia/symptoms.htm
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Current chapter:
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Next sections Misdiagnosis of Dyspareunia Misdiagnosis of Underlying Causes of Dyspareunia Doctors and Medical Specialists for Dyspareunia Glossary for Dyspareunia Next chapters: Menarche Perimenopause Placenta previa Morning sickness ... Feedback
Symptoms of Dyspareunia
General information about symptoms of Dyspareunia: The symptom information on this page attempts to provide a list of some possible symptoms of Dyspareunia. This symptom information has been gathered from various sources, may not be fully accurate, and may not be the full list of symptoms of Dyspareunia. Furthermore, symptoms of Dyspareunia may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of symptoms and whether they are indeed symptoms of Dyspareunia. List of symptoms of Dyspareunia: The list of symptoms mentioned in various sources for Dyspareunia includes: More symptoms of Dyspareunia: In addition to the above information, to get a full picture of the possible symptoms of this condition and its related conditions, it may be necessary to examine symptoms that may be caused by complications of Dyspareunia

37. SEXUAL PAIN (DYSPAREUNIA) - A Patient's Guide
Medic8 Family Health Guide your trusted source for health information online. More than 500 health-related articles written by qualified health
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Medical News Medic8 Search ... About Medic8 SEXUAL PAIN (DYSPAREUNIA) - a patient's guide Editorial Team Overview Physical pain during intercourse is called dyspareunia Pain during sexual intercourse can be physical or psychological A condition called vaginismus involves a spasm of the pelvic muscles and is a cause of dyspareunia Vaginismus can make inserting tampons and penetration impossible The use of plastic dilators to relax the vagina has almost a 100 percent success rate in vaginismus Dyspareunia can also be caused by other conditions such as vaginal or pelvic infections, endometriosis, or other pelvic conditions

38. Painful Intercourse (dyspareunia)
PAINFUL INTERCOURSE (dyspareunia). Many women have had the experience of External dyspareunia can also be a sign of infection, most commonly a yeast
http://www.rickmd.com/probdysp.htm
PAINFUL INTERCOURSE (DYSPAREUNIA) Many women have had the experience of discomfort or pain with sexual intercourse. This can be felt as external or deep or both. The causes and solutions depend on the exact details.
EXTERNAL (OR SUPERFICIAL) DYSPAREUNIA
This type of discomfort usually feels like a burning sensation or a sensation of dryness, with too much friction. This most commonly occurs as a result of inadequate lubrication. The solution is more foreplay to increase arousal and natural lubrication and/or assisting nature by adding some lubrication. External dyspareunia can also be a sign of infection, most commonly a yeast infection. Persistence of this problem requires an evaluation by a gynecologist. When you go to the doctor, make sure you tell him or her exactly what's wrong. If you just go in for a regular check-up, you may not have the problem solved.
DEEP DYSPAREUNIA
Many women sometimes feel discomfort or pain with deep penetration. This may be a normal response to the pressure on sensitive internal parts. The obvious solution is to avoid deep penetration. Some common solutions include:
  • Woman on top, controlling the depth of penetration

39. Dyspareunia (Painful Intercourse)
dyspareunia and vaginismus (spasm of the pubic muscles of the lower vagina) are often A regular exercise program while not a treatment for dyspareunia,
http://www.wramc.amedd.army.mil/education/pat_edu/womenhlth/Sexuality/dyspareuni
Women's Health
Dyspareunia (Painful Intercourse)
Basic Information

Description
    Recurrent and persistent genital pain associated with sexual intercourse. Dyspareunia and vaginismus (spasm of the pubic muscles of the lower vagina) are often linked.
Frequent Signs and Symptoms
    Pain in the genital area during sexual activity, including foreplay, intercourse or attempted intercourse. Pain may be mild or severe, and it may very with different intercourse positions.
Causes
    Physical causes include:
    • Infection of the genitals, including herpes and others involving the vagina, cervix, fallopian tubes or ovaries.
    • Pressure against the vaginal wall caused by scarring from operations or radiation treatment.
    • Tight episiotomy scar from vaginal repair after childbirth.
    • A fibroid or other uterine tumor.
    • Endometriosis.
    • A hymen that is imperforate (not opened), torn or thicker than normal.
    • A bruised opening to the urethra
    • Inadequate vaginal or condom lubrication.
    • Allergic reactions to diaphragms, condoms or contraceptive foams and jellies.
    • Dryness and thinness of the vaginal wall after menopause due to estrogen deficiency.

40. THE MERCK MANUAL--SECOND HOME EDITION, Dyspareunia In Ch. 250, Sexual Dysfunctio
dyspareunia is pain during sexual intercourse. The pain of dyspareunia may be superficial, occurring in the genital area (in the vulva, including the
http://www.merck.com/mmhe/sec22/ch250/ch250b.html
var externalLinkWarning = "The link you have selected will take you to a site outside Merck and The Merck Manuals.*n*nThe Merck Manuals do not review or control the content of any non-Merck site. The Merck Manuals do not endorse and are not responsible for the accuracy, content, practices, or standards of any non-Merck sources."; Search The Second Home Edition , Online Version Search Index A B C D ... Z Sections Accidents and Injuries Blood Disorders Bone, Joint, and Muscle Disorders Brain, Spinal Cord, and Nerve Disorders ... Women's Health Issues Resources Anatomical Drawings Multimedia Pronunciations Weights and Measures ... , Online Version Section Women's Health Issues Chapter Sexual Dysfunction Topics Introduction Decreased Libido Dyspareunia Orgasmic Disorder Sexual Arousal Disorder Vaginismus Vulvodynia Dyspareunia Buy The Book Print This Topic Email This Topic Pronunciations diaphragm dyspareunia endometriosis uterus ... vaginismus Dyspareunia is pain during sexual intercourse. The pain of dyspareunia may be superficial, occurring in the genital area (in the vulva, including the opening of the vagina), or deep, occurring within the pelvis due to pressure on internal organs. The pain may be burning, sharp, or cramping. Pelvic Floor Disorders ). Taking antihistamines can cause slight, temporary dryness of the vagina. During breastfeeding, the vagina may become dry because estrogen levels are low.

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