Dyspareunia: A Special Type of Chronic Pelvic Pain - Assignment Example

Dyspareunia Dyspareunia… Is it just a simple pain disorder or a sexual disorder? Dyspareunia is simply defined as the “painful sexual inter .But lately, arguments about whether should it be classified as a ‘Pain Disorder” or a ‘Sexual Disorder’ in the DSM-IV-TR criteria has been raising eyebrows. In this paper, arguments where it should be categorized are presented. It will be based on the definitions of pain disorder and sexual dysfunctions and of course, the standard of DSM-IV-TR. However, to fully understand the issue about classifying dyspareunia as a sexual disorder or pain disorder, let’s define first what sexual and pain disorders are. According to John Miller, sexual disorders are associated to a meticulous part of the sexual response cycle. Such sexual dysfunctions include sexual desire disorders, sexual pain disorders, and sexual arousal disorders. Thus, if a person has difficulty in some stage of the response cycle or experiences pain during sexual intercourse, he/she, according to Miller, is positive in having a sexual dysfunction. Sexual dysfunctions have many types. Sexual dysfunction is said to have a sexual dysfunction as early as ones sexual fantasies are increasing while the actual intercourse is decreasing and later on, the absence of it. This kind of sexual disorder is called as Hypoactive Sexual Desire Disorder. However, before any sexual difficulty was supposed to be called a disorder or dysfunction, an individual must be affected first. (Bornstein J, Shapiro S, Rahat M, Goldshmid N, Goldik Z, Abramovici H, et al., 1996) Furthermore, one rare sexual dysfunction is called as the Sexual Aversion Disorder, wherein the person involved is relentlessly avoiding having genitals contact with his/her partner and thus, having a great effect with the sexual relationship. Actually, there are so many kinds of sexual disorders, like Female Sexual Disorder, Male Erectile Disorder, Female and Male Orgasmic Disorder, Premature Ejaculation and of course the most popular among the categories of sexual disorders; dyspareunia. Dyspareunia is considered as a sexual pain disorder wherein it is a genital pain that comes with having sexual intercourse. Both sex partners can experience this; however, it is more common among women. It is said that dyspareunia is sometimes chronic in nature. (Butcher J, 1999) On the other hand, Vertosick Frank (2000), discussed in his article in ‘behave net’ that if the presence of psychological factors played an important role in the pain felt by a person, like in the start, exactness, exacerbation or continuation of the pain, this is considered as a pain disorder. Thus, the pain is not caused deliberately nor created or mocked. Another thing to classify what is pain disorder; we can associate it with psychological factors and general medications. Diagnostic for the pain disorder is recognized as follows: pain in one or more anatomical parts is the principal focus of the clinical arrangement and is of strictly adequate to demand medical attention; what causes pain is basically misery or with mutilation in occupational, social or in other important areas of functioning; the pain is not faked nor intentionally produced and it is not associated with mood, anxiety or psychotic disorders; and lastly, psychological factors played a significant role in the beginning, rigorousness, exacerbation or in maintenance of the pain. (Binik, Y. M., 2005) Based on the definitions of sexual and pain disorder, we can clearly draw the line in categorizing dyspareunia. However, to make the arguments about the classification of dyspareunia more clearly and the information more accurately, lets define dyspareunia and what are the standards of DSM-IV-TR in labeling it as a sexual pain disorder. Dyspareunia, according to Steege and Ling, is the repeated and persistent genital pain related with sexual activity, in either the male or female. It may be due to emotional, organic and or psychogenic causes. However, some studies said that dyspareunia is associated with a more negative attitude toward sexuality and of course with more sexual function mutilation and more importantly, has an inferior level when it comes to relationship adjustment. Moreover, studies found out that those women whom experiencing dyspareunia are not surprisingly found to be less active in sexual intercourse, with poorer desires in sexual activity, and less orgasmic with oral stimulation and intercourse. So in this explanation, we can clearly state that dyspareunia is really a sexual disorder and not just a pain disorder. (Steege JF, Ling FW, 1993) Likewise, women experiencing dyspareunia is said to be with low physical and emotional fulfillment and with decreasing happiness with sexual activities. A person with dyspareunia is obviously suffering from depression, phobic anxiety and mood swings. That a simple pain disorder may not produce. However, other studies showed no difference from norms with respect to psychopathology, marital alteration or behavior towards sexual intercourse. (Heim LJ, 2001) Still, to categorize dyspareunia easier and accurately, it is of big importance to discuss all the causes of this dysfunction. In relation to this, the common causes of dyspareunia are also associated with the most sexual dysfunction causes such as organic and or psychosocial. Organic causes of dyspareunia include physical or medical factors such as injury, illness and or drug effects while on the other hand psychosocial causes consist of psychological, interpersonal, environmental and cultural factors. This is another point to be taken that dyspareunia is not just a pain disorder. Nevertheless, sexual dysfunction in a person may be a permutation of numerous factors but sometimes, the causes are seldom unidentifiable. (Heim LJ, 2001) Another point that should be taken to prove that dyspareunia is not just a simple physical pain or a pain disorder is that there were reports that dozens of females suffered from it while having sex and affects their orgasms. However, the common causes of dyspareunia among women are poor vaginal lubrication and drugs that have a drying effect on the users and can be a basis of disorders such as diabetes, vaginal infections and estrogen deficiencies. Other causes of this sexual pain disorder are inflammation around the vaginal opening or the vulva, blisters, rashes, irritation or infection of the clitoris, disorders of the vaginal opening, such as scarring from an episiotomy, intact hymen or remnants of the hymen that are stretched during intercourse and disorder of the urethra or anus. Other causes of dyspareunia are disorders of the vagina that includes surgical scarring, thinning of vagina walls wherein due to aging or estrogen deficiency and lastly irritation due to chemicals that can be obtained from contraceptive materials and or douches. (Van Lankveld JJ, Weijenborg PT, ter Kuile MM., 1996) So you see that dyspareunia has many causes and these grounds are not a very plain basis to argue that dyspareunia should be considered as a simple pain disorder. Additionally, there are also different kinds of dyspareunia that one may experience. And this cannot be categorized with just a pain disorder. When you are in pain, you don’t classify which kind of pain you are experiencing, while in dyspareunia you categorize this pain or difficulty. Like what mentioned above, there are many cases that dyspareunia can be experienced. The first one is the “Entry” or most renowned as the “Superficial Dyspareunia”. This kind of sexual disorder may be an outcome of a variety of conditions affecting the labia or the vestibule. Vaginismus and inadequate lubrication from incomplete arousal is commonly associated with a history of pain during entry. (Van Lankveld JJ, Weijenborg PT, ter Kuile MM. 1996) This entry pain is also related to vulvodynia, atrophy and transient causes such as fungal or vulvar dystrophies and bacterial vaginitis. Inadequate estrogen levels may also cause entry dyspareunia, although most typical pain broadens into the vagina area and wall. (Van Lankveld JJ, Weijenborg PT, ter Kuile MM. 1996) The other type of dyspareunia is the so-called Deep Dyspareunia. In this type of sexual dysfunction, inadequate lubrication and atrophic changes become the foundation of the sexual problems. This is with regards to dryness or friction of penile movement. The vaginal cask may not enlarge and stretch in reaction to the arousal phase. This will surely lead to discomfort, in predominantly definite positions of penile impact on the woman‘s cervix. The pain allied with deep propulsion is often illustrated as "something being bumped into." Some etiologies comprise endometriosis, pelvic gripping and pelvic obstruction. Adnexal pathology, endometritis and scraping from pelvic stirring infection are less recurrent causes of dyspareunia. A marginal number of women with uterine retroversion and pelvic relaxation are experiencing pain. What also causes deep dyspareunia is the irritable bowel syndrome and inflammatory bowel disease, but these diseases are mostly associated with other diagnoses of chronic pelvic pain. (Bornstein J, Shapiro S, Rahat M, Goldshmid N, Goldik Z, Abramovici H, 1996) On the other hand, the psychosocial causes of dyspareunia are as common and diverse as organic ones. It is normally complicated to develop an apparent understanding of how psychosocial issues can contribute to sexual dysfunction, specifically, dyspareunia. Furthermore, to know better what dyspareunia is, discussing more about the common causes of the pain during the sexual intercourse would be a big help. There are so many causes of this sexual disorder. It includes the following: tipped or retroverted uterus, this is where some women with slanted uterus experience pain and discomfort during sexual intercourse. This happens when the penis collide with the cervix or uterus during sex. This circumstance is identified as ‘collision dyspareunia.’ The other one is the endometriosis. The tissue lining or the uterus which is identified as the endometrium, may grow outside the uterus causing deep pain during sex. (Steege JF, Ling FW, 1993) With addition to the aforementioned above, among the most common causes of pain during sex also include the infection-bacterial or yeast infections. Another one is the lack of estrogen. This normally happens during menopause, the vaginal walls become thinner and the amount of vaginal lubrication decreases. Actually, dyspareunia has many causes. It includes the physical and emotional problems, drugs side effects, and pelvic floor myalgia. (Steege JF, Ling FW, 1993) And these causes cannot be stated as the effects of a simple pain, right? But to understand this kind of issue, whether dyspareunia should be classified as a sexual pain disorder or a pain disorder, lets look at how DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) standardized such disorders. In 2000, American Psychiatric Association published this revised fourth edition of DSM-IV-TR in replace of the DSM-IV. And it is said that sometime in the near future, DSM-V will replace it. (sorry for that..) This is to set forth diagnostic descriptions, criteria, and other information to be a funnel in classifying and diagnosing mental disorders. This DSM-IV-TR is the standard classification of mental disorders used by mental health professionals in the United States. This was intended to be applicable in an extensive range of milieu and be useful to medical professionals and researchers of many different orientations in the future. It was also established to have more standardized criteria for any kind of disorders. (Sorry again.) (Wikipedia: Dyspareunia, 2006) So now, when it comes in classifying whether dyspareunia is a sexual pain disorder or just a plain pain disorder, I agree with DSM-IV-TR that it should be considered as a sexual pain disorder. I agreed with it because I think that the examples augmented by Diagnostic and Statistical Manual of Mental Disorders are proof enough to categorize dyspareunia as a sexual dysfunction. Like for instance, dyspareunia is described as the sexual pain that a person experiences during intercourse that is not necessarily intentionally produced or faked and as having many possible organic causes. While on the other hand, pain disorder is defined as a throbbing that is sometimes caused by psychological disorders and with outside affecting factors. (Heim, Lori, 2006) Thus, sexual pain disorders like dyspareunia are caused by several factors that are not necessarily due to psychological aspects. Dyspareunia can be caused by several factors like interpersonal and contextual factors that woman aged 20-60 years old may experience. This may sometimes decrease the emotional relationship with their partner during sexual activity and or have a great effect with the general emotional well-being, that even the strongest predictors of distress about sex may experience. I don’t quite understand what is meant here (Basson, 2005) Rosemary Basson’s study about the women’s sexual dysfunctions discussed that women who defined themselves to be in fine mental health were much less likely than women with lower self-rated mental health to account suffering from their sexual affiliation. (Odds ratio 0.41, 95% confidence interval 0.29– 0.59) With regards to these matters, I think that dyspareunia is not misallocated. It should really belong within the category of sexual disorder. My arguments are based on the simple definitions of pain and the occurrence of pain. Pain can be experienced not only during the actual intercourse. And in case of dyspareunia, many women attested that they only felt the pain during their actual sexual intercourse with their partners. And this sexual pain is neither produced nor faked, rather, to most instances, may cause the decreasing of orgasms of the partners involved. And lastly, in pain disorders, psychological factors played a vital role from the beginning and in the maintenance of the pain, which compared to the sexual disorder’s definitions, are too much opposing. Actually, there is almost no controversy today regarding the classification of dyspareunia as a sexual dysfunction. This is because both the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) and the International Classification of Disease (WHO, 1992) consider dyspareunia in their sections on sexual dysfunction and specifically define it with respect to sexual intercourse. The DSM-IV-TR defines dyspareunia as recurrent or persistent genital pain that is associated in either a male or a female. It can also be caused by the marked distress or interpersonal difficulty. (Heim LJ, 2001) Another proof that dyspareunia should be classified by the DSM-IV-TR as a Sexual Disorder is that in women’s sexual dysfunctions’ definitions, it was explained that this kind of dysfunction continue to reflect phases of sexual response, but they now clarify the tendency of the phases to overlap (especially desire, arousal and expectation, which usually contribute to dysfunctions). The latest focus is away from unprompted or initial yearning and toward triggered desire with supplementary arousal. Suitable consideration is now paid to the poor relationship amid the subjective sexual stimulation or pleasure and objective procedures of increases in genital vasocongestion. (Binik, Y. M. 2005) This is another necessary point to be taken because it just clearly shows that dyspareunia is just again not, a simple pain disorder. Many proofs and evidences confirmed that dyspareunia is a disorder, a sexual disorder. Another point that have to be taken is that in this dysfunction, the aggrieved party is not just the person who has dyspareunia but also the partner. Dyspareunia affects both sexes. At first, it was thought that it was only a female sexual dysfunction but some studies showed that males’ species can also be affected by this kind of dysfunction. Normally, the pain can be felt in the penis but can also be felt in the testes or internally, which is commonly associated with the prostate or seminal vesicles problems. Therefore, if dyspareunia should be classified as a pain disorder, the person who suffers only is the person who is experiencing the pain and not his/her partner also. And like females, the males who are experiencing dyspareunia, the usual causes of this dysfunction or disorder are the organic type, which includes infection of the penis, foreskin, testes, urethra or the prostate gland. Moreover, men sometimes build up painful penile irritation when exposed to some vaginal contraceptive foams or creams. It is about equally as likely for the cause of male dyspareunia to be psychosocial in nature. Nearly all of the psychosocial issues that may contribute to female dyspareunia apply to men as well. So you see, dyspareunia is not just a simple pain disorder. (Heim, Lori, 2006) One important thing to consider also in categorizing dyspareunia is the medications. In simple pain disorders, extensive treatments are not always necessary. But with sexual dysfunction, you must undergo a process or a series of procedures. You must understand first why is that dysfunction happening to you and what might cause it. Then, you must seek professional help with this kind of sexual disorder. This is because sometimes, a very painful sexual intercourse might affect your relationship with your partner that may lead to greater pain. When talking about greater pains, we consider the things such as anxiety, mood swings, and loss of interests in sexual activities or intercourse that might irritate your partner and lower the quality of your relationship. (Heim LJ, 2001) However, dyspareunia can be treated just like other sexual dysfunctions. It can usually be treated once the probable causes have been identified. Organic diseases can typically be addressed after a meticulous gynecological or medical examination, and psychotherapy can generally help with the psychosocial factors. (http://www.cmaj.ca/cgi/content/full/172/10/1327) Likewise, dyspareunia suits with the recent DSM-IV-TR classification standard for sexual dysfunctions much better than it fits those for pain disorders. Empirical data from diagnostic, experimental, and therapy outcome studies support this conclusion. The reconceptualization of dyspareunia as a sexual disorder rather than as a pain disorder has very imperative implications for the understanding and dealing of this prevalent but neglected womens health problem. (Bornstein J, Shapiro S, Rahat M, Goldshmid N, Goldik Z, Abramovici H, et al.,1996) Thus, in knowing what category dyspareunia really belongs is a big help in solving or curing this kind of disorder, especially among women. Many authorities actually believe that developmental factors, such things as negative family attitudes towards sex, gender identity complex, traumatic childhood or adolescent sexual experiences, and troubled parent-child relationships may all prejudice one toward budding sexual dysfunction. And with the topics regarding dyspareunia, when a child has been brought up to believe that sex is not right and will cause unbearable pain, the person that who learned these kind of things at an early stage might actually develop or might experience painful sexual intercourse. Similarly, a painful prior sexual experience can produce an anticipation of painful intercourse in future experiences. Thus, in classifying dyspareunia in the right category it should be, whether a pain disorder or a sexual disorder is very important. I just can’t figure out why there are still people who always ask things that should no longer necessarily be discussed. For example, the DSM-IV-TR and the International Classification of Disease have already agreed that dyspareunia is a sexual pain disorder; there are still people who questioned this truth for not very obvious reasons. In any manner, I would just like to stress that this kind of dysfunction or whatever you want it to be called, should sometimes be discussed in terms of ‘point prevalence’, some in terms of ‘lifetime prevalence’, and some in terms of both. Wherein ‘point prevalence’ refers to the estimated proportion of people in the population thought to suffer from the disorder at any given point in time and ‘lifetime prevalence’ is an estimate at a given point in time of all individuals who have ever suffered from the disorder. These incidences refer to the rate of new cases in a specified period of time (usually annually). (LaBruzza, 1997) I believe, dyspareunia’s classification is not really a big issue that should be further debated on. The classification for dyspareunia as a sexual disorder was made by DSM-IV-TR just before the case was well-known to people, especially among women. References: (This is the APA format.you can check it if I used the right format here. Thanks.) Author, A. A. (Year of publication). Title of work: Capital letter also for subtitle. Location: Publisher. Bornstein J, Shapiro S, Rahat M, Goldshmid N, Goldik Z, Abramovici H, et al. (1996). Polymerase Chain Reaction Search for Viral Etiology of Vulvar Vestibulitis Syndrome. America: J Obstet Gynecol. Van Lankveld JJ, Weijenborg PT, ter Kuile MM. (1996). Psychologic Profiles of Sexual Function in Women with Vulvar Vestibulitis and Their Partners. America: J Obstet Gynecol. Steege JF, Ling FW. (1993). Dyspareunia: A Special Type of Chronic Pelvic Pain. North America: Obstet Gynecol. Butcher J. (1999). ABC of sexual health: female sexual problems II: Sexual Pain and Sexual Fears. BMJ. Heim LJ. (2001). Evaluation and Differential Diagnosis of Dyspareunia. Am Fam Physician. Binik, Y. M. (2005). "Should dyspareunia be retained as a sexual dysfunction in DSM-V? Painful Classification Decision." Arch Sex Behavior.. Vertosick, Frank (Hardcover 2000). “Why We Hurt: The Natural History of Pain.” Retrieved, June 8 2006 from http://www.behavenet.com/capsules. Heim, Lori, LTC, USAF, MC. American family Physicians. Retrieved June 8, 2006, from http://www.aafp.org/afp/20010415/1535.html. Basson, Rosemary. Womens Sexual Dysfunction: Revised and Expanded Definitions CMAJ. Retrieved May 10, 2005 from http://www.cmaj.ca/cgi/content/full/172/10/1327 Wikipedia. The free dictionary. Last modified May 17 2006. Retrieved June 8 2006 from http://en.wikipedia.org/wiki/Dyspareunia Read More