Causes of Sexual aversion disorder
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Dyspareunia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Definitions
–Sexual pain disorder: Persistent or recurrent genital pain of nonorganic cause associated with sexual stimulation, thus causing personal stress; subcategories include dyspareunia and vaginismus
–Superficial dyspareunia: Pain or dysfunction felt upon initial penetration
–Deep dyspareunia: Pain or dysfunction felt deep within the pelvis during intercourse
–Vaginismus: Painful involuntary spasm of the vagina, preventing intercourse
–Vulvar vestibulitis: A chronic and persistent clinical syndrome characterized by severe pain with vestibular touch or attempted vaginal entry, tenderness in response to pressure within the vulvar vestibule, and physical findings confined to various degrees of vestibular erythema
–Vulvodynia: Chronic vulvar discomfort
(e.g. burning, stinging, irritation, rawness)
-
Neurologic etiologies: Nerve damage or infection, dysesthetic (essential) vulvodynia
-
Gynecologic etiologies: Gynecologic tumors (e.g., vulvar, cervical, uterine, ovarian, or rectal cancer; fibroids), Bartholin's gland inflammation
-
GI: Constipation, irritable bowel syndrome, colitis, diverticulitis, GI tumors (in pelvis)
-
Urinary: Interstitial cystitis, urethritis, urethral diverticulum
-
Infectious: Endometritis, vaginitis, PID, salpingitis, vulvovaginitis, herpes genitalis, post-herpetic neuralgia, Bartholin's abscess
-
Dermatologic etiologies: Vaginal atrophy, lichen sclerosis, Behçet syndrome, contact dermatitis
-
Musculoskeletal: Pelvic floor myopathy, fibromyalgia, levator ani myalgia, dysfunctional vaginismus
-
Endocrine: Estrogen deficiency, endometriosis
-
Psychiatric: Female sexual dysfunction(s)
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Iatrogenic: Surgical (e.g., pelvic adhesions, episiotomy, strictures), pharmacologic (drying soaps or agents, topical medications, OCPs)
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Trauma: Vaginal lacerations or ecchymoses
-
Primary pain disorder
-
Severely retroverted uterus
-
Imperforate hymen
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Impotence:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Central nervous system disorders
Spinal cord lesions from trauma produce sudden impotence
A complete lesion above S2 (upper motor neuron lesion) disrupts descending motor tracts to the genital area, causing a loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower motor neuron lesion) causes a loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders
Hypogonadism from testicular or pituitary dysfunction may lead to impotence from a deficient secretion of androgens (primarily testosterone)
Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders
With Peyronie’s disease, the penis is bent, making erection painful and penetration difficult and eventually impossible
Phimosis prevents erection until circumcision releases the constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Psychological distress
Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Other causes
Alcohol and drugs
Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence, page 352.)
Surgery
Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dyspareunia:
Causes
(Professional Guide to Diseases (Eighth Edition))
Physical causes of dyspareunia include an intact hymen; deformities or lesions of the introitus or vagina; marked retroversion of the uterus; genital, rectal, or pelvic scar tissue; acute or chronic infections of the genitourinary tract; and disorders of the surrounding viscera (including residual effects of pelvic inflammatory disease or disease of the adnexal and broad ligaments).
Among the many other possible physical causes are:
❑ endometriosis
❑ benign and malignant growths and tumors
❑ insufficient lubrication
❑ radiation to the area
❑ allergic reactions to diaphragms, condoms, or other contraceptives.
Psychological causes include fear of pain or of injury during intercourse, recollection of a previous painful experience, guilty feelings about sex, fear of pregnancy or of injury to the fetus during pregnancy, anxiety caused by a new sexual partner or technique, and mental or physical fatigue. Men and women can suffer pain in the pelvic area during or soon after sexual intercourse.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dyspareunia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Allergies
Allergic reactions to diaphragms or condoms may result in dyspareunia.
Atrophic vaginitis
In postmenopausal and breast-feeding women, decreased estrogen secretion may lead to inadequate vaginal lubrication and dyspareunia, which intensifies as intercourse continues. Accompanying signs and symptoms include pruritus, burning, bleeding, and vaginal tenderness. Patients may complain of a watery discharge at the same time that they’re feeling “dry.”
Bartholinitis
This inflammatory disorder may produce throbbing pain accompanied by vulvar tenderness during intercourse. The patient may also complain of pain with walking or sitting. Chronic inflammation causes a purulent discharge from the infected cyst.
Cervicitis
This inflammatory disorder causes pain with deep penetration. It may also cause dull lower abdominal pain, a purulent vaginal discharge, backache, and metrorrhagia.
Condylomata acuminata
These papular, mosaic, warty growths occur on the vulva, vaginal and cervical walls, and perianal area. They may bleed, itch, cause burning or paresthesia in the vaginal introitus, and become tender during and after intercourse. A profuse, odorless vaginal discharge may also occur.
Cystitis
Dyspareunia may occur if the patient has inflammation or infection of the bladder. Associated findings include dysuria; urinary urgency, frequency, or incontinence; pyuria; and, after coitus, hematuria.
Endometriosis
This disorder causes intense pain during deep coital penetration. In addition, aching pain may occur during gentle thrusting or during a pelvic examination. The pain is usually in the lower abdomen or behind the uterus and may be worse on one side. It may be relieved by changing coital positions. Other signs and symptoms include dysmenorrhea, irregular menses, infertility, painful urination or defecation, and rectal bleeding and hematuria during menses. Typically, a tender, fixed adnexal mass is palpable on bimanual examination.
Herpes genitalis
During intercourse, friction against lesions on the labia, vulva, vagina, or perianal skin causes pain and itching. The lesions are fluid-filled and usually painless at first, but may rupture and form shallow, painful ulcers with erythema and edema. Related findings include leukorrhea, fever, malaise, headache, inguinal lymphadenopathy, myalgia, and dysuria.
Occlusive or rigid hymen
Dyspareunia may prevent penetration in this condition.
Ovarian cyst or tumor
In this disorder, lower abdominal pain accompanies deep penetration during intercourse. Other signs and symptoms include chronic lower back pain; a tender, palpable abdominal mass; constipation; urinary frequency; menstrual irregularities; and hirsutism.
Pelvic inflammatory disease
Deep penetration causes severe pain that’s unrelieved by changing coital positions. Uterine tenderness may also occur with gentle thrusting or during a pelvic examination. This disorder also causes fever; malaise; a foul-smelling, purulent vaginal discharge; menorrhagia; dysmenorrhea; a soft, enlarged uterus; severe abdominal pain; nausea and vomiting; cervical motion tenderness; and diarrhea.
Uterine prolapse
Sharp or aching pain occurs when the penis strikes the descended cervix of a patient with uterine prolapse. Other effects are dysmenorrhea, pelvic pressure, leukorrhea, urine retention and urinary incontinence, and chronic lower back pain.
Vaginitis
This infection produces dyspareunia along with vulvar pain, burning, and itching during and for several hours after coitus. These symptoms may be aggravated by sexual arousal aside from intercourse. Vaginal discharge is typical; the type varies with the causative organism. Candida albicans produces a curdlike, odorless to musty-smelling discharge; Trichomonas vaginalis produces a yellow-green, frothy, fish-smelling discharge; bacterial vaginosis and Neisseria gonorrhoeae produce a profuse whitish yellow, foul-smelling discharge. Pruritus and dysuria may also occur.
Other causes
Contraceptive and hygienic products
Some spermicidal jellies, douches, and vaginal creams and deodorants cause irritation and edema, resulting in dyspareunia.
Diaphragms and intrauterine devices
An ill-fitting diaphragm may produce cramps with intercourse. An incorrectly placed intrauterine device may cause dyspareunia during orgasm.
Drugs
Antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs decrease lubrication, resulting in dyspareunia.
Episiotomy
If the episiotomy scar constricts the vaginal introitus or narrows the vaginal barrel, the patient may experience perineal pain with coitus.
Pelvic irradiation
Radiation therapy for pelvic cancer may cause pelvic and vaginal scarring, resulting in dyspareunia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Impotence:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Central nervous system disorders
Spinal cord lesions from trauma produce sudden impotence. A complete lesion above S2 (upper-motor-neuron lesion) disrupts descending motor tracts to the genital area, causing loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower-motor-neuron lesion) causes loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders
Hypogonadism from testicular or pituitary dysfunction may lead to impotence from deficient secretion of androgens (primarily testosterone). Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders
With Peyronie’s disease, the penis is bent, making erection painful and penetration difficult and eventually impossible. Phimosis prevents erection until circumcision releases constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Peripheral neuropathy
Systemic diseases, such as chronic renal failure and diabetes mellitus, can cause progressive impotence if the patient develops peripheral neuropathy. This condition affects about 50% of males with diabetes. Associated signs and symptoms of diabetic neuropathy include bladder distention with overflow incontinence, orthostatic hypotension, syncope, paresthesia and other sensory disturbances, muscle weakness, and leg atrophy.
Psychological distress
Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Trauma
Traumatic injury involving the penis, urethra, prostate, perineum, or pelvis may cause sudden impotence due to structural alteration, nerve damage, or interrupted blood supply.
Vascular disorders
Various vascular disorders can cause impotence. These include advanced arteriosclerosis affecting both major and peripheral blood vessels, Leriche’s syndrome (slowly developing occlusion of the terminal abdominal aorta), and arteriosclerosis, thrombosis, or embolization of smaller vessels supplying the penis.
Other causes
Alcohol and drugs
Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence.)
Surgery
Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Impotence:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Central nervous system disorders.Spinal cord lesions from trauma produce sudden impotence. A complete lesion above S2 (upper motor neuron lesion) disrupts descending motor tracts to the genital area, causing a loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower motor neuron lesion) causes a loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders.Hypogonadism from testicular or pituitary dysfunction may lead to impotence from a deficient secretion of androgens (primarily testosterone). Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders.With Peyronie's disease, the penis is bent, making erection painful and penetration difficult and eventually impossible. Phimosis prevents erection until circumcision releases the constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Psychological distress.Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Other causes
Alcohol and drugs.Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence.)
Surgery.Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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