• Too frequent intercourse: sperms are immature (no time for maturation).
• Too infrequent intercourse: not coincide with the time of ovulation.
pain sensation on attempt of intercourse.
(vaginitis is the commonest cause).
A. Primary dyspareunia:
• Timing: dating from the 1st coitus.
• Causes: vaginismus & vaginal agenesis.
B. Secondary dyspareunia:
• Timing: present after a period of painless coitus.
1. Superficial dyspareunia:
Pain just with penetration.
1) vulval lesions e.g. vulvitis & large tumours.
2) Vaginal lesions e.g. vaginitis & large tumours.
3) Extra-genital lesions e.g. anal fissure.
2. Deep dyspareunia:
Pain occurs after penetration.
Due to: 1) cervical lesions e.g. cervical fibroid.
2) Uterine: fixed RVF.
3) Tubal: chronic salpingitis.
4) Pelvic lesions: pelvic endometriosis.
treatment of the cause.
violent reflex spasm of pelvic girdle muscles on any attempt at sexual intercourse.
a) Primary vaginismus: mainly psychological due to anxiety.
b) Secondary vaginismus: reflex due to dyspareunia.
a) Primary vaginismus: psychotherapy & gradual dilatation of the vagina may be tried.
b) Secondary vaginismus: treatment of the cause of dyspareunia.
Effluvium seminis definition:
Seminal fluid poured excessively from the vagina after act of intercourse.
Effluvium seminis treatment:
*raise the buttocks on a pillow during coitus.
*The wife remains in supine position for ½ -1 hour after coitus
sexual drive disorder in which there is no desire or failure to achieve orgasm.
Frigidity causes :
1. Psychological and Marital problems.
2. Female circumcision. 3. Causes of dyspareunia.
* treatment of the cause.
* Methyl testosterone (androgen)to ↑ sensitivity of clitoris.
Disturbance of sexual relations PPT (power point presentations):
Sexual dysfunction & infertility PPT:
1. Benha University Hospital, Egypt Aboubakr Elnashar
2. SD can be either a cause or a consequence of infertility. Infertility may exacerbate already present SD.
3. Introduction By the time a couple is seen in an infertility clinic: At least one year of trying, & failing, to become pregnant. Each unsuccessful month leaves them with a greater sense of concern, anxiety, guilt, blame, or anger at not becoming pregnant.
4. In the clinic: •Investigations: Semen analysis & postcoital test (tabulated sex). •Recommendations. Couples are told when to have sex & when to abstain. •Treatments: medical or surgical. Results: 1.The intimate sexual behavior comes under the scrutiny & direction of the doctor.
5. 2. Conception becomes more strongly linked to attendance at infertility clinic than lovemaking. 3.The cause of infertility (male, tubal, unovulatory) may be clarified or unexplained. Recognition of the cause of infertility: acceptance of childlessness & return to normal sexual behavior. Unexplained infertility: prolonged & mutual agony
6. Aboubakr Elnashar
7. Incidence 5% of causes of infertility
8. Types Male SD 1.Loss of desire, with a consequent decrease in sexual activity. 2.Erectile problems. 3.Premature ejaculation- Little or no control over ejaculatory response, & ejaculation may occur before vaginal entry achieved. 4.Retrograde ejaculation-difficulty ejaculation intravaginally, or at all.
9. Female SD 1.Loss of desire. 2.Vaginismus. 3.Dysparunia 4.Anorgasmia: orgasm is not essential for conception (rape),but it improves the chances slightly ( stimulate cervical & tubal activity & stimulate secretions favorable for spermatozoa, the cervix remains open for min)
10. Diagnosis (Sexual history) To avoid wasting time & resources. People can undergo months or years of invasive & expensive investigations & treatment when simple, clear questions about their sexual lives may elicit the cause of infertility.
11. Screening sexual history should be a part of any gynecological history taking. Brachmann et al (1989) asked 2 questions: 1. Are you sexually active? 2. Do you have any sexual difficulties? 16% of non-complaining females have SD. So the gynecologist who state that I donot see FSD in my clinic is not looking hard enough or avoiding the topic altogether.
12. Comprehensive sexual history: General •1. Do you & your husband have similar levels of sexual interest? 2. How frequently do you have SI? 3. Are you satisfied with the current frequency of sexual activity? •1. Do you have difficulty becoming sexually aroused? 2. Does your husband have difficulty becoming sexually aroused? •Do you have problems reaching orgasm? •Is intercourse is painful?
13. Specific analysis of the problem 1. Onset, duration, course 2. Situational or total 3. Aggravating or ameliorating factors 4. Past treatments & outcome 5. Patient own view: the cause, husband reaction
14. Three types of SD need to be born in mind. 1.Retrograde ejaculation: 2% of diabetics at orgasm, the ejaculate is expelled back into the bladder. Examination of postejaculatory urine sample for the presence of sperms. 2.Anejaculation: Some men ejaculate with masturbation but not while sexual intercourse 3.Non vaginal sex: Ask about the sexual behavior. Anal sex, umbilical sex, manual stimulation alone.
16. Causes For many infertile couples, •Lovemaking becomes baby making, •Play becomes work. • Couples are concerned with the procreative aspects of intercourse, not the recreational aspects.
17. 1. The stress of infertility: Anger, panic, despair & grief. 2. The stress of investigations (postcoital test, semen analysis). Recommendations (SI in fertile period) & Treatment. 3.Ignorance & lack of sexual education.
18. Types In both: 1.Diminished sexual desire. 2.Decreased sexual activity during nonfertile periods. Intercourse may be avoided, so that the fertility problem is not reminded. 3. Arousal difficulties because of anxiety or distress. 4. Difficulty in achieving orgasm.
19. In male 1.Transitory impotence. 2.Transitory ejaculatory failure. •For some men, one or two failures during sexual intercourse begins a vicious circle of fear of failure, with anxiety leading to further failures.
20. Prevalence •In Egypt: No studies
21. •In Nigeria (Audu, 2002) Diminished desire: 78% Dysparunia: 57% Difficult sexual arousal: 20% Difficulty in achieving orgasm: 20%. These affects coital frequency & sexual acceptance, thus complicating infertility. There is a need to address these issues when managing infertile couple.
22. •In India (Jain et al, 2000) Male: Premature ejaculation: 66% Erectile dysfunction: 15% Decreased libido: 11% Orgasmic failure: 8%
23. Female: Dysparunia: 58% Decreased libido: 28% Orgasmic failure: 14% Important observations: Various type of misconceptions Lack of sexual education & awareness.
24. •Long term effects of infertility on wellbeing [psychological & sexual] (Balen et al,1993) A significant lower level of wellbeing compared with women in general A third of infertile women & a fifth of the infertile men had serious well-being problems. Emotional help & counseling are important in learning them to live with infertility.
26. 1.Every gynecologist should be aware of the relation between infertility & SD. 2.SD are common in infertile couple 3.Taking sexual history before, during & after treatment of infertility is essential.
27. 4.SD causing infertility can be successfully treated (in two thirds of cases) saving time, efforts & money of the investigations & treatments of infertility. 5.Educating the couple on the impact of treatment on their sexual function & asking them to seek help if symptoms develop.