SEXUAL PAIN Home messages, a summary from Presentations, moderated Posters and Podiums

Transcription

1 SEXUAL PAIN Home messages, a summary from Presentations, moderated Posters and Podiums María Luisa Banfi, MD Gynecologist, Sexologist Montevideo, Uruguay, South America CHICAGO 2012,SMS- ISSM, World Meeting on Sexual Medicine

2 IN WOMEN :

3 THE VULVA COULD INTERFERE WITH SEX.

4 Vulval pain, Introital pain Vaginal or deep pain

5 WHY DYSPAREUNIA? WHY VAGINISMUS?

6 Psicosocial, psicosexual, or PHISICAL PAIN :???? WHY and how DID they BEGIN? HOW and why do they go on?

7 Many causes «A MULTIDIMENSIONAL EXPERIENCE»

8 Addressing sexual pain, anxiety and pelvic floor dysfunction with physical therapy Talli Y. Rosenbaum, MSc., PT,IF AASECT Certified Sex Therapist Pelvic Floor Physiotherapist

9 THE PELVIC FLOOR

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11 AS A DEFENSIVE REACTION AFFECTS AROUSAL and LUBRICATION INCREASE FRICTION

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15 Sexual Pain, Dyspareunia & Pelvic Floor Dysfunction : PSYCHOBEHAVIORAL INTERVENTIONS Susan Kellogg Spadt, PhD CRNP IF Director: Sexual Medicine The Pelvic & Sexual Health Institute, Philadelphia Prof: OBGYN:Drexel University College of Medicine Prof: Human Sexuality: Widener University

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20 As gynecologist and Sexologist I can say that we have to see the intact anatomy BEFORE the first intercourse. We have to see the signs in the right moment. We must avoid the tightening of the pelvic floor muscles.

21 DISCOVERING THE ENTRANCE 14 yo

22 LOOKING FOR WITH A COTTON SWAB A NEAR COMPLETE MEMBRANE SURROUNDING the INTROITUS

23 Unconsummated couple 18 yo

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25 THE FISSURES, THE SKIN DAMAGE

26 58 yo THE ANATOMICAL CHANGES with AGE,

27 THE MUCOSAL and THE SKIN ATROPHY turns the penetrations, impossible

28 Causes and Treatment of Sexual Pain in Women Andrew T. Goldstein, MD FACOG The Centers for Vulvovaginal Disorders 3 Washington Circle NW, Suite 205 Washington DC Telephone: Obstetrics@yahoo.com

29 INTROITAL DYSPAREUNIA (VESTIBULODYNIA) DIFFERENT CAUSES : Hormonally Mediated Vestibulodynia ( OCPS ) Hypertonic Pelvic Floor Muscle Dysfunction Neuroproliferative Vestibulodynia : A congenital B - acquired Lichen sclerosus, Lichen planus Desquamative Inflammatory Vaginitis Chronic Candidiasis Vulvar Granuloma Fissuratum

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31 DIFFERENT TREATMENTS : Hormonally Mediated Vestibulodynia ( OCPS ) Stop hormonal contraceptives then use: estradiol 0.02%/testosterone 0.1% in methylcellulose Hypertonic Pelvic Floor Muscle Dysfunction Botox injections Neuroproliferative Vestibulodynia : A congenital B acquired Interferon, gabapentin Consider referral to vulvar specialist for vestibulectomy if conservativ treatments fail

32 Do not attribute dyspareunia to sexual abuse, anxiety, or depression just because YOU can t figure out what is going on.

33 Local Hormone Therapy: Is It Really Local? James A. Simon, MD, CCD, NCMP, FACOG Clinical Professor Department of Obstetrics and Gynecology George Washington School of Medicine James A. Simon, MD, PC Women s Health & Research Consultants Washington, DC

34 Genitourinary Changes After Menopause Most Bothersome Symptom (MBS--FDA) Vaginal dryness Dyspareunia Vaginal/vulvar irritation Vaginal soreness Dysuria Bleeding associated with sexual activity

35 Vaginal Atrophy Estrogen therapy promotes vaginal cell growth, cellular maturation, fosters recolonization with lactobacilli, enhances vaginal blood flow, decreases vaginal ph, improves vaginal thickness and elasticity and vulvovaginal symptoms Vaginal preparations superior to oral

36 In breast cancer patients, the focus is on little if any systemic absorption

37 KRYMAN M.L., BERMAN L. POSTMENOPAUSAL WOMEN and VAGINAL DRYNESS and PAINFUL INTERCOURSE and their IMPACT on WOMENS SEXUAL HEALTH On line 1043 women AGE : yo 73% in a committed relationship 56% experienced vaginal dryness Only 17 % reported that it does not bother at all

38 ALL THESE WOMEN said : VAGINAL DRYNESS / PAINFUL, MAKES me not want to have intercourse ANYMORE Some of them who spoke to health care professionals (2 in 5), waited more than 2 yrs 93% of those who experience pain, still engage in intercourses because of theirs partners.

39 IN THE PATIENTS IN TREATMENT OF VULVAR PAIN IN WOMEN WITH VULVADYNIA Berman, Staag, Malemed DAYLY APPLICATION, of topical cream, decrease pain Jellyfish, can supress the inflammation and pain associated.

40 Alves, Ambrogini, Lordello, Silva, Haidar. 162 pt 93 % postmenopausal 110 reported one or more of these symptons : 77,3 % VAGINAL DRYNESS 39.1 % DYSPAREUNIA 70.9 % DECREASE in SEXUAL DESIRE 42.7% AVOID INTIMATE CONTACT

41 EVALUATING THEIR QoL : 18.5% VERY DISSATISFIED 19,8% DISSATISFIED 25 % NIETHER SATISFIED NOR DISSATISFIED 36,4 % FEEL SATISFACTION

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45 MALE DYSPAREUNIA IS OFTEN UNDERESTIMATED THIS SYMPTON SHOULD BE INCLUDED IN ANY EVALUATION OF SEXUAL FEMALE AND MEN.

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47 INTERNET SURVEY, AGED 18 yo or more, excluded HIV positive,1190 PARTICIPANTS. 59 % refered anal pain Participants rated inadequated lubrication and lack of oral or digitoproctic stimulation prior to penetrations, as the most important factors predicting pain

48 Prevention Primary care Sexual education Could be good tasks!

49 In men!

50 We will be very gratefull as WOMEN!

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