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??????????? The term is loosely used for both difficult and painful coitus. The The following classification of the causes of dysparerunia is suggested:
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Due to male partner
-????????? Gross congenital abnormality of the penis
-????????? Impotence
-????????? Premature ejaculation
-????????? Complete an surprising ignorance in the technique of coitus
Due to female partner
-????????? Painful lesions in the region of the introitus such as vulvitis (acute and chronic), urethral caruncle.
-????????? Bartgholin’s cyst and abscess, tender scars from obstetric trauma or operation and painful lesions of the anal canal notable fissure
-????????? Obstructive conditions at the vaginal introitus.
-????????? Obstructive conditions above the vaginal introitus
-????????? Congenital stenosis
-????????? Aquired stenosis
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Uterine condition which are not obstructive but because they are painful, give rise to collision dyspareunia
-????????? Cervitis
-????????? Chronic parametiritis and parametrial scar
-????????? Adenomyosis uterus
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Lesions of the uterine appendages
-????????? Acute and chronic salpingo – oophoritis
-????????? Endometriosis of the poucth of Douglas, recto-vaginal septum and uterosacral ligaments
-????????? Prolapsed ovaries associated with retroversion
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Clinical investigations
??????????? Clinical investigation of the problem of dyspareunia should be conducted along similar lines to that of vaginismus, assuming that the husband is normal
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Clinically dyspareunia is divided into
-????????? Superficial where the pain occurs immediatedly penetration is attempted
-????????? Deep seated where the pain is not associated with penetration but appreciated only after this has occurred and is usually localized by the patient has being in the depth of vagina.
-????????? Post coital dyspareunia
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??????????? This is an abnormally maintained posture, often associated with continuous, plastic rigidity. The dystonias are closely related to choreo-athetosis; the expression ‘dystonic movements’ is sometimes used, but the term can also be used to describe the flexed posture of Parkinson’s disease (flexion dystonia) or the fixed hemiplegic flexed posture (hemiplegic dystonia). The abnormal postures of dystonia vary in relation to different circumstances: for example, dystonic posturing in torsion dystonia may be relieved by lying supine or by standing in contact with a? wall. The term dystonia is sometimes used to include all involuntary movements that are accompanied by abnormal postures.
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