#Cystitis

30y/Male patient C/o low back pain 6month H/o recurrent UTI Treated with culture sensitive antibiotics Relief for some time However problem persist Suggest Dx Ddx Rx plz Thank you

Friends today I am discussing about Dyspareunia In Women. Pain during intercourse. What is dyspareunia? The word dyspareunia is derived from the Greek language, and the meanings include "difficulty in mating" or "badly mated." Dyspareunia or pain during sexual intercourse can occur both in men and women but is more common among women. The pain can range from moderate to severe and occurs in a woman's labial or vulvar areas, during or immediately after sex. The pain may also be experienced as a pelvic pain or vaginal pain and is often accompanied by a burning or throbbing sensation. What are the causes of dyspareunia? There are a variety of causes that can lead to dyspareunia: Depression, fear, and anxiety which can affect sexual arousal and lead to conditions such as vaginismus, or vaginal dryness A history of sexual abuse or trauma Stress Domestic violence The medical factors that can lead to dyspareunia include: Atrophic vaginitis or vaginal atrophy which is a common condition that causes thinning, drying or inflammation of the vaginal lining in postmenopausal women Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases like candida, herpes simplex or genital warts Skin disease, such as psoriasis or lichen sclerosus. Cystitis or inflammation of the bladder wall caused by a bacterial infection Endometriosis a painful gynaecological condition, which occurs in women when the tissue that makes up the uterus lining develops elsewhere in the body. Fibroids which are often benign tumours that grow on the wall of the uterus Interstitial cystitis which is a chronic painful bladder condition Irritable bowel syndrome (IBS) which is a functional disorder of the digestive tract Ovarian cysts a condition where a build-up of fluid within an ovary occurs Pelvic inflammatory disease (PID) which causes inflammation of the female reproductive organs, usually caused by infection Uterine prolapse a condition in which one or more pelvic organs extend into the vagina The other causes that can lead to dyspareunia include: Side effects of some drugs Allergic reaction to clothing, or spermicides What are the symptoms of dyspareunia? How is dyspareunia diagnosed? The symptoms of dyspareunia include: Lack of sexual desire Inability to get aroused Pain that occurs only during sexual penetration Repeatedly experiencing pain while the partner thrusts Burning sensation along with the pain Inability to experience orgasm Pain while inserting a tampon Throbbing or burning sensation which occurs with the pain and lasts for a long time after the intercourse Diagnosis A medical evaluation for dyspareunia includes: The doctor asking in detail about your sexual history, medical and surgical history, when did your pain begin, whether it occurs in certain sexual positions. In case of multiple sex partners, the patient needs to mention if the pain occurs only with certain partners. A pelvic exam by the doctor to check for any form of infections. During the pelvic exam, the doctor may apply gentle pressure on the genital muscles with a cotton swab to identify the location of the pain. Based on the physical exam the doctor may recommend a pelvic ultrasound a visual exam of the vagina, using an instrument called a speculum What are the complications of dyspareunia? Dyspareunia does not usually cause any form of severe health complications. However, it can affect the sexual life of the person. With the right intervention and treatment, dyspareunia can be managed and even cured. What is the treatment for dyspareunia? Medical Treatment for Dyspareunia The treatment of dyspareunia varies according to the cause: In case of dyspareunia which is caused by vaginal dryness, the doctor prescribes vaginal lubricants and may also suggest adequate foreplay. In case of infections and sexually transmitted diseases, the doctor will prescribe antibiotics. In case of allergies, the doctor may prescribe topical creams. For women suffering from dyspareunia due to hormonal problems, hormonal therapy may be prescribed. Surgical intervention may be required for women suffering from problems such as abnormal endometrial tissue growth or uterine fibroids. Psychological counselling may be required for women who have suffered from sexual abuse and trauma. Exercising for Managing Dyspareunia Stretch exercises which strengthen the pelvic floor can help immensely in doing away with the symptoms of dyspareunia. Practicing yoga regularly can help in strengthening and removing the tightness of muscles that can cause the pain associated with dyspareunia. Yoga can also decrease stress levels, anxiety, depression and boost your self-image and self-confidence. Doing The Kegel Exercise Doing the Kegel exercise can help with the symptoms of dyspareunia. The Kegel exercise was named after Dr. Arnold Kegel, who has popularized them in the ‘50s.This exercise initially was meant to cure patients suffering from urinary incontinence (often after childbirth). Gradually the efficacy of Kegel’s exercise was discovered for patients who suffer from conditions like dyspareunia and vaginismus. You can easily identify the vaginal muscles which play an active part during sex with this simple exercise. Go to the bathroom and urinate a little, then stop the flow of your urine. Then start urinating again, retain the flow of urine, and stop again and then start again. Do so until you have emptied your bladder. The muscles which just acted according to your wishes are the same ones involved in dilating and contracting during sex especially during vaginal penetration. Once you identify these muscles it is important to exercise them in order to be able to contract and relax these muscles at will. This will help you gain control over the vaginal muscles keeping pain at bay during sexual penetration. This is known as Kegel’s exercise. The exercise of alternatively stopping and letting the urine flow is only for test purposes to identify the muscles which need to be exercised while performing the Kegel's exercises. Warning: Please do not do the Kegel exercise while urinating. When you are still at the stage of practicing the Kegel exercise, do not attempt a sexual intercourse with penetration. The Kegel Exercise Practice the Kegel exercise for a week or two. Find a quiet suitable place to do the exercise. You can do it after waking up in the morning and just before bedtime while lying on your bed. Follow the steps given below: Contract your pelvic muscles. Squeeze and hold for 3 seconds Then relax for another 3 seconds. Repeat the exercise for as many as 10 times each session, until you can do around 15 repetitions. Initially, a certain effort of concentration will be needed to contract the pelvic muscles only, without contracting the abdominal and gluteal muscles. When you get used to it, it will become automatic. Once you become comfortable doing these sessions quietly in bed, you can do the Kegel exercises anytime while doing some other activities for example, watching TV, working on your computer, in your car, etc. Syncing the Kegel Exercises with Breathing Exercises Once you are comfortable doing Kegel’s exercise anywhere, sync it with breathing exercises: Focus on your breathing for a few minutes. Breathe in and out deeply a couple of times to relax yourself. Then inhale deeply and hold your breath for a few seconds while strongly contracting your pelvic floor muscles. Then exhale deeply and relax these muscles. Repeat several series of this exercise. You can do this exercise in front of a mirror in order to visualize your vaginal muscles at work. This can immensely help to improve your mental awareness of this part of your body and help boost your performance when you resume your sex life. This could be due to vaginal infection. Please get examined by gynaecologist and get the vagina seabed for culture and sensitivity. Ask health queries and get free answers from doctors in 24 hrs Did you know? Dyspareunia in Women Dyspareunia affects 8 - 22% of females, making it a very frequent issue in gynecologic practice. Even without this disorder a significant proportion of women – between 6.5% and 15% – experience varying levels of pain in their genital areas particularly during sexual intercourse at some point in their life. Here are a few effective homeopathic treatments that can help get rid of pain during intercourse: Sepia and lycopodium: It is the top homeopathic medicine for vaginal dryness. Sepia and lycopodium are evaluated as the best cures. Sepia is suggested where vaginal dryness occurs along with itching. Pain from vaginal dryness during intercourse also calls for the use of sepia. Bellis perennis: This medicine helps cure the wounded sensation in the vagina, if intercourse is obstructed due to pain and spasms. Cactus grandiflora: This is used when the vagina shuts close during the act of intercourse. Intercourse might be simpler just before periods. Coffea: This may be used when, if the vulva and vagina are oversensitive and you feel heat as well as itchiness. Cuprum: This medicine is prescribed for cramping in the vagina and the legs, during intercourse. Ferrum: When your vagina feels dry and aches, this medicine may be prescribed. Gelsemium: This medicine is used to treat any tension preceding intercourse. These symptoms usually show an inclination towards vaginismus.

Dyspareunia Pain Having Sex:- Dyspareunia is a term used for pain felt in the genital area or pelvis during or after having sex (intercourse). Nobody really knows exactly how common it is, as many women never seek medical help. However, questionnaires asking women if they have symptoms suggest that somewhere between 1 and 4 out of 10 women experience it. Most commonly, this is early in their sexual lives or around the menopause. There are many causes of dyspareunia, most of which are not serious or damaging in nature, but all can be detrimental to your sex life and ultimately may lead to relationship difficulties. It can be a vicious circle, with pain leading to nervousness about having sex, and nervousness leading to dryness and further pain. It's also not uncommon for dyspareunia to remain after the cause has been treated, particularly if things have been left untreated for a while. For this reason, it is important to seek help early, so that treatable causes can be discovered and managed. This leaflet discusses the types and possible causes of dyspareunia. What is dyspareunia? Dyspareunia is pain felt in the genital area or pelvis during or after having sex (intercourse). It may be thought of as either superficial dyspareunia or deep dyspareunia. They have different causes and treatments and, although it's possible to experience both at the same time, most women find that their dyspareunia is predominantly one or the other type. Superficial dyspareunia This is pain felt in the lips of the vagina (labia), at the vaginal entrance (introitus) and the lower part of the vagina. It typically begins with penetration or very early on after intercourse has begun. It is sore and instant. It is usually quickly relieved by stopping penetration, although you may be sore to the touch afterwards for a little while. The causes of superficial dyspareunia are usually local problems of the labial, vaginal and perineal skin (the perineum is the area of skin between the vaginal opening and the back passage). Deep dyspareunia This is the term for pain felt deeper in the pelvis during or after intercourse. It can also spread to involve the fronts of the thighs. It may be sharp or dull, may stop when penetration stops or can continue for minutes or even hours. The causes of this type of pain usually lie rather deeper in the pelvis. Causes of superficial dyspareunia Skin bridge Formation of a little bridge of scar tissue at the very back of the vaginal entrance (introitus) is common after childbirth, particularly if you have had a cut between the vagina and back passage (anus) - a procedure called episiotomy. The scar tissue contains nerve endings and is very sensitive, and so it causes pain on penetration. The pain tends to become worse as having sex (intercourse) continues, as the skin bridge becomes rubbed by the continuing rubbing of penetration. Intact hymen The hymen is a membrane that lines the vaginal opening. Early in your sex life the hymen is broken down by the act of having sex. In many young women it will already have been stretched by use of tampons. The name 'intact hymen' is misleading, as the hymen does in fact have a small hole in it from birth. This hole becomes larger little by little as girls grow older. However, the hymen can be quite thick and the hole not quite large enough. This can mean that early in her sexual life a woman my feel pain from the hymen as it is forced open the first time she has intercourse. The pain is superficial, felt at the entrance to the vagina as soon as penetration is attempted and may prevent it from taking place. Vaginismus Vaginismus causes a powerful and often painful contraction of the muscles around the entrance to the vagina, which makes penetration painful or impossible. It may also prevent the use of tampons and any sort of gynaecological examination. The spasm of vaginismus is not something you can cause deliberately; it's completely outside your control. It may seem to begin for no reason but can also result from a painful or worrying experience of sex, when it becomes a kind of protective reflex. However, vaginismus is upsetting and dispiriting for both halves of a couple, as it can prevent the enjoyment of sex for many years and can prevent sex completely. Once it has begun, fear of failure and nervousness about not being able to have sex make it worse. It's important to seek help to break the cycle of anxiety and pain. Vaginismus is not difficult to treat but your doctor may need to refer you to a psychologist or specialist physiotherapist. Bartholinitis Bartholin's glands are a pair of glands on either side of the vagina, in the tissues of the wall. They can become inflamed and tender causing Bartholinitis and this will lead to pain during sex. Occasionally, the glands swell during sex, so that it starts off as painless but then becomes painful as it continues. See separate leaflet called Bartholin's Cyst and Abscess for more details. Vulvodynia This is a very troublesome condition where the vulval area becomes painful and extremely sensitive to pressure and touch. It can be accompanied by severe pain on attempted penetration. It can also cause the vulval area to be painful touched and during activities of everyday living. It can lead to frustration and depression, as symptoms can be very long-standing. The causes are uncertain but may involve the nerves in the area becoming much more sensitive than normal and the way the brain communicates wtih these nerves changing in some way. Treatment includes the use of emollient soap substitutes, creams that numb the area, medicines that lessen pain, physiotherapy and cognitive behavioural therapy. Lichen sclerosus This is a scarring skin condition which may affect women of any age, including children. It can affect men too. It results in thinning of the skin of the genital area, together with formation of white patches. It may be caused by the immune system. It causes itching and pain, which can last for a very long time. It's often mistaken for thrush as it can be very itchy and sometimes slightly sore. Lichen sclerosus carries a small risk risk of cancer of the genital skin. For this reason it should be diagnosed and treated - treatment is usually with regular application of creams. Female genital mutilation Female genital mutilation (which used to be known as female circumcision), involves varying degrees of mutilating surgery to the genitals of a girl. In the more extreme forms, the vagina is stitched shut. Following genital mutilation there is usually permanent scarring, which may lead to damaged nerves and pain. Any of these issues can cause pain on penetration and may make sex impossible. Vaginal abnormalities Very rarely, abnormalities of the vagina itself make sex painful or even impossible. These include pieces of extra tissue inside the vagina which are present at birth (vaginal septa). Causes of superficial and deep dyspareunia Vaginal trauma The vagina is pretty flexible and strong and usually recovers well from the stretch and (sometimes) small tears of childbirth. However, more significant injury to the vagina - for example, from difficult childbirth or mutilation - can lead to scarring and then to pain and difficulty during sex (intercourse). Vaginal or genital infection Infections of the vagina and the area around it cause inflammation of the tissues and so commonly cause pain on having sex. Infection may be with thrush (candida - a yeast that often lives in the bowel), with viruses such as herpes and with germs (bacteria). A wide range of bacterial infections can infect the vagina. Some (but by no means all) are sexually transmitted. The vagina is not always sore and itchy before sex but becomes so afterwards. There is often a coloured discharge and you may notice an offensive smell. Vaginal dryness Sometimes pain during sex is due to lack of lubrication, meaning that the vagina is too dry. Normally, the vagina produces secretions which keep it moist and these increase when you become sexually aroused. If there isn't enough foreplay, or you are not aroused enough, you may not produce enough secretions to make penetration comfortable. However, it isn't always as simple as that. There may be reasons why you don't produce the secretions that you should. These can include psychological reasons such as nervousness because sex has previously been uncomfortable; anxiety around becoming pregnant; or anxiety around waking your sleeping children. Dryness can also be for physical reasons - the vagina tends to be drier after the menopause (see below). Some medicines can cause vaginal dryness, including some contraceptive methods. Vaginal dryness is also associated with a condition called Sjögren's syndrome, in which the body's secretions are generally rather reduced. Finally, pregnancy itself can make the vagina dry during intercourse (although it can also have the opposite effect). Vaginal atrophy After the menopause the levels of hormones in your body fall - particularly the level of oestrogen. Oestrogen is the hormone that keeps the vaginal wall strong and resistant. It increases the blood supply and the level of secretions and makes the wall softer and more stretchy. Therefore, when oestrogen levels fall after the menopause, the tissues become thinner, less stretchy and less well lubricated. Sometimes they can become as fragile and delicate as the vaginal tissues of young girls (who have not yet reached puberty and started their periods). There are lots of very effective treatments for this problem. Causes of deep dyspareunia Deep dyspareunia can be caused by the genital organs themselves but may also be caused by other structures in the tummy (abdomen) that can be easily knocked during sex (intercourse). There are therefore many possible causes of deep pain in the tummy during sex. Cervical pain The neck of the womb (cervix) should not normally be painful. However, if can become infected by many of the organisms which can infect the vagina - particularly herpes. If the cervix becomes inflamed then knocking it with the penis during sex may cause deep pain in the pelvis and sometimes across the fronts of the thighs. The cervix may also become tender and sensitive if you have an intrauterine contraceptive device, particularly if it is sitting a little too low or falling out. This can cause sudden sharp pains in the cervix during sex. (Fortunately cervical cancer is very rare and does not usually cause painful sex.) Endometriosis Endometriosis is a condition in which little bits of womb (uterine) lining become embedded in other parts of the body. Most usually this is in the ovaries, the Fallopian tubes that link the womb to the ovaries, and the cervix. These bits of tissue bleed whenever you have a period. This blood tends to cause scar tissue formation with sticking of organs to one another, and the whole pelvis can become painful. Endometriosis is typically found in young women, and may only become apparent when they come off the contraceptive pill if they have been taking it for a while. This is because 'the pill' suppresses it and is, in fact, a treatment for endometriosis. Endometriosis causes pain on sex, typically pain that comes on with deep penetration and continues for some time after penetration is over. It also causes painful periods, and women with endometriosis can find it difficult to get pregnant. Ovarian cysts The presence of cysts on the ovaries can cause pain during sex (intercourse). This is because the ovaries can be knocked by the penis during intercourse and this can cause the cysts to leak fluid. It's not unusual to have cysts on the ovaries, as cyst formation is a normal part of the period (menstrual) cycle. However, these 'physiological cysts' are typically very small. Larger cysts are more likely to leak and cause pain, and can be a sign of endometriosis, especially in younger women. In women who have passed their menopause, ovarian cysts are worrying, as they can be a sign of ovarian cancer. Another, harmless form of pain from the ovary is called 'Mittelschmerz.' This is pain when an egg is released from the ovary. Pain from Mittelschmerz may not be related to sex at all, and typically lasts for two or three days in the middle of the month - but sex may make it worse when it's there. Fibroids and growths in the womb Fibroids are non-cancerous (benign) growths in the muscle of the womb, which can cause the womb itself to become quite bulky. This is not always painful but it can lead to discomfort during sex. Causes related to womb position In some women the womb tilts backwards, rather than forwards; the ovaries then tend to fall backwards too. This can lead to them being knocked in positions involving deep penetration. This can result in deep pain in the pelvis that is more noticeable with deep penetration and which settles slowly when penetration stops or when you change your position. Bowel pain During intercourse the bowel is also knocked and moved. If the bowel is sensitive or tender then this can be the origin of pain during sex. This is particularly likely in women who have Crohn's disease, ulcerative colitis or irritable bowel syndrome, all of which are conditions that cause the bowel to be painful. Pelvic inflammatory disease This is a condition of the Fallopian tubes, the womb and, sometimes, the ovaries. It is caused by infection and makes these organs inflamed. As they tend to move during sex, this is painful. The pain is typically felt deep in the pelvis, is worse with deep penetration and settles slowly when penetration stops. Pelvic inflammatory disease also tends to make you feel unwell, and may cause a temperature and a vaginal discharge. Bladder pain The bladder sits on top of your womb, just behind and above your pubic bone. Like the womb, the bladder moves and gets pressed on during intercourse. So, if the bladder is inflamed, this may hurt. Typical causes include urine infections and interstitial cystitis. This is a condition in which the bladder becomes sensitive and painful. It behaves like a urine infection but no infection is present. Summary Symptoms of dyspareunia (pain felt in the pelvis during or after sex) are distressing and depressing. They can affect your sex life, your fertility and even your relationship. Many of the causes have a very simple solution and it is important to seek help if you are experiencing problems. Any donations are always appreciated for the time and effort https://www.paypal.me/Drnmnoori

65 years female Irritable bladder Bladder biopsy for comments

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