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(B) of the pathogenesis
As for female sexual dysfunction research, the people gradually realize that painful intercourse is not merely a psychological barrier, as well as its physiological and pathological basis. Hormones on female sexual function has an important regulatory role, estradiol levels directly affect the central and peripheral nerve function and nerve cell signal transduction. With aging and the arrival of menopause, blood estrogen levels drop, most women will experience changes in sexual function to varying degrees. Mainly for lack of sexual desire, decreased frequency of sexual activity, painful intercourse, decreased sexual response, sexual orgasm and genital sensory loss and other difficulties. Studies have shown that non-adrenergic / non-cholinergic (NANC) neurotransmitter nitric oxide (NO) involved in the physiological mechanism of female sexual response, increasing vaginal blood flow, lubrication and secretion; and NANC nerves may regulate the clitoris and vaginal smooth muscle relaxation. Surgical castration or menopause and women with high lactation hyperlipidemia reduces estrogen levels, can reduce vaginal nitric oxide synthase (NOS) expression, NO levels in the vagina, vaginal wall fibrosis, increased vaginal mucous membrane caused by apoptosis, lead to decreased secretion of vaginal mucosa, lack of vaginal lubrication, dryness; In addition, fibrosis of the vaginal wall compliance decreased vaginal relaxation, vaginal intercourse, lack of reacti


ve hyperemia, the ductility of the penis into difficulties, leading to the occurrence of female sexual pain . Animal experiments showed that estradiol may widen the touch receptors in pudendal nerve, pudendal nerve region of lower sensory thresholds. Women after menopause, estrogen replacement therapy restored the function of characteristics of the clitoris and vagina, and close to the level before menopause. Estrogen can also vasodilation, to improve the vagina, clitoris and urethral artery. Masters 1966, the first such occurrence reported in postmenopausal women associated with the physiological changes of sexual function, recognizing that some changes in sexual function and estrogen levels decline, but not with estradiol lower than 50pg/ml directly related. Estrogen replacement therapy can significantly improve symptoms. And NO similar, NANC neurotransmitter vasoactive peptide (VIP) can cause vascular and non-vascular smooth muscle relaxation, increasing blood flow and pelvic and vaginal lubrication and vaginal secretion, but it is not clear about its regulatory mechanism.
Distribution of certain parts of female genitalia have different receptors, such as bodies and cilia touch, pressure and vibration sense bodies, pain free end, temperature sensation, feelings of bodies and bodies such as multi-sensory Gul. Human mons pubis, labia majora, clitoris and hymen pain distribution of free nerve endings rich. Genital infections, the local inflammatory response inherent in redness, swelling, heat, pain and discomfort, the pain of the release of inflammatory mediators such as prostaglandin E (PGE) to stimulate local pain free nerve endings, so that the sensitivity to pain perineum increase in the time of sexual , friction or collision will undoubtedly raise the local pain, pain during intercourse while the woman appears, manifested as burning pain, tingling (mons pubis, labia majora and the vaginal orifice), referred pain (the clitoris ), etc.; In addition, the inflammation of the vulva, vagina and the surface rupture Organized injury, inflammatory secretions increase the vaginal pH, vaginal lubrication characteristics change, resulting in lack of vaginal lubrication, dryness, coupled with sexual intercourse, aggravated local damage, vaginal, vulvar pain, burning pain and astringent.
Jensen has reported 322 patients with vulvovaginal infections, 86% had genital pain, 71% described pain during intercourse, 66% improved after treatment.
Chronic pelvic adhesions, endometriosis, the vaginal dome after the painful nodules, and disease limit the cervix and uterus on the move, reducing the ductility of the vagina, sexual intercourse occurred and (or) after sexual intercourse vaginal deep and (or) pelvic pain, localized or diffuse or blunt pain stretch, and sustainable for several hours to 1 day. Production mainly due to the pain of pulling and visceral excitement to cause pelvic congestion and inflammation caused by reflex.
For cardiac pain during intercourse, its pathogenesis is mainly the central and peripheral nervous system or cause reflection and transmission of information the release of neurotransmitter abnormalities, as a result of the fear of sexual intercourse or sexual intercourse when the spirit of high tension, inhibition of the central nervous system function and information conduction, thereby inhibiting the production of physiological sexual arousal, the vagina of reactive hyperemia, lubrication is not enough, leading to pain during intercourse; In addition, as women's lack of awareness of genital anatomy and physiology, coupled with the lack of both knowledge and experience of life, when the excitatory response in the asexual woman vagina not accommodate diastolic, no synovial fluid secretion, penis too deep into force contradict the Department of and ligaments of the cervical, or vaginal opening and the vaginal wall causing damage and stimulate the nerve endings generate or increase the pain or discomfort.
Vaginismus sexual intercourse phobia also known, is the patients penis, on the genitals produce "injury" caused by extreme fear. In fact, the smooth muscle of vaginal sex organs, to accommodate the expansion of the great, delivery can be used to accommodate the fetal head was delivered proof. A high degree of tension, fear will lead to genital adrenergic neurotransmitter noradrenaline (NA) release increased, causing smooth muscle contraction or spasm vaginal wall, vaginal ring outside the mouth of skeletal muscle in the pudendal nerve release acetylcholine (Ach) under the action of spasmodic contraction occurs also impede the smooth progress of the penis or inserted into the penis can not withdraw to pain.


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