Female Sexual Health

Female Sexual Dysfunction
女性性功能困擾

1. Vaginismus

  1. Definition: The vagina rejects insertion in any way, such as tampons, duckbill pliers, fingers, penis, and etc. which cause muscle contraction or vaginismus, and there is a distinction of severity. In severe cases, it is impossible to have sexual intercourse and in mild cases, it hurts.
    定義:
    陰道禁止任何方式的侵入,像是棉條、鴨嘴鉗、手指、陰莖……,導致肌肉收縮或痙攣,並有嚴重程度上的區分,重者無法性交,輕者感到疼痛。

  2. Diagnosis: The diagnostic criteria for vaginismus are still controversial today, the more often mentioned is Lamont that classified into four levels according to severity:
    Level 1: Patient with vaginismus feel spasms at the bottom of the pelvis, and pain can be controlled by comfort;
    Level 2: Spasms occur throughout the pelvis and can still be relieved by comfort;
    Level 3: Patient raises hips to avoid being examined;
    Level 4: Raise hips and tightly close thighs to refuse to be examined.
    診斷:陰道痙孿 (Vaginismus)的的診斷標準現今仍舊爭議不斷,較常被提及的是拉蒙特(Lamont)依照嚴重的程度分為四級:
    1級:陰道痙攣患者在骨盆底部痙攣,可以藉由安撫控制疼痛;
    2級:痙攣在整個骨盆發生,仍可經由安撫而緩解;
    3級: 患者抬高臀部以避免被檢查;
    4級:抬高臀部並且緊閉大腿,以拒絕被檢查。

  3. Cause:
    There are many hypotheses for the cause of vaginismus, but it is difficult to propose a clear standard in terms of physical or psychological causes. In the discussion on the psychosocial level, there are some inscriptions, including the protection of self, the reactions from fear of sex, the fear of pain, the lack of sex education and knowledge, the pressure of traditional society, the influence of religion, conservative sex and etc. These factors can be seen more or less in the oral dictation of women with vaginismus, and they are also common psychological effects on physiological reactions
    病因:
    陰道痙孿的病因有許多假說,卻難以提出在生理或心理病因上明確的規範。在社會心理層面的探討中則有所著墨,包含了對自我的保護、害怕性行為所產生的反應、疼痛的恐懼、對性教育和知識的不足、傳統社會的壓力、宗教的影響、保守的性態度…,這些因素在女性陰道痙攣的個案口述中或多或少都能窺見一二,也是常見的心理影響到生理的反應。

  4. Treatment:
    From the past simply physiological treatment, it has developed into both physical and psychological progress, including expansion exercises, taking medication to reduce anxiety, psychological counseling, and botox injection.
    Sexual happiness self-aid method: Improved through sexual counseling and supplemented with physical behavior training.
    治療:
    從過往單純的生理治療方式,發展為生理與心理同時並進,包含了擴張練習、服用藥物降低焦慮、心理諮商、施打內毒桿菌等等。
    性福自助法:透過性心理諮詢,並輔以生理上行為的訓練,從中獲得改善。

2. Pain during intercourse (Dyspareunia)

  1. Definition and diagnosis: In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), painful intercourse (Dyspareunia) and vaginal spasms (Vaginismus) have been integrated into “genito-pelvic pain/ penetration disorder).
    定義與診斷:
    精神疾病診斷準則手冊第五版裡(DSM-5)已將性交疼痛(Dyspareunia)與陰道痙攣(Vaginismus)整合成「骨盆性器疼痛/插入障礙」(genito-pelvic pain/penetration disorder)。

  2. Continue or repeat one or more of the following difficulties for at least 6 months:
    (1) inserted into the vagina during intercourse.
    (2) Significant external vaginal or pelvic pain during vaginal intercourse or attempted insertion.
    (3) Obvious fear or anxiety, vaginal or pelvic pain, before or during vaginal intercourse.
    (4) Pelvic muscles are tightened or contracted during vaginal intercourse.
    持續或反覆出現以下一項(或更多)困難至少約6個月以上:
    (1) 性交時插入陰道口 
    (2) 陰道內性交或企圖插入時顯著外陰道或骨盆疼痛
    (3) 在性交準備插入時,插入期間或插有明顯恐懼或焦慮外陰陰道或骨盆疼痛。
    (4) 在性交插入時骨盆肌肉繃緊或緊縮

  3. Cause: Evaluation prioritizes physiological factors. In fact, most of them are psychological reactions that affect the physiological pain.
    病因: 
    評估以生理因素為優先,實際上則多為心理影響生理所產生的疼痛反應。

  4. Treatment: When the vagina suffers from an acute infection, medication works best. Most intercourse pain is a very complex psychogenic physiological response, so the treatment method focuses on psychological and behavioral changes.
    治療:當陰道遭受到急性感染時,用藥才是最佳的方式。多數的性交疼痛是很複雜的心因性生理反應,所以在治療的方法上著重於心理以及行為上的改變。

3. Female Sexual Interests/ Excitement Disorders

  1. Definition and diagnosis: lack of or significant reduction of sexual desire, the appearance of three or more of the following symptoms for at least 6 months, the situation caused mild, moderate and severe distress:
    (1) Absent/ reduced interest in sexual activity.
    (2) Absent/ reduced interest in sexual fantasies.
    (3) Absence/ reduction of previous sexual activity and no feelings for sexual partner invitations.
    (4) In most or all (about 75%-100%) of sexual experience, there is absent/ reduced excitement/ pleasure towards sexual behavior
    (5) Absent/ reduced sexual interest/ excitation towards any internal or external sexual implication, such as written, spoken or visual.
    (6) In most or all (about 75%-100%) of sexual experience, there is absent/ reduced feeling towards sexual organs or other parts.
    定義與診斷:缺乏或明顯降低性慾,出現下列三種以上症狀並持續至少約6個月,其情形引起輕、中及重度的困擾外:
    (1) 對性活動無/降低興趣。
    (2) 對性幻想無/降低興趣。
    (3) 無/降低原先的性行為,且對性伴侶的邀約無感。
    (4) 在大部份或所有(約75%-100%)的性行為經驗中,對性行為無/降低興奮/愉悅感。
    (5) 對任何內在或外在性/色情的暗示,例如:書面、口語或視覺等,無/降低性興趣/興奮。
    (6) 在大部份或所有(約75%-100%)的性行為經驗中,對性器官或其它部份無/感覺降低。

  2. Treatment: Check the physical condition and take the medicine as needed. If it is not a physiological factor, you should consider the effect of cognition, psychology, society and etc. to get improvement.
    治療:
    檢視生理狀況後視情形服用藥物,若非生理因素則需考慮認知、心理、社會等的影響,以獲得改善。