American Medical Association Family Medical Guide - American Medical Association [263]
Diagnosis and Treatment
Your doctor can diagnose vaginismus from your description of the symptoms and an examination of your genital area. If the doctor suspects a physical cause, he or she will order any tests necessary to diagnose it. If no physical cause is detected, the doctor probably will refer you to a sex therapist for treatment. The therapist will work with you to find the underlying cause of the problem and help you overcome it.
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Infertility
Infertility is a medical condition that impairs a person’s ability to have children. Doctors diagnose infertility when a couple has failed to achieve a pregnancy after having unprotected intercourse for several months. Doctors also consider women infertile who have become pregnant but have not been able to have a live birth because of repeated miscarriages or stillbirths. Infertility affects more than 6 million people nationwide, occurring in both men and women.
Coping with infertility can be a difficult, life-changing process that produces strong feelings of loss and disappointment. Both women and men may feel helpless, angry, or guilty; men may feel that it diminishes their masculinity and women their femininity. Couples who undergo treatment for infertility often experience hope followed by disappointment.
Diagnostic techniques, innovative drugs, and surgical procedures are available to help many infertile couples. Most cases of infertility are treated with medication or surgery. However, about 5 percent of cases require more sophisticated assisted reproductive techniques, such as in vitro fertilization.
The Causes of Infertility
Infertility is a problem usually experienced as a couple. There are many causes of infertility, and a couple can have more than one medical condition that affects their fertility. About 40 to 50 percent of cases of infertility result from a difficulty with the woman’s reproductive system and about 30 to 40 percent from a difficulty with the man’s. In approximately 10 to 30 percent of couples, infertility results from either factors related to both the man and the woman or is considered unexplained. Many causes of infertility are reversible with treatment, but some are not. If the cause of infertility cannot be corrected, techniques exist that can bypass it and result in a pregnancy. However, there are no guarantees of success from infertility treatment and, in spite of repeated attempts, some couples never conceive.
Causes of Infertility in Women
The causes of infertility in women are numerous and range from a deficiency of eggs, to infection that causes obstructive scarring in the reproductive system, to medical conditions such as diabetes or thyroid disorders that alter metabolism. The most common causes of infertility in women are:
• Lack of ovulation Failure to ovulate (release an egg from the ovary during the menstrual cycle) is usually caused by a hormonal imbalance.
• Polycystic ovarian syndrome Polycystic ovarian syndrome (see page 865), a metabolic disorder characterized by abnormal hormone levels, affects up to 10 percent of all women. An imbalance of the ovulation-stimulating hormones, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) blocks ovulation.
• Infection Sexually transmitted diseases (STDs; see page 477) or peritonitis (inflammation of the membrane lining the wall of the abdominal cavity) can cause scarring and blockage of the fallopian tubes.
• Endometriosis The growth of uterine tissue in the pelvis can either block an egg’s passage from the ovary through a fallopian tube or form ovarian cysts.
• Pelvic surgery Surgery in the pelvic area can result in adhesions (bands of fibrous scar tissue) that obstruct or misshape a woman’s reproductive organs, preventing an egg from reaching a fallopian tube or the uterus.
• Abnormal growths in the uterus Fibroids (see page 867) or polyps inside the uterus can prevent a fertilized egg from implanting in the