进入性(性交)疼痛控制研究
【摘 要】 目的:探讨女性学相关体系的形成，促进其为临床实践服务。方法：利用近20年来的临床经验以及相关的药学、药理学、药效学研究，借鉴世界上有关性与神经与大脑机制的最新研究成果，引入医学伦理学、循证医学、流行病学的理念、方法，进行梳理、综合、调适。结果：传统医学（疾病医学）与性医学在“病”的判定上存在差异，两者分别以“生存”与“生存质量”为标准；进入性疼痛不能愉悦并不影响生存，因而不为传统医学正视，这是大量患者无处求医的根源；按传统医学模式对进入性疼痛治疗，难以进行实验室检验，并少有阳性发现，因而治疗也难有针对性。利用循证医学理念、方法，容易达到预期目的。进入性疼痛的病理确实存在生理因素，如由较强的痛感可引起神经超敏反应；由神经递质产生负情绪可导致内分泌系统抑制；阴道黏膜的高拉伸性需要在高敏感的状态下修复等；因此，要加强相应的临床治疗学研究。结论：对进入性疼痛控制的系统研究，将有利于丰富女性学内容，促进其在临床上的应用与发展。
【关键词】 进入性; 性交疼痛; 耐受性功能失常; 身心运动; 关联症状; 性假条; 性重启; 置换; 流行症状学
Study on pain management of pain caused by penis insertion (sexual pain)
CHA Jianzhong 1, WANG Shufan 2, LI Songlin 1, WANG Xiaomin 3
1 Ke Li Institute, Wuhan Ke Li Science and Technology Development Co., Ltd., Hubei 430015, China
2 Association for Sexology in Wuhan, Hubei 430010, China
3 Hubei Institude for Food and Drug Control, Hubei 430061, China
【Abstract】 Objectives: To discuss the formation of related system of women’s studies that could promote the clinical practice services of the studies. Methods: We can learn about the latest research results on sexual, neural and brain mechanisms around the world that introduce the ideas and methods of medical ethics, evidence-based medicine and epidemiology to sort out, integrate and adjust though the clinical experiences and related researches on pharmacy, pharmacology and pharmacodynamy in past 20 years. Results: There is a differences on the determinant of “disease” between traditional medicine (disease medicine) and sexual medicine that as “survival” and “quality of life” as a standard respectively. Pain caused by penis insertion with pleasure does not affect survival. Therefore, it has not faced squarely to traditional medicine that is the root of nowhere to seek medical advice for a large number of patients. It is difficult to carry out the laboratory testing for treatment of pain caused by penis insertion by traditional medicine model, and few positive findings. Thus, it is difficult to targeted therapy. The desired objective is achieved easily by the ideas and methods of evidence-based medicine. The physiological factors of pain caused by penis insertion do exist, such as, nerve hypersensitivity caused by strong pain, inhibition on endocrine system caused by negative emotions produced by neurotransmitters, the repair of vaginal mucosa’s high stretch need under high sensitivity condition. Therefore, we should enhance the researched on corresponding clinical therapy. Conclusions: The management system on pain caused by penis insertion will help to eich the content of women’s studies, and promote its clinical application and development.
【Key words】 Penis insertion; Sexual pain; Tolerance of sexual dysfunction; Body-mind exercise; Associated symptoms; Asking for sexual leave; Restart of sexual function; Replacement; Epidemic symptomatology
性交困难是女性性功能障碍（FSD）中常见的一种症状，通常所指“当尝试或完成阴道进入或阴茎与阴道性交时出现的持续、周期性疼痛”（Basson,Althof,etal.,2004）[1]。世界性健康学会（WAS）国际咨询委员会随后更新了这个定义，增加了进入过程中的疼痛，而不仅是尝试进入时。
“很少有关于性交困难的控制性研究”(B.R.Komisaruk,C.Beyer-Flores,B.Whipple,2006)[2]，“至今为止，有关FSD以科学实验为基础的文章却凤毛麟角”（马晓年，2005）[3]；“科学界对FSD了解太少”，“在妇产科教材里，找不到FSD内容”（张渺，2004）[4]。以至2003年元月4日《英国医学杂志》上刊载了《澳大利亚财经评论》驻华盛顿记者莫伊尼汉（Ray Moynihan）撰文称“重新定义FSD的科学家和医生中，不少人与制药公司关系密切”，“FSD是制造出来的疾病”。然而一周后，《英国医学杂志》收到70余封不同意见的来信，“很多医生认为性问题都是心理因素引起，但确有是由生理因素造成”，“正是因为有这样的医生和记者，众多FSD女性才会长期被漠视”[4]。