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  • Abdomen Acute
  • Abdominal Infarction
  • Abdominal Pain
  • Abdominal Pain Chronic
  • Abdominal Pain-Lower Abdomen
  • Abdominal Pain-Upper AbdomenAbdominal
  • Absence Seizure
  • Abuse-Psychological, Physical, Or Sexual
  • Acoustic Neuroma
  • Acromegaly
  • Acute Appendicitis, Unspecified
  • Acute Intermittent Porphyria (AIP)
  • Acute Renal Failure
  • Acute Stress Disorder
  • Addison's Disease
  • ADHD Adult
  • ADHD-Sleep Disorder Related To ADHD
  • Adjustment Disorder
  • Adrenal Disease
  • Adrenal Disease-Cushing's
  • Adrenal Insufficiency-Addison's Disease
  • Adult ADHD (ADD)
  • Agoraphobia
  • AIDS-Acquired Immune Deficiency Syndrome
  • Akathisia
  • Akathisia Medication-induced
  • Alcohol Abuse
  • Alcohol Dependence
  • Alcohol Dependence In Remission
  • Alcohol Use Disorder
  • Alcohol-Flush-Aldehyde Dehydrogenase Deficiency
  • Aldehyde Dehydrogenase Deficiency
  • Alopecia Areata
  • Alopecia Secondary To Childbirth
  • Alopecia Universalis
  • Alopecia-Male Pattern Baldness
  • Alopecia-Medication-induced
  • Alopecia-Telogen Effluvium
  • Alopecia-Traction
  • Alport Syndrome
  • Aluminum Toxicity
  • Alzheimer's
  • Alzheimer's Dementia
  • Amnestic Disorder
  • Amphetamine Abuse
  • Amphetamine Dependence
  • Amphetamine Dependence In Remission
  • Amyloidosis
  • Amyotrophic Lateral Sclerosis
  • Amyotrophic Lateral Sclerosis (ALS)
  • Anemia
  • Aneurysmal Subarachnoid Hemorrhage
  • Angina Pectoris
  • Angina Unstable
  • Ankylosing Spondylitis
  • Anorexia Nervosa
  • Anorgasmia
  • Antisocial Personality Disorder
  • Anxiety Disorder
  • Anxiety Disorder Due To Another Medical Condition
  • Anxiety-Agoraphobia
  • Anxiety-Organic
  • Anxiety-PTSD (Post-traumatic Stress Disorder)
  • Anxiety-Specific Phobia
  • Aortic Aneurysm
  • Appendicitis
  • Appendicitis-Acute, Unspecified
  • Arrhythmia
  • Arsenic Toxicity
  • Arthritis
  • Arthritis-Cervical
  • Arthritis-Osteoarthritis
  • Arthritis-Rheumatoid
  • Asperger's Syndrome
  • Asthma
  • Atonic Seizure
  • Atypical Depression
  • Auditory Hallucinations
  • Auriculotemporal Nerve Syndrome
  • Autoimmune Hepatitis
  • Avitaminosis
  • Avoidant Personality Disorder
  • B12 Deficiency
  • Bacterial Preexisting Heart Conditions
  • Balance-Disequilibrium-Benign Positional Vertigo
  • Balance-Disequilibrium-Cerebellar Disease
  • Balance-Disequilibrium-Friedreich's Ataxia
  • Balance-Disequilibrium-Labyrinthitis-Acute
  • Balance-Disequilibrium-Vertigo-Central
  • Balance-Disequilibrium-Vertigo-Medication-induced
  • Balance-Disequilibrium-Vertigo-Peripheral
  • Balance-Disequilibrium-Vertigo-Toxin-induced
  • Balance-Disequilibrium-Vestibular-Neuritis
  • Balding-Alopecia Areata
  • Balding-Alopecia Secondary To Childbirth
  • Balding-Alopecia Universalis
  • Balding-Alopecia-Male Pattern
  • Balding-Alopecia-Medication-induced
  • Balding-Alopecia-Traction
  • Balding-Telogen Effluvium
  • Barbiturate -use
  • Barbiturate Abuse
  • Barbiturate Dependence
  • Benzodiazepine Abuse
  • Benzodiazepine Dependence
  • Benzodiazepine Dependence In Remission
  • Benzodiazepine Use
  • Bereavement
  • Bile Duct Obstruction
  • Binge Eating Disorder
  • Bipolar
  • Bipolar Disorder
  • Bipolar Irritability
  • Bipolar-Atypical Depression
  • Bipolar-Dissociative Disorder
  • Bipolar-Dissociative Identity Disorder
  • Bipolar-Irritability
  • Bipolar-Kleptomania
  • Bipolar-Pathological Gambling
  • Bipolar-SAD (Seasonal Affective Disorder)
  • Bladder Disorder
  • Bladder Disorder, Unspecified
  • Bladder Disorder-Unspecified
  • Bladder-Incomplete Bladder Emptying
  • Bladder-Incontinence-Unaware
  • Bladder-Incontinence-Urge Incontinence
  • Bladder-Incontinence-Urinary Stress Incontinence
  • Bladder-Urinary Urgency
  • Bleeding Disorder
  • Blood In The Urine
  • Blood-Anemia
  • Blood-Bleeding Disorder
  • Blood-Epistaxis
  • Blood-Hematemesis
  • Blood-Hematochezia
  • Blood-Hematuria
  • Blood-Hemochromatosis
  • Blood-Hemoptysis
  • Blood-Melena
  • Blood-Polycythemia
  • Blood-Sickle Cell Anemia
  • Blood-Thrombocytopenia
  • Body Dysmorphic Disorder
  • Body Fluid Change
  • Borderline Personality Disorder
  • Boron Toxicity
  • Bowel-Constipation
  • Bowel-Diarrhea
  • Bowel-Diverticulitis
  • Bowel-Diverticulosis
  • Bowel-Essential Palatal Tremor
  • Bowel-Food Allergy
  • Bowel-Gastritis
  • Bowel-Gastroenteritis
  • Bowel-Hiatal Hernia
  • Bowel-Lactase Deficiency
  • Bowel-Nutrition-Gluten-Celiac Disease
  • Bowel-Nutrition-Lactose Intolerance
  • Bowel-Nutrition-Malabsorption
  • Bowel-Nutrition-Malnutrition
  • Bowel-Nutrition-Tropical Sprue
  • Bowel-Pain-Abdomen
  • Bowel-Pain-Abdomen-Acute
  • Bowel-Pain-Abdomen-Chronic
  • Bowel-Pain-Abdomen-Infarction
  • Bowel-Pain-Abdomen-Lower
  • Bowel-Pain-Abdomen-Upper
  • Bowel-Pain-Abdomen-Visceral
  • Bowel-Pain-Abdomen-Viscus-Perforation
  • Bowel-Pain-Erosive Esophagitis
  • Bowel-Pain-Heartburn-GERD
  • Bowel-Pain-IBS
  • Bowel-Pain-Obstruction
  • Bowel-Pain-Peritonitis
  • Bowel-Pain-PUD (Peptic Ulcer Disease)
  • Bowel-Pain-Regional Enteritis
  • Bowel-Pain-Ulcer
  • Bowel-Pain-Ulcer-Gastric
  • Bowel-Pain-Ulcer-Small Intestine-Duodenal
  • Bowel-Pain-Ulcer-Zollinger-Ellison Syndrome
  • Brain Dementia-Amnestic Disorder
  • Branchial Neuralgia
  • Bronchiectasis
  • Bronchitis
  • Bruxism (teeth Grinding)
  • Bulimia
  • Caffeine Dependence
  • Caffeine Intoxication
  • Caffeine-induced Sleep Disorder
  • Cancer
  • Cancer-Bladder
  • Cancer-Breast
  • Cancer-Cervical
  • Cancer-Colon
  • Cancer-Esophageal
  • Cancer-Gastrointestinal
  • Cancer-Kidney
  • Cancer-Leukemia
  • Cancer-Leukoplakia
  • Cancer-Lung
  • Cancer-Lymphoma
  • Cancer-Malignant Neoplasm: Mouth, Unspecified
  • Cancer-Medullary Thyroid Carcinoma
  • Cancer-Melanoma
  • Cancer-Mouth
  • Cancer-Multiple Myeloma
  • Cancer-Ovarian
  • Cancer-Pancreatic
  • Cancer-Pituitary
  • Cancer-Prostate
  • Cancer-Renal Cell Carcinoma
  • Cancer-Skin
  • Cancer-Stomach
  • Carbon Monoxide Poisoning
  • Carcinoid
  • Cataract
  • Cerebellar Disease
  • Cervical Spondylosis
  • Charcot-Marie-Tooth Disease
  • Charles Bonnet Syndrome
  • Chlamydia Infection
  • Choledocholithiasis
  • Cholesteatoma
  • Chorea Gravidarum
  • Chronic Daily Headache
  • Chronic Fatigue Syndrome
  • Chronic Kidney Failure (CKD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic Pain
  • Chronic Renal Failure
  • Circadian Rhythm Sleep Disorder
  • Cluster Headache
  • Cocaine Abuse
  • Cocaine Dependence
  • Cocaine Dependence In Remission
  • Coital Cephalgia
  • Coital Cephalgia-dull Type
  • Coital Cephalgia-explosive Type
  • Coital Cephalgia-postural Type
  • Collagen Vascular Disease
  • Conduct Disorder
  • Congestion-Drug-induced
  • Congestive Heart Failure
  • Congestive Heart Failure (CHF)
  • Constipation
  • Conversion Disorder
  • COPD
  • Costochondritis
  • Cranial Nerve Palsy
  • Creutzfeldt-Jakob
  • Creutzfeldt-Jakob Disease
  • Crohn's Disease Or Regional Enteritis
  • Cushing's Disease
  • Cystic Fibrosis
  • Cystitis
  • Cystitis, Unspecified
  • Deep Vein Thrombosis
  • Dehydration
  • Delirium
  • Delirium-Aneurysmal Subarachnoid Hemorrhage
  • Delirium-Lewy Body Dementia
  • Delirium-Postconcussion Syndrome
  • Delirium-Traumatic Brain Injury
  • Delusional Disorder
  • Delusional Disorder-erotomanic
  • Delusional Disorder-jealousy
  • Delusional Erotomania
  • Delusional Jealousy
  • Dementia
  • Dementia Amnestic Disorder
  • Dementia NOS
  • Dementia Vascular
  • Dementia-Alzheimers
  • Dental-Poor Fitting Dentures
  • Dental-Poor Hygiene
  • Dependent Personality
  • Depersonalization Disorder
  • Depression
  • Depression-Bereavement
  • Dermatopolymyositis
  • Diabetes Insipidus
  • Diabetes Mellitus
  • Diarrhea
  • Disease Of The Small Intestine, Unspecified
  • Disease Of Anus And Rectum, Unspecified
  • Disease Of Biliary Tract, Unspecified
  • Disease Of Intestine, Unspecified-Colon Proximal
  • Disease Of Intestine, Unspecified-Small Intestine
  • Disease Of Stomach And Duodenum, Unspecified
  • Disease Of The Proximal Colon, Unspecified
  • Disequilibrium-Benign Paroxysmal Positional Vertigo (BPPV)
  • Disequilibrium-Central Vertigo
  • Disequilibrium-Cerebellar Disease
  • Disequilibrium-Friedreich\'s Ataxia
  • Disequilibrium-Labyrinthitis Acute
  • Disequilibrium-Vertigo-Medication-induced
  • Disequilibrium-Vertigo-Peripheral
  • Disequilibrium-Vertigo-Toxin-induced
  • Disequilibrium-Vestibular Neuritis
  • Disorder Of Brain, Unspecified-Brainstem Or Pons
  • Disorder Of Brain, Unspecified-Hemisphere
  • Disorder Of The Brainstem Or Pons, Unspecified
  • Disorder Of The Cerebral Hemisphere, Unspecified
  • Disorder-Body Dysmorphic
  • Disorder-Impulse Control
  • Disorder-Intermittent Explosive
  • Disruptive Behavior Disorder
  • Disruptive-Conduct Disorder
  • Dissociative Disorder
  • Dissociative Identity Disorder
  • Dissociative-Depersonalization Disorder
  • Diuretic-induced Hypokalemia
  • Diverticulitis
  • Diverticulosis
  • Drug Induced Edema
  • Dry Mouth
  • Dyspareunia
  • Dysthymia
  • Early Morning Awakening
  • Eating Disorder
  • Eating Disorder, Medication-induced
  • Eating Disorder-Binge
  • Eating-Anorexia Nervosa
  • Eating-Bulimia
  • Eating-Laxative/Diuretic Abuse
  • Eating-Obesity
  • Eating-Reactive Hyperphagia
  • Eating-Weight Gain-Drug-induced
  • Edema
  • Edema-Drug Induced
  • Electrolytes-Magnesium-Hypomagnesemia
  • Electrolytes-Potassium Deficiency
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Empty
  • Endocrine Disease-Adrenal
  • Endocrine-Adrenal Disease
  • Endocrine-Adrenal Insufficiency-Addison's Disease
  • Endocrine-Adrenal-Cushing's
  • Endocrine-Adrenal-Hyperaldosteronism
  • Endocrine-Carcinoid
  • Endocrine-Diabetes Mellitus
  • Endocrine-Diabetes Mellitus-Hypoglycemia
  • Endocrine-Gout
  • Endocrine-Hyperparathyroidism
  • Endocrine-Hyperparathyroidism - Primary Type
  • Endocrine-Hyperparathyroidism - Tertiary Type
  • Endocrine-Hypogonadism
  • Endocrine-Hypoparathyroidism-reversable
  • Endocrine-Hypopituitarism
  • Endocrine-Hypothyroidism
  • Endocrine-Metabolic Syndrome
  • Endocrine-Pancreatic Disease
  • Endocrine-Pancreatitis
  • Endocrine-Pheochromocytoma
  • Endocrine-Pituitary Adenoma
  • Endocrine-Porphyria Acute Intermittent
  • Endocrine-Thyroid-Hyper
  • Endocrine-Thyroid-Hypo
  • Enuresis
  • Enuresis/Bedwetting
  • Epilepsy-Seizure-Absence (petit Mal)
  • Epistaxis
  • Erectile Dysfunction
  • Erosive Esophagitis
  • Erythema-Drug Induced
  • Essential Palatal Tremor
  • Essential Tremor
  • Estrogen Related Hair Growth
  • Excessive Daytime Sleepiness
  • Exhibitionism
  • Eye-Cataract
  • Eye-Glaucoma
  • Factitious Disorder
  • Fainting
  • Fatigue
  • Fatigue-Chronic Fatigue Syndrome
  • Fatigue-Myasthenia Gravis
  • Female Orgasmic Disorder
  • Female Pattern Baldness
  • Female Sexual Arousal Disorder
  • Fetishism
  • Fibromyalgia
  • Fluid-Dehydration
  • Fluid-Polydipsia Psychogenic
  • Fluid-Polydipsia Secondary
  • Fluid-Weight Change
  • Flush-Aldehyde Dehydrogenase Deficiency
  • Flushing
  • Flushing Of Skin Due To A Spinal Cord Lesion Above T6
  • Flushing Of The Skin
  • Flushing-Drug Induced
  • Flushing-Gustatory Flushing Syndrome
  • Flushing-Harlequin Syndrome
  • Flushing-Mastocytosis
  • Flushing-VIPoma
  • Folic Acid Deficiency
  • Food Allergy
  • Friedreich\'s Ataxia
  • Frotteurism
  • Gallbladder Disease
  • Gallbladder Disease-choledocholithiasis
  • Gastric Or Peptic Ulcer
  • Gastritis
  • Gastroenteritis
  • Gastroesophageal Reflux Disease (GERD)
  • Gender Identity Disorder
  • Generalized Anxiety Disorder
  • Giant Cell Arteritis
  • Gingivitis
  • Glaucoma
  • Glomus Tumor (paraganglioma)
  • Glomus Tumors
  • Gluten-Celiac Disease
  • Gonorrhea
  • Gout
  • Guillain-Barre Syndrome
  • Gustatory Flushing Syndrome
  • Hair-Alopecia-Male Pattern Baldness
  • Hair-Balding-Alopecia Areata
  • Hair-Balding-Alopecia Medication-induced
  • Hair-Balding-Alopecia Secondary To Childbirth
  • Hair-Balding-Alopecia Universalis
  • Hair-Balding-Alopecia-Telogen Effluvim
  • Hair-Balding-Alopecia-Traction
  • Hair-Estrogen Related Hair Growth
  • Hair-Female Pattern Baldness
  • Hair-Tinea Capitis
  • Hair-Trichotillomania
  • Hallucination
  • Hallucination-Gustatory
  • Hallucinations
  • Harlequin Syndrome
  • Head Trauma
  • Head-Trauma To Scalp
  • Headache
  • Headache-Chronic Daily Headache
  • Headache-Cluster Headache
  • Headache-coital Cephalgia
  • Headache-Coital Cephalgia -dull Type
  • Headache-Coital Cephalgia -explosive Type
  • Headache-Coital Cephalgia -postural Type
  • Headache-Hemicrania Continua
  • Headache-Medication Overuse
  • Headache-Migraine
  • Headache-Migraine Probable
  • Headache-Migraine Status
  • Headache-Migraine With Aura
  • Headache-Migraine Without Aura
  • Headache-Migraine-Retinal
  • Headache-Psychogenic
  • Headache-sinus
  • Headache-Tension
  • Hearing
  • Hearing Problem
  • Hearing-Medication-induced Loss
  • Hearing-Meniere's Disease
  • Hearing-Tinnitus
  • Hearing-Traumatic Tinnitus
  • Heart Cardiac
  • Heart Disease
  • Heart-Angina
  • Heart-Angina - Emergency
  • Heart-Arrhythmia
  • Heart-Bacterial Endocarditis
  • Heart-CHF
  • Heart-Claudication-Intermittent
  • Heart-claudication-Neurogenic
  • Heart-HCM
  • Heart-MI
  • Heart-Mitral Stenosis
  • Heart-Pericarditis
  • Heavy Smoker
  • Heavy Tobacco Smoker
  • Hematemesis
  • Hematochezia
  • Hematuria
  • Hemicrania Continua
  • Hemochromatosis
  • Hemoptysis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • Hepatitis G
  • Hepatolenticular Degeneration-Wilson's Disease
  • Heroin Abuse
  • Heroin Dependence
  • Heroin Dependence In Remission
  • Hiatal Hernia
  • Hip Pain
  • Histrionic Personality
  • HIV Infection
  • Homicide
  • Huntington's Disease
  • Hyperaldosteronism
  • Hypercalcemia
  • Hypercholesterolemia
  • Hyperhidrosis-Idiopathic
  • Hyperparathyroidism
  • Hyperparathyroidism - Primary Type
  • Hyperparathyroidism - Tertiary Type
  • Hyperprolactinemia
  • Hypersomnia
  • Hypertension
  • Hyperthyroidism
  • Hypertriglyceridemia
  • Hypertrophic Cardiomyopathy
  • Hypoactive Sexual Desire
  • Hypoactive Sexual Desire Disorder
  • Hypochondriasis
  • Hypoglycemia
  • Hypogonadism
  • Hypokalemia
  • Hypokalemia
  • Hypokalemia-Diuretic-induced
  • Hypomagnesemia
  • Hypoparathyroidism
  • Hypoparathyroidism-reversable
  • Hypopituitarism
  • Hypothyroidism
  • Hypothyroidism
  • Idiopathic Hyperhidrosis
  • Impulse Control Disorder
  • Incomplete Bladder Emptying
  • Incontinence-stress Type
  • Incontinence-unaware Type
  • Incontinence-Urge
  • Incontinence-urge Type
  • Increased Intracranial Pressure
  • Infection-AIDS
  • Infection-Creutzfeldt-Jakob
  • Infection-Gonorrhea
  • Infection-HIV
  • Infection-Lyme Disease
  • Infection-Malaria
  • Infection-Rheumatic Fever
  • Infection-Syphilis
  • Infection-Urinary Schistosomiasis
  • Infection-Viral Infection
  • Inferior Temporal Lobe Seizure
  • Inflammatory Disease Of Uterus, Unspecified
  • Inhalant Abuse
  • Inhalant Dependence In Remission
  • Initial Insomnia
  • Insomnia
  • Insomnial-Early Morning Awakening
  • Intermittent Claudication
  • Intermittent Explosive Disorder
  • Intracranial Pressure - Increased
  • Involuntary Emotional Expression Disorder (IEED)
  • Iron Deficiency
  • Irritable Bowel Syndrome (IBS)
  • Kidney Disease
  • Kidney Stone
  • Kidney-Alport Syndrome
  • Kidney-Chronic Renal Failure
  • Kidney-Diabetes Insipidus
  • Kidney-Pyelonephritis
  • Kidney-Renal Failure
  • Kidney-Renal-Failure-Acute
  • Kidney-Uremia
  • Kleine-Levin Syndrome
  • Kleptomania
  • Knee Pain
  • Labyrinthitis Acute
  • Lactase Deficiency
  • Lactose Intolerance
  • Laxative/Diuretic Abuse
  • Lead Toxicity
  • Learning Disorder
  • Leukoplakia
  • Lewy Body Dementia
  • Liver Cirrhosis
  • Liver Disease
  • Liver Disease - Cirrhosis
  • Liver Disease-autoimmune Hepatitis
  • Liver-Cirrhosis-billary
  • Liver-Common Bile Duct Obstruction
  • Liver-Hepatitis B
  • Liver-Hepatitis C
  • Liver-Hepatitis D
  • Liver-Hepatitis E
  • Liver-Hepatitis G
  • Liver-Hepatolenticular Degeneration-Wilson's Disease
  • Liver-Viral Hepatitis
  • LSD Abuse
  • LSD Dependence
  • LSD Dependence In Remission
  • Lung-Asthma
  • Lung-Bronchiectasis
  • Lung-Bronchitis
  • Lung-COPD
  • Lung-Pleurisy
  • Lung-Pneumonia
  • Lung-Pulmonary Embolism
  • Lung-TB
  • Lupus Erythematosus
  • Lupus Erythematosus-Drug Induced
  • Lyme Disease
  • Magnesium-Hypomagnesemia
  • Malabsorption
  • Malaria
  • Male Orgasmic Disorder
  • Malignant Neoplasm Of Mouth, Unspecified
  • Malnutrition
  • Malnutrition-Gluten-Celiac Disease
  • Manganese Toxicity
  • Marijuana Abuse
  • Marijuana Dependence
  • Marijuana Dependence In Remission
  • Mastocytosis
  • Medication Overuse Headache
  • Medication-induced Eating Disorder
  • Medication-induced Erythema
  • Medication-induced Flushing
  • Medication-induced Hearing Loss
  • Meiges Syndrome
  • Melena
  • Meniere's Disease
  • Menopause
  • Menopause-Drug Induced
  • Menopause-early
  • Menopause-Perimenopause
  • Menopause-Postmenstrual Duress
  • Menopause-surgical
  • Mental Retardation
  • Meprobamate Abuse
  • Meprobamate Dependence
  • Meprobamate Dependence In Remission
  • Meprobamate Use
  • Mercury Toxicity
  • Mescaline Abuse
  • Mescaline Dependence
  • Mescaline Dependence In Remission
  • Metabolic Syndrome
  • Metal Toxicity-Aluminum
  • Metal-Aluminum
  • Metal-Arsenic
  • Metal-Boron
  • Metal-Lead
  • Metal-Mercury
  • Metal-Selenium
  • Metal-Tellurium
  • Metal-Zinc
  • Middle Insomnia
  • Migraine Headache
  • Migraine Headache-probable
  • Migraine Headache-retinal
  • Migraine Headache-status
  • Migraine Headache-with Aura
  • Migraine Headache-without Aura
  • Mitral Valve Stenosis
  • Movement Disorder
  • Movement-Akathisia-Neuroleptic-induced
  • Movement-ALS
  • Movement-Chorea Gravidarum
  • Movement-CTD-Polymyalgia Rheumatica
  • Movement-Dermatopolymyositis
  • Movement-Essential Tremor
  • Movement-Guillain-Barre Syndrome
  • Movement-Huntington's
  • Movement-Myoclonus
  • Movement-Parkinson's
  • Movement-Parkinsonism
  • Movement-Tardive Dyskinesia
  • Movement-Tic Disorder
  • Movement-Tourette's Disorder
  • Movement-Transient Tic Disorder
  • Multiple Sclerosis
  • Myasthenia Gravis
  • Myocardial Infarction
  • Myoclonic Seizure
  • Myoclonus
  • Narcissistic Personality
  • Narcolepsy
  • Nasal Congestion-Rebound Congestion
  • Neurodermatitis
  • Neurofibromatosis
  • Neurofibromatosis-I
  • Neurofibromatosis-II
  • Neurogenic Claudication
  • Neuroleptic Malignant Syndrome
  • Neuropathies
  • Night Eating Syndrome
  • Night Sweats
  • Nightmare Disorder
  • Nocturia
  • Nonadherence
  • Nonne-Milroy's Disease
  • Nose Bleed
  • Nutrition-Iron Deficiency
  • Nutrition-Lactose Intolerance
  • Nutrition-Malabsorption
  • Nutrition-Malnutrition
  • Nutrition-Thiamine B1 Deficiency
  • Nutrition-Tropical Sprue
  • Nutrition-Vitamin-Avitaminosis
  • Nutrition-Vitamin-B12 Deficiency
  • Nutrition-Vitamin-B5-Pantothenic Acid Deficiency
  • Nutrition-Vitamin-B6-Pyridoxine Deficiency
  • Nutrition-Vitamin-B9-Folic Acid Deficiency
  • Nutrition-Vitamin-D Deficiency
  • Obesity
  • Obsessive-compulsive Disorder (OCD)
  • Obstruction Intestinal
  • Obstruction-Common Bile Duct
  • OCD
  • OCD Personality
  • OCD-medication Induced
  • Olfactory Hallucinations
  • Opioid Abuse
  • Opioid Dependence
  • Opioid Dependence In Remission
  • Optic Neuritis
  • Oral Cancer
  • Oral Facial Dystonia
  • Oral-Dry Mouth
  • Oral-Gingivitis
  • Orgasmic Disorder
  • Orgasmic Disorder-Female
  • Orgasmic Disorder-males
  • Orthostasis
  • Osteoporosis
  • Other And Unspecified Lesions Of Oral Mucosa
  • Overactive Bladder
  • Pain Abdominal Chronic
  • Pain Abdominal Infarction
  • Pain Disorder
  • Pain Disorder Due To Anatomical And Psychological Conditions
  • Pain Disorder-Psychiatric
  • Pain Disorder-Psychological & General
  • Pain-Abdomen-Acute
  • Pain-Abdominal
  • Pain-Abdominal-Localized To The Lower Abdomen
  • Pain-Abdominal-Localized To Upper Abdomen
  • Pain-Abdominal-Perforation Of Viscus
  • Pain-Abdominal-Visceral
  • Pain-Bowel-Obstruction
  • Pain-Branchial Neuralgia
  • Pain-Chronic Pain
  • Pain-Costochondritis
  • Pain-Erosive Esophagitis
  • Pain-Gastric Ulcer
  • Pain-Heartburn-Gastroesophageal Reflux Disease
  • Pain-Hip
  • Pain-Irritable Bowel Syndrome (IBS)
  • Pain-Peptic Ulcer Disease (PUD)
  • Pain-Peritonitis
  • Pain-Thalamic Central Pain Syndrome
  • Pain-Ulcer
  • Pain-Ulcer-Duodenal
  • Pain-Ulcer-Zollinger-Ellison Syndrome
  • Pancreatic Disease
  • Pancreatic Disease Unspecified
  • Pancreatitis
  • Panic Attacks
  • Panic Disorder
  • Pantothenic Acid Deficiency
  • Paranoid Personality
  • Paraphilia
  • Parkinson's Disease
  • Partial Seizure
  • Partial Seizures
  • Partialism
  • Pathological Gambling
  • Pathological Gambling-medication Induced
  • PCP Dependence
  • PCP Dependence In Remission
  • Pedophilia
  • Pedophilia Exclusive
  • Pedophilia Limited To Incest
  • Pelvic And Perineal Pain
  • Pelvic Inflammatory Disease
  • Pelvic Inflammatory Disease (PID)
  • Perforation Of Viscus
  • Pericarditis
  • Perimenopause
  • Periodic Limb Movement Disorder
  • Peripheral Neuropathy
  • Peripheral Vascular Disease
  • Peripheral Vascular Disease (PVD)
  • Peritonitis
  • Personality Avoidant
  • Personality Disorder
  • Personality-Antisocial
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  • Dyspareunia

    Dyspareunia, or  painful intercourse  is a condition involving persistent or recurrent genital pain that occurs just before, during or after intercourse and that causes personal distress.  Dyspareunia can also lead to tightening of the vaginal muscles on penetration called vaginismus, and this is often extremely painful and often makes penetration physically impossible, adding to the problem.

    Dyspareunia is reported almost exclusively by women, and most women with dyspareunia complain of superficial pain, which occurs upon penetration; never-the-less, dyspareunia can also occur in men. Painful intercourse is reported in community-based studies in 8–23% of the female population. A recent Swedish survey of women suggested that dyspareunia occurs in 9.3% of females, with the incidence being higher among the young and the sexually inexperienced and relatively lower among females over age 50. Women who have co-existent nervousness and depression have a greater likelihood of dyspareunia.

    Elements Needed for Comfortable Intercourse

    The three elements necessary for comfortable intercourse for a women include vaginal lubrication, vaginal expansion, and relaxation of the pelvic floor muscles.

    Vaginal Lubrication

    Normally, in response to sexual arousal, the vaginal walls produce the majority of vaginal lubrication used for friction reduction.

    Without vaginal lubrication the resultant vaginal dryness leads to pain during vaginal penetration ( dyspareunia).  Approximately 20% of women experience lubrication difficulties.

    Vaginal Expansion

    During sexual arousal the vagina increases in length by about 35-40% and expands in width at the upper end by about 6 cm. In a in the non-aroused state, the vaginal walls resemble a collapsed tube of toothpaste. So, the vaginal wall can be tight enough to hold a pencil, or  during sexual arousal the vagina "tents" out, and during childbirth it is wide enough to accommodate a baby's head.

    Pelvic Floor Relaxation

    The “pelvic floor” refers to a group of muscles, ligaments, and connective tissue that attach to the front, back, and sides of the pelvic bone and sacrum at the bottom of the spine. Like a sling, these muscles support the organs in the pelvis, including the bladder, uterus (prostate in men), and rectum. They also wrap around your urethra, rectum, and vagina (in women).

    The pelvic floor has a quadruple function that includes keeping the pelvic organs in their normal anatomical position, maintaining the gravid uterus in place and allowing birth (parturition), and insuring that the urethra, vagina and rectum are kept closed when not in use.

    In Addition, the pelvic floor muscles are important in the arousal phase of a woman's sexual cycle. Pelvic floor muscle activity during the arousal phase stimulates increased blood flow and swelling of the clitoris. also, the pelvic floor relaxes to allow for painless sexual intercourse. If the pelvic floor muscles do NOT relax, especially during penetration, then pain results.  Contrastingly , women who have weak pelvic floor musculature may have difficulties in achieving orgasm.

    The elements necessary for comfortable intercourse for a man include swelling of the testicles, tightening of the scrotum, secretion of a lubricating liquid, followed by the testicles being drawn up into the scrotum, and rhythmic contractions of the muscles at the base of the penis result in the ejaculation of semen.

    Studies have shown that the great majority of women and men, provided they are in good enough health and have an adequate partner, remain sexually interested and active until the end of life

    Causes of Dyspareunia

    Dyspareunia occurs for a variety of reasons including structural, medical, and psychological problems.  

    Anatomical  Causes of Dyspareunia

    Hymenal Remnants

    In women, common anatomic conditions leading to dyspareunia include hymenal remnants, which can limit the opening of the vagina.

         

    Vulvar Vestibulitis

    Vulvar vestibulitis is a condition of unknown cause, characterized by pain and burning in specific sites on the vulva. The pain is most noticeable during intercourse and is very consistent, both in character and location. The pain and tenderness is distributed in a U-shaped pattern around the opening of the vagina (introitus) and includes the hymeneal remnants and up to 1 cm of skin exterior to the hymen.  Some women with vestibulitis report they have always felt this type of discomfort during intercourse. Others seem to have acquired the condition, and they have painless intercourse initially, and later develop the painful intercourse characteristic of vulvar vestibulitis.

     

    Septate Vagina

    A septate vagina is a vagina with a congenital wall or band of tissue that divides it vertically and in some cases horizontally that creates create a double vagina.

    Vaginismus

    Vaginismus, defined as involuntary recurrent or persistent involuntary spasms of the pelvic floor musculature (located in the the outer third of the vagina),  interferes with vaginal penetration and produces pain and causes psychological distress. If a woman anticipates that the insertion of anything into the vagina will be uncomfortable, then this anticipation induces the involuntary muscle spasm of the pelvic floor.  

    Some women exhibit involuntary muscle spasm (vaginismus) at the first attempt to insert anything in the vagina, a condition known as "primary vaginismus."  Vaginismus then, usually develops as a conditioned response to any subsequent attempt at vaginal penetration, and this muscle spasm reoccurs with each attempt at inserting anything in the vagina. Obviously, if vaginismus is present, then intercourse will be painful and will also cause further psychological distress. "Secondary vaginismus" occurs when other causes of dyspareunia go untreated and once pleasurable intercourse becomes painful. 

     

    Vaginismus has been reported from sex therapy clinical studies to be the exclusive cause of dyspareunia in 12–17% of women with dyspareunia. In addition,  vaginismus is a primary problem in more than 55% of patients presenting with a symptom of dyspareunia.

     

    Medical Causes of Dyspareunia

    Medical causes for dyspareunia include infections of the vagina, lower urinary tract, cervix, or fallopian tubes; endometriosis; surgical scar tissue from episiotomy or other previous obstetric or gynecologic trauma to the vagina; menopausal or radiation-induced atrophy; inflammation of the urinary tract, rectum, or vagina; ovarian cysts; pelvic tumors; or fixation of pelvic tissues. Also, women are often unaware of chronic constipation can be the primary source of their discomfort.

    Psychological Dyspareunia

    Unfortunately, symptoms are often not only physiologically (structural or medical) based but also psychologically based or some combination of the two. Intrapsychic issues are the main contributing factor in approximately 43% of people presenting with dyspareunia. Components of fear or anxiety about sex and intimacy problems are often paramount. Studies show that interpersonal conflict is the primary contributing factor in about 27% of cases of dyspareunia. These conflicted relationships are characterized by poor communication including special difficulty talking about sex and emotions. Psychologic pressure to "perform" sexually is often present, especially when sexual intercourse is the primary or only source of sexual pleasure making orgasm a measure of intimacy for one or both partners.

    Dyspareunia Risk Factors

    People who are sexually inexperienced (particularly if their partners are also inexperienced) and females who are peri- or post-menopausal are more likely to experienced dyspareunia. In addition, "psychological dyspareunia", including that associated with lack of desire, or that associated with prior or ongoing sexual or domestic violence can cause the external portions of the genitalia to become uncomfortable sensitive. Additionally, this type of abuse can cause pain with arousal, at initial penetration, at the mid-vaginal depth, with deep penetration, with orgasm, and pain AFTER intercouse.

    If you are suffering from dyspareunia, then see your healthcare provider or a Family Practice, Internal Medicine, Urologist, or Psychiatrist that specializes in sexual disorders.

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