The nature of treatment and outcome of dyspareunia depends on the cause of the pain.
Women
- For painful intercourse in women after pregnancy, gentleness and patience should be exercised. Wait at least three weeks after childbirth before resuming sexual relations.
- For painful intercourse in menopausal women, use lubricants and estrogen-containing creams or medications as prescribed.
- For painful intercourse caused by endometriosis, medications can be obtained. Surgery, which might give total relief, may also be an option.
- For painful intercourse due to other complications, disease, or psychological factors, see your health care provider. Vulvar vestibulitis may be very successfully treated with surgical intervention.
Men
- For painful intercourse caused by penile skin infections, use antibiotics as prescribed.
- For painful intercourse caused by herpes, follow your health care provider's advice.
- For painful intercourse caused by prostatitis, sitz baths provide some soothing. Avoid alcohol and caffeine. Antibiotics, as prescribed by the doctor, will help fight infection. Prostatitis and urethritis can be quite successfully treated.
- When no organic cause of the pain can be found, and the cause is suspected to be psychological, sex therapy may prove helpful.
What To Expect
Your medical history will be obtained and a physical examination performed.
Detailed medical history questions documenting difficulty with intercourse may include:
- When did it develop?
- Is intercourse painful every time that it is attempted?
- Has it always been painful?
- Is it painful for your spouse, also?
- Where is the pain? (Labia, vagina, entire pelvic area?)
- What are your attitudes towards sex?
- Does the pain occur during entry?
- Has there been a significant traumatic event in the past (rape, child abuse, or similar)?
- What illnesses, diseases, and disorders are being treated?
- What medications are being taken?
- Has there been a significant emotional event recently?
- What have you done to try to make intercourse less painful?
- How well has it worked?
- What other symptoms are present?
Unless the problem is clearly caused by one person's physical issues, the couple involved should see the doctor together. Physical examination may include a pelvic exam (for women), a prostate exam (for men), and a rectal exam. If a physical problem is suspected, tests will be ordered. Antimicrobial or anti-inflammatory medications may be administered.
Prevention
Good hygiene and routine medical care will help to some extent. Adequate foreplay and stimulation will aid in ensuring proper lubrication of the vagina. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant since it is not water-soluble and may encourage vaginal infections.
Treatment of Vaginismus
Dyspareunia inhibits sexual interest as well as responsiveness. In some situations vaginismus may occur, causing the vaginal muscles to involuntarily contract and clamp down as a self-protective way of avoiding the anticipated discomfort.
The treatment of choice with vaginismus is an extensive therapy program combining education and counseling with behavioral exercises. Exercises include pelvic floor muscle contraction and relaxation (Kegel exercises) to improve voluntary control.
Vaginal dilation exercises are recommended using plastic dilators, and should be done under the direction of a sex therapist or other health care provider. Treatment should involve the partner. This should include gradually more intimate contact culminating in intercourse.
Educational treatment should provide information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.
Prognosis
When treated by a specialist in sex therapy, success rates are usually very high.
Sexual Pain Disorder. Last reviewed 10/24/2006
- Diagnostic and Statistical Manual of Mental Disorders
- Dyspareunia Fact Page
- American Family Physician
- Griffith's 5-Minute Clinical Consult
- Kistner's Gynecology & Women's Health
- National Institutes of Health - National Library of Medicine. Medical management of endometriosis-associated pain
