Dyspareunia medical therapy

Dyspareunia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

Medical Therapy

Dyspareunia is treated by taking the following steps:

• Carefully taking a history.
• Carefully examining the pelvis to duplicate as closely as possible the discomfort and to identify a site or source of the pelvic pain.
• Clearly explaining to the patient what has happened, including identifying the sites and causes of pain.
• Removing the source of pain when possible.
• Prescribing very large amounts of water-soluble sexual or surgical lubricant during intercourse. Discourage petroleum jelly. Moisturizing skin lotion may be recommended as an alternative lubricant, unless the patient is using a condom or other latex product. Lubricant should be liberally applied (2 tablespoons full) to both the phallus and the orifice. A folded bath towel under the receiving partner's hips helps prevent spillage on bedclothes.
• Instructing the receiving partner to take the phallus of the penetrating partner in their hand and control insertion them-self, rather than letting the penetrating partner do it.
• Encouraging the couple to add pleasant, sexually exciting experiences to their regular interactions, such as bathing together (in which the primary goal is not cleanliness), mutual caressing without intercourse, and using sexual books and pictures. In couples where a woman is preparing to receive vaginal intercourse, such activities tend to increase both natural lubrication and vaginal dilation, both of which decrease friction and pain.
• Recommending a change in coital position to one admitting less penetration. In women receiving vaginal penetration, this is recommended for those who have pain on deep penetration because of pelvic injury or disease:
  • In women receiving vaginal penetration: maximum vaginal penetration is achieved when the receiving woman lies on her back with her pelvis rolled up off the bed, compressing her thighs tightly against her chest with her calves over the penetrating partner's shoulders. Minimal penetration occurs when a receiving woman lies on her back with her legs extended flat on the bed and close together while her partner's legs straddle hers.
  • If no penetration is tolerable, the couple may substitute oral sex and masturbation for intercourse.