Dyspareunia medical therapy
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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]
Overview
The mainstay of treatment for dyspareunia is the treatment of the underlying cause.
Medical Therapy
Dyspareunia is treated by taking the following steps:[1]
- 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.
- Medical treatment depends on the cause of dyspareunia. for example:
- if vaginal dryness is the problem, prescribing very large amounts of water-soluble sexual or surgical lubricant during intercourse or increased clitoral stimulation before intercourse to ease penetration. 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.
- For vaginal yeast infections, you will be given antifungal medication. Antibiotics will be prescribed for urinary tract infections or sexually transmitted diseases. To relieve painful inflammation, try sitz baths, which are warm-water baths in a sitting position.
- For atrophic vaginitis, estrogen therapy will be prescribed, either as a vaginal formulation or as a pill.
- For skin diseases affecting the vaginal area, the treatment will vary depending on the disease. For example, lichen sclerosis and lichen planus often improve with steroid creams.
- For vulvar vestibulitis, typical therapies include topical estrogen cream, low-dose pain medications, and physical therapy with biofeedback to lower the muscle tension in the pelvic floor.
- If endometriosis may be prescribed medication or may need surgical procedures to control or remove abnormal growths of uterine tissue.
- For dyspareunia that has no apparent physical cause or has lasted for months or years, may need psychological counseling to address stress or anxiety regarding sexual intercourse. If a medical cause is successfully treated and pain has not been resolved yet, a diagnosis of vulvodynia or genito-pelvic/penetration disorder is appropriate.
- Non-Medical treatment: Education about vulvar self-care, including avoidance of douch-es, possible irritants, and allergens, is an important first step for practitioners [8]. Knowledge of genital anatomy and the female sexual response cycle may also be beneficial to facilitate a greater understanding of what to expect from sexual encounters and to reduce anxiety. Psychological intervention, often in the form of CBT, aims to explore a woman’s thoughts, emotions, behaviors, and relationship dynamics associated with the experience of her sexual pain.
The medical treatment of dyspareunia in men depends upon the cause.
- If the discomfort is caused by an allergic reaction to a particular brand of condom or spermicide, anti-allergic medication might be prescribed so that the condition subsides and suggest to use a different brand
- If the pain is caused by the partner’s intrauterine contraceptive device that protrudes from her cervix, her doctor can trim its threads so that they do not protrude far through the cervix
- If it is caused by an infection, antibiotics might be prescribed for both patient and his partner or may refer you to an STD specialist
- If no physical cause is found to be causing the pain, refer the patient to a sex therapist, and a counselor who can help him to work through any psychological problems together with his partner.