Dyspareunia - Treatment

Treatment

After proper diagnosis involving carefully taking a complete history and examining the pelvis to duplicate as closely as possible the discomfort and to identify a site or source of the pelvic pain, dyspareunia is treated by taking the following steps:

• Clearly explaining to the patient what has happened, including identifying the sites and causes of pain. Making clear that the pain will, in almost all cases, disappear over the time or at least will be greatly reduced. If there is a partner, also explaining to him the causes and treatment and encouraging him to be supportive.
• Removing the source of pain when needed.
• Encouraging the patient to learn about her body, to explore her own anatomy and learn how she likes to be caressed and touched.
• 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), or mutual caressing without intercourse. 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. Prior to intercourse, oral sex may also prove very useful to relax and lubricate the vagina (providing both partners are comfortable with it).
• 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 (two tablespoons full) to both the penis 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 penis of the penetrating partner in their hand and control insertion themselves, rather than letting the penetrating partner do it.
• For those who have pain on deep penetration because of pelvic injury or disease: Recommending a change in coital position to one admitting less penetration. 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. A device has also been described for limiting penetration.

Estrogen treatment is often used in cases of vaginal dryness, usually in post-menopausal women. In certain cases, surgery can also be an option. For example, in the case of vulvar vestibulitis, a study done involving 69 women showed moderate to excellent improvement in 83% of the surgeries, with an additional 7% of the patients obtaining further improvement from repeat surgery.