Pain During Intercourse (cont.)
Treatment of Painful Intercourse
Treatment of pain during intercourse depends on the cause.
Introital pain may be treated when the cause is identified.
- Atrophy (thinning of the vaginal walls): Entrance
(introital) pain caused by vaginal atrophy is common among
postmenopausal women who do not take estrogen replacement
medication. Blood flow and lubricating capacity respond directly
to estrogen replacement. The most rapid reversal of vaginal
atrophy occurs when topical estrogen vaginal cream is applied directly to the vagina and its opening. This cream is available by prescription only. Newer non-estrogen products are also now available.
- Urethritis and urethral syndrome:
Irritation of the urethra
and lower bladder can be caused by a lack of estrogen. This may result in urinary burning, frequency, and
hesitancy. In such cases
there may be no evidence of bacterial infection on microscopic
examination of the urine.
In the absence of any chronic inflammation of the urethra, these
symptoms may be caused by these symptoms may be caused by muscle
spasms, anxiety, low estrogen levels, or a combination of these
factors. The doctor may dilate the urethra or may prescribe low-dose
antibiotics. At times,
antidepressants and antispasmodic medications to reduce muscle contractions in the bladder may also be prescribed.
- Inadequate lubrication: Treatment of inadequate lubrication depends on
its specific etiology. One option of treatment includes water-soluble lubricants (for use with
as other types of lubricants may damage wall of the prophylactic). If adequate arousal does not take place, more extensive foreplay might be
helpful in increasing vaginal moisture.
Painful spasms of muscles
at the opening of the vagina may be an involuntary but
appropriate response to painful stimuli. These spasms may be due
to several factors, including painful intromission, previous
painful sexual experiences, prior sexual abuse, or an unresolved
conflict regarding sexuality. For a woman with vaginismus, her
doctor may recommend behavior therapy, including vaginal
- Vaginal strictures (abnormal narrowing): Doctors commonly see vaginal strictures
following pelvic surgery, pelvic
menopause. Passive dilation and estrogen are used to treat these strictures.
Occasionally, vaginal reconstructive surgery is necessary.
- Interstitial cystitis:
This condition refers to
chronic inflammation of the bladder with no known cause.
intercourse is a common symptom. A physician may perform a
cystoscopy (a procedure to look inside the bladder) and distend
(stretch) the bladder wall in order to attempt treatment of the
condition. Other treatments include bladder washings with
dimethyl sulfoxide (DMSO),
as well as oral medications, e.g.
imipramine (Tofranil) or pentosan (Elmiron).
Endometriosis occurs when the lining of the uterus is found
in ectopic locations outside the interior of the uterus. Pain during intercourse caused by
seen frequently. Relief of this pain often indicates success in treating endometriosis.
- Vulvovaginitis (inflammation of the vulva and vagina): Whether recurrent or chronic, this problem is common despite the rise in the number of over-the-counter treatments.
- If not responsive to self-treatment with lubricating gels or initial treatment by a
physician, a woman may need a more thorough evaluation to identify the cause.
- A physician may ask a woman if she is using an antibiotic or antifungal medication or if she douches. If so, these practices should be stopped to help determine whether a specific disease-causing organism is present.
Instruction in proper vaginal hygiene may be helpful.
- Treatment is based on the presence of bacteria or other organisms. Often, no single organism is identified. The doctor may talk to the woman about proper hygiene.
- If recurring symptoms are shared with a sexual partner, both individuals should be tested for
sexually transmitted diseases (STDs).
- A physician should consider the possibility of intermittent urethral infection with
STD), as well as
the more common
urinary tract infection.
If either is discovered, they should be treated with the
- Pelvic adhesions (tissue that has become stuck together, sometimes developing after surgery): Pain with intercourse caused by pelvic adhesions can be relieved by removing
or cutting free the adhesions.
- Uterine retroversion:
to the causes previously discussed, the patient may also
have what is called uterine retroversion as a cause of
their pain. This
term refers to a uterus which is tilted backward in the
pelvis, as opposed to the normally forward tilted
can be congenital or due to childbirth injury to the
ligaments supporting the uterus. It may also be due to pelvic adhesions which pull
the uterus backward into an abnormal location.This condition frequently requires gynecologic
surgery for correction.
With an adequate
history, physical examination, and laboratory testing, the
doctor should be able to pinpoint the cause of dyspareunia.This will allow for the development of a plan of action
that will afford the best possibility of resolution of the
pelvic pain syndrome.
Medically Reviewed by a Doctor on 2/16/2016
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