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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 condoms, 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.
  • Vaginismus: 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 relaxation exercises.
  • Vaginal strictures (abnormal narrowing): Doctors commonly see vaginal strictures following pelvic surgery, pelvic irradiation, or 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. However, painful 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: Endometriosis occurs when the lining of the uterus is found in ectopic locations outside the interior of the uterus. Pain during intercourse caused by endometriosis is 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 chlamydia, (an STD), as well as the more common urinary tract infection. If either is discovered, they should be treated with the appropriate antibiotics.
  • 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: In addition 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 orientation. This 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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