Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Treatment of pain during intercourse depends on the cause.
Entrance pain may be treated when the cause is identified.
of the vaginal walls): Entrance pain caused by atrophy is common among
postmenopausal women who do not take hormone replacement medication. Blood
flow and lubricating capacity respond directly to hormone replacement. The
most rapid relief of atrophy comes from applying topical estrogen vaginal
cream directly to the vagina and its opening. This cream is available by
Urethritis and urethral syndrome: With this condition, a woman may urinate frequently with urgency, pain, and difficulty, but a urinalysis can find no identifiable bacteria. These symptoms may be caused by chronic inflammation of the urethra (the tube through which urine exits the body) from muscle spasms, anxiety, low estrogen levels, or a combination of these causes. 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 the cause. Options include water-soluble lubricants
(for use with condoms; other types of lubricants may damage condoms) or
other substances such as vegetable oils. If arousal does not take place,
more extensive foreplay might be needed during sexual relations.
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
insertion, previous painful experiences, previous 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 after pelvic surgery, radiation, or menopause. Passive
dilation and estrogen are used to treat these strictures.
Interstitial cystitis: This chronic inflammation of the bladder has no known cause; however, pain with intercourse is a common symptom. A health care provider may perform a cystoscopy (a procedure to look inside the bladder), or a urologist may distend (stretch) the bladder to examine the bladder wall. These procedures often work to clear the condition. Other treatments include bladder washings with dimethyl sulfoxide (DMSO) and prescriptions of imipramine
Endometriosis: Endometriosis occurs when the lining
of the uterus is found outside the uterus. Pain during intercourse caused by
endometriosis is not uncommon. 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 doctor, a woman may need a more
thorough evaluation to identify the cause.
A doctor may ask the woman if she uses antibiotic
or antifungal medication or if she douches. If so, these practices should
be stopped to help determine whether a specific disease-causing organism
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
A doctor considers the possibility of intermittent urethral infection with chlamydia, an STD, as well as a more obvious urinary tract infection, and then treats 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 the adhesions.
Uterine retroversion: The health care provider may find physical causes of the pain, including ovarian cysts, pelvic inflammatory disease, endometriosis (uterine lining tissue out of place), or
retroversion of the uterus (uterus is tilted backward instead of forward).
A doctor should be able to find the cause and to
select proper treatment for pain experienced during intercourse. Sometimes, the
doctor refers the woman to a specialist.