Dyspareunia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

The mainstay of treatment for dyspareunia is the treatment of the underlying cause. Non-Medical treatment also should be considered. Psychological intervention, often in the form of CBT can be helpful.

The medical treatment of dyspareunia depends upon the cause.^[1]

• 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. Lubricant should be liberally applied (2 tablespoons full) to both the phallus and the orifice.
• Antifungal medication for vaginal yeast infections. Antibiotics will be prescribed for urinary tract infections or sexually transmitted diseases.
• Estrogen therapy for atrophic vaginitis will be prescribed, either as a vaginal formulation or as a pill.
• The treatment will vary depending on skin diseases affecting the vaginal area, . For example, lichen sclerosis and lichen planus often improve with steroid creams.
• Typical therapies include topical estrogen cream, low-dose pain medications, and physical therapy with biofeedback to lower the muscle tension in the pelvic floor for vulvar vestibulitis.
• Medication or surgical procedures may be needed to control or remove abnormal growths of uterine tissue in endometriosis.
• 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.
  

In men
The medical treatment of dyspareunia in men depends upon the cause.

• Anti-allergic medication might be prescribed if there is an allergic reaction to a particular brand of condom or spermicide
• Trim its threads so that they do not protrude far through the cervix if the pain is caused by the partner’s intrauterine contraceptive device that protrudes from the cervix
• Antibiotics might be prescribed if the infection is the cause of dyspareunia for both patient and his partner

Education about vulvar self-care, including avoidance of douch-es, possible irritants, and allergens, is an important first step for practitioners. 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 patient’s thoughts, emotions, behaviors, and relationship dynamics associated with the experience of sexual pain.