You Have Multiple Treatment Options for Dyspareunia

Though sex shouldn't hurt, pain during penetration is common. Dyspareunia, the medical term for painful vaginal intercourse, may affect up to 75 percent of women at some point. Left untreated, it often has a negative impact on self-esteem and intimate relationships.

If you're experiencing dyspareunia, talk to your doctor. There are many potential reasons for your pain, from quick-fix issues such as vaginal dryness to chronic conditions such as endometriosis.

Keeping track of exactly when and where the pain occurs may facilitate a speedy, accurate diagnosis.

The importance of a proper diagnosis

Diagnosing dyspareunia is tricky because the term can refer to a diagnosis or a symptom as part of the diagnosis of something else, said Alexander Lin, M.D., a board-certified OB-GYN and the medical director of women's health at Northwestern Medicine in Chicago.

If there is no discernible reason for the pain, the diagnosis is "idiopathic dyspareunia." This means dyspareunia with an unknown cause. Obviously, a doctor needs to understand the problem to treat it, so the outlook is better for dyspareunia cases with an underlying cause.

Of course, pain is complex. Sometimes it's caused by more than one factor.

For example, if you have uterine fibroids, your doctor might attribute your pain to the fibroids. However, if dyspareunia persists after fibroid removal, the doctor must consider additional physical or psychological factors.

Maybe you also have low estrogen or another underlying condition, or perhaps you're experiencing "anticipatory pain," an involuntary tensing of your pelvic muscles, Lin said.

"Ultimately, the underlying cause may still be a socioemotional issue, which may be difficult to uncover and resolve," he said.

Treatment options

Treatment options depend on the cause of your dyspareunia. Pain caused by an underlying condition tends to resolve when that condition is treated, according to Lin.

Medications

If you're experiencing pain because of an infection or medical condition, medication may help.

For instance, painful sex caused by an infection might resolve after a course of antibiotics. Your doctor may also recommend local anesthetics, such as lidocaine, for short-term pain relief.

Low estrogen is a common cause of painful intercourse. Hormonal treatments for dyspareunia include topical estrogen in the form of cream or vaginal inserts. The Food and Drug Administration (FDA) has also approved two drugs—prasterone and ospemifene—for treating dyspareunia in postmenopausal women.

In some instances, patients with overactive pelvic floor muscles have experienced relief after getting botulinum toxin (Botox) injections into those muscles. However, this is not a first-line treatment and is recommended only as a supplement to other therapies.

Other treatments

Medication, obviously, isn't always the answer to solving dyspareunia. Other useful treatments include:

• Desensitization therapy. Retraining your vaginal muscles to relax before, during and after intercourse can relieve some cases of dyspareunia. This is especially true when there is anticipatory pain.
• Physical therapy. Sometimes dyspareunia is caused by pelvic organ prolapse, a condition in which pelvic muscles no longer hold surrounding organs in place, or overactive pelvic floor muscles. "Pelvic physical therapy is a mainstay for treating pelvic floor dysfunction or for patients who have developed anticipatory pain," Lin said.
• Counseling. If you have a history of painful sex, abuse or trauma, talking to a therapist can help reduce anticipatory pain and anxiety related to intercourse. When socioemotional factors are at play, Lin said a multidisciplinary approach that includes mental health support is more likely to be successful.

Home remedies and tips for coping with painful sex

Women experiencing dyspareunia often develop feelings of anxiety, depression and low self-esteem in regard to intimacy. Fortunately, small changes can improve comfort with sex and reduce the chances of genital pain.

For example, you can use lubrication. Some cases of dyspareunia are caused by vaginal dryness. Using a personal lubricant can reduce friction and make sex comfortable again. Alternatively, change positions. In some cases, the pain occurs only with deep penetration. Try having sex in different positions that allow you to control penetration depth or avoid deep thrusting altogether.

Remember that vaginal penetration isn't the only way to be intimate. Try nonpenetrative activities. If you cannot enjoy intercourse without pain, try activities such as kissing, oral sex or massage.

Outlook

Painful sex can be isolating, but letting it continue unchecked only worsens your tension, anxiety or discomfort. Talk to your doctor if you notice pain during penetration, even if it's not a new problem.

Diagnosing and treating dyspareunia takes patience. Sometimes the solution is simple, for example, using lubrication because of postmenopausal dryness. Sometimes treatment requires both medical and psychological support.

But with a thorough evaluation, diagnosis and treatment, most patients do get better, Lin said.

The bottom line: Don't hesitate to talk to your doctor about painful intercourse. The problem might be more common than you think, and the first step to relief is pinpointing the cause.

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