Treatment options vary, depending on the underlying cause of the pain.
If an infection or medical condition contributes to your pain, treating the underlying cause may resolve your problem. Changing medications known to cause lubrication problems also may eliminate your symptoms.
For most postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to your vagina.
The drug ospemifene (Osphena) was recently approved by the Food and Drug Administration to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining, but doesn't seem to have estrogen's potentially harmful effects on the breasts or the lining of the uterus (endometrium). Drawbacks are that the drug is expensive, it may cause hot flashes, and it has a potential risk of stroke and blood clots.
Different types of therapy may be helpful, including:
Jan. 24, 2015
- Desensitization therapy. During this therapy, you learn vaginal relaxation exercises that can decrease pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse.
Counseling or sex therapy. If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.
Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.
- Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Dec. 6, 2014.
- Ebert MH, et al. Current Diagnosis & Treatment: Psychiatry. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=10. Accessed Dec. 8, 2014.
- Stewart EG. Differential diagnosis of sexual pain in women. http://www.uptodate.com/home/. Accessed Dec. 8, 2014.
- Lenz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.clinickey.com. Accessed Dec. 6, 2014.
- Dyspareunia. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gynecology_and_obstetrics/sexual_dysfunction_in_women/dyspareunia.html?qt=dyspareunia&alt=sh. Accessed Dec. 8, 2014.
- Bachmann G, et al. Treatment of vaginal atrophy. http://www.uptodate.com/home/. Accessed Dec. 8, 2014.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 9, 2014.