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Treatments and drugs
By Mayo Clinic staffPainful intercourse used to be viewed primarily as a psychological problem that required psychological treatment. Fortunately, that view is outdated. Researchers and doctors now understand the many causes of dyspareunia and recommend an integrated, multifaceted treatment approach. Your particular treatment depends on the underlying cause of your pain.
Sexual techniques and counseling
You and your partner may be able to minimize pain with a few changes to your sexual routine:
- Switch positions. If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.
- Communicate. Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
- Don't rush to the main event. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
- Use lubricants. A personal lubricant — such as the water-based lubricant System JO or silicone-based lubricant Pink — can make sex more comfortable. For some women, personal lubricants that contain glycerin can promote yeast infections. Read labels carefully or ask your doctor to recommend a product to try.
Medications and therapies
In some cases, medications or therapy are necessary to treat painful intercourse.
- Treating underlying conditions. If an infection or medical condition is contributing to your pain, treating the underlying cause may resolve your problem. Changing medications known to cause lubrication problems also may eliminate your symptoms.
- Estrogen therapy. For most postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with a prescription cream, tablet or flexible vaginal ring.
- 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.
- MacNeill C. Dyspareunia. Obstetrics and Gynecology Clinics of North America. 2006;33:565.
- Stewart EG. Approach to the woman with a sexual pain disorder. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2009.
- Stewart EG. Causes and treatment of sexual pain disorders. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2009.
- Steege JF, et al. Evaluation and treatment of dyspareunia. Obstetrics & Gynecology. 2009;113:1124.
- Ryan L, et al. 10-minute consultation: Female dyspareunia. British Medical Journal. 2004; 328:1357.
- Heim LJ. Evaluation and differential diagnosis of dyspareunia. American Family Physician. 2001;63:1535.
- Chasson S. Female sexual dysfunction. In: Schuiling KD, et al. Women's Gynecologic Health. Sudbury, Mass.: Jones and Bartlett; 2006:343.
- Birnbaum SL. Medical evaluation of female sexual dysfunction. In: Goroll AH, et al. Primary Care Medicine. 5th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=booktext&D=books&AN=00140049/5th_Edition/115&XPATH=/OVIDBOOK%5b1%5d/METADATA%5b1%5d/TBY%5b1%5d/EDITORS%5b1%5d. Accessed Nov. 11, 2009.
- Latthe P, et al. WHO systematic review of prevalence of chronic pelvic pain: A neglected reproductive health morbidity. BioMed Central Public Health. 2006;6:177. http://www.biomedcentral.com/1471-2458/6/177. Accessed Nov. 10, 2009.
- Swanson JB (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 19, 2009.
