treatment

Last edited 07/2018 and last reviewed 03/2021

Depends on cause.

Management typically focuses on treating underlying causes where appropriate

Consider other issues which may cause pain:

• bowel problems, such as irritable bowel or colitis,
• bladder problems or fear of incontinence
• musculoskeletal conditions - advice on
• different coital positions
• regarding the timing of analgesics or the use of cushions may be useful

A penetration desensitisation programme is useful in dyspareunia and vaginismus

• encourage the patient to insert one finger, then two, and then three into her vagina, while relaxing the lower muscles
• clear instructions and regular follow up are important

Psychological therapy may be useful in some patients.

• sensitive assessment and exploration of the woman's fears and thoughts is important
• issues connected with the birth of the child may be discussed with a counsellor
• encourage the patient to talk to her partner and resolve any relationship difficulties they might have or refer them to a couples counsellor
• if psychosexual problems persist refer her to a psychosexual therapist
• patients partner should be involved at this stage (if not already seen them together)

Surgical treatment methods include:

• Fenton’s procedure - increase the dimensions of the introitus
• intramuscular injection of botulinum toxin
• surgical decompression of the pudendal nerve (3)

Reference:

• (1) Ryan L, Hawton K. Female dyspareunia. BMJ. 2004;328(7452):1357
• (2) Denman M. Investigating dyspareunia. GPonline 2012.
• (3) Fischer G et al. Vulvovaginal pain and dyspareunia. Part 2: Multidisciplinary  management.  MedicineToday. 2014; 15(8): 43-50