From the Guidelines
Treating pelvic pain during orgasm typically requires a multifaceted approach, and the most effective treatment is often pelvic floor physical therapy, which can help alleviate pelvic dysfunction and improve sexual function, as supported by the most recent study 1.
Key Considerations
- Pelvic floor physical therapy is a highly recommended treatment, involving 8-12 weekly sessions with a specialized therapist who can teach relaxation techniques and exercises to reduce muscle tension.
- Vaginal moisturizers or lubricants can be used during intercourse to reduce friction that may contribute to pain.
- Topical prescription medications, such as vaginal estrogen or ospemifene, can be considered for survivors with sexual dysfunction, as they have been shown to be effective in treating vaginal dryness and dyspareunia 1.
Treatment Options
- Pelvic floor physical therapy: 8-12 weekly sessions with a specialized therapist
- Vaginal moisturizers or lubricants: to reduce friction during intercourse
- Topical prescription medications: vaginal estrogen or ospemifene for vaginal dryness and dyspareunia
- Vaginal dilators: may be beneficial for survivors with pain during sexual activity and vaginal stenosis from pelvic radiation
Important Notes
- The safety of vaginal hormones has not been firmly established in survivors of estrogen-dependent cancers, and their use should be approached with caution 1.
- Ospemifene is recommended as an option for dyspareunia in survivors without a history of estrogen-dependent cancers 1.
- A thorough discussion of the risks and benefits of each treatment option should be had with the patient, and a healthcare provider should be consulted for proper diagnosis and personalized treatment recommendations.
From the Research
Treatment Options for Pelvic Pain during Orgasm
- Pelvic floor physical therapy is often the first-line treatment for many musculoskeletal causes of pelvic pain, including pelvic floor myofascial pain, vulvodynia, and nerve injuries 2, 3
- Additional medical management may include neuromodulation in oral or topical form, vaginal muscle relaxants, or pelvic floor botulinum toxin or trigger point injections 2
- Gabapentin has been shown to be effective in treating chronic pelvic pain in women, with significant reductions in pain intensity scores from baseline to 3 and 6 months 4
- Pregabalin has also been compared to gabapentin in the treatment of neuropathic pain, with pregabalin showing superior results in terms of efficacy and safety 5
- However, gabapentin may be more effective than pregabalin in certain cases, such as urological chronic pelvic-pain syndrome 6
Medication Options
- Gabapentin and pregabalin are two medications that have been studied for their effectiveness in treating pelvic pain, with gabapentin showing potential analgesic benefits in patients with neuropathic pain 4
- Pregabalin has been shown to have superior efficacy and safety compared to gabapentin in some studies, with significant improvements in patient-reported outcomes and lower opioid consumption 5
- However, the choice of medication will depend on individual patient needs and medical history, and should be determined in consultation with a healthcare provider 2, 3, 6, 4, 5
Non-Pharmacological Interventions
- Pelvic floor physical therapy is a non-pharmacological intervention that can be effective in treating pelvic pain, with a focus on improving pelvic floor muscle strength, endurance, and relaxation 3
- Other non-pharmacological interventions, such as lifestyle modifications and stress management techniques, may also be helpful in managing pelvic pain 2, 3