From the Guidelines
For treating female pelvic pain with orgasm, lubricants for all sexual activity or touch, in addition to vaginal moisturizers to improve vulvovaginal tissue quality, may be tried first. This approach is based on the most recent and highest quality study available, which suggests that lubricants and vaginal moisturizers can help alleviate symptoms of vaginal dryness and pain during sexual activity 1.
Some key points to consider when treating female pelvic pain with orgasm include:
- Using vaginal moisturizers at a higher frequency (three to five times per week) in the vagina, at the vaginal opening, and on the external folds of the vulva for symptom relief 1
- Considering low-dose vaginal estrogen for women who do not respond to conservative measures, after a thorough discussion of risks and benefits 1
- Offering lidocaine for persistent introital pain and dyspareunia 1
- Referring patients to a urologist or urogynecologist for further evaluation and treatment of urinary incontinence or to a colorectal surgeon for fecal incontinence 1
- Considering cognitive behavioral therapy and pelvic floor (Kegel) exercises to decrease anxiety and discomfort and lower urinary tract symptoms 1
It's also important to note that the evidence base for interventions to treat female sexual dysfunction in survivors is weak, and high-quality studies are needed 1. However, based on evidence from other populations and consensus among experts, treatment should be guided by the specific type of problem, and may include both over-the-counter and prescription options, as well as pelvic physical therapy and integrative therapies 1.
In terms of specific treatments, vaginal androgens (such as DHEA) can be considered for vaginal dryness or pain with sexual activity, and have been shown to be effective in reducing dyspareunia in postmenopausal women 1. Additionally, pelvic physical therapy (including pelvic floor muscle training) may improve sexual pain, arousal, lubrication, orgasm, and satisfaction 1.
Overall, a comprehensive evaluation and personalized treatment plan should be developed in consultation with a gynecologist or pelvic pain specialist, taking into account the individual's specific needs and medical history.
From the Research
Treatment Options for Female Pelvic Pain with Orgasm
- The treatment of female pelvic pain with orgasm can be complex and may involve a combination of psychological, behavioral, and pharmacological approaches 2, 3, 4, 5, 6.
- Psychological treatment, such as directed masturbation, sensate focus, and psychotherapy, has been shown to be effective in helping women with female orgasmic disorder (FOD) to gain or regain the ability to have orgasms 2.
- For chronic pelvic pain (CPP), a multimodal approach is often recommended, including patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care 3.
- Pharmacologic treatment strategies for CPP may include analgesics, hormonal suppression, anesthetics, antidepressants, membrane stabilizers, and anxiolytics 5.
- Pelvic floor physical therapy is often the first-line treatment for many musculoskeletal causes of pelvic pain, and additional medical management may include neuromodulation, vaginal muscle relaxants, or pelvic floor botulinum toxin or trigger point injections 6.
Approaches to Managing Female Sexual Pain
- Managing female sexual pain, or genito-pelvic pain/penetration disorder (GPPPD), requires a comprehensive approach that addresses the physical, emotional, and psychological aspects of the condition 4.
- Treatment for GPPPD may involve a combination of medical, psychological, and behavioral therapies, including pelvic floor physical therapy, cognitive-behavioral therapy, and pharmacological interventions 4, 6.
- A thorough assessment of the biopsychosocial factors that contribute to pelvic pain is essential for developing an effective treatment plan 3.
Importance of Interdisciplinary Care
- The management of female pelvic pain with orgasm often requires an interdisciplinary approach, involving clinicians from multiple specialties, including gynecology, urology, physical medicine and rehabilitation, and psychology 3, 6.
- Collaboration between healthcare providers and patients is crucial for developing a personalized treatment plan that addresses the unique needs and goals of each individual 3, 6.