From the Guidelines
For pain experienced during orgasm, also known as dysorgasmia, the most effective treatment approach is a multidimensional plan that addresses the underlying issues, which can be physiologic, psychologic, disease- or medication-induced, and interpersonal, as recommended by the NCCN guidelines 1.
Treatment Options
- Pelvic floor physical therapy exercises to strengthen and relax pelvic muscles, which can be done 2-3 times daily for 10-15 minutes each session, have been shown to improve sexual function in survivors of gynecologic cancers 1.
- Over-the-counter pain medications like ibuprofen (400-800 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours) may be taken before sexual activity to reduce pain.
- Topical lidocaine gel (2-5%) applied to the genital area 10-20 minutes before sexual activity can help numb the area and reduce pain, as demonstrated in a study of breast cancer survivors 1.
- Vaginal moisturizers, gels, and oils can help alleviate symptoms such as vaginal dryness and sexual pain, although data on these over-the-counter products are limited 1.
- Cognitive behavioral therapy (CBT) has been shown to be effective at improving sexual functioning in breast cancer survivors 1.
Important Considerations
- The effectiveness of these treatments can vary depending on the underlying cause of the pain, which is why a professional medical evaluation is crucial for developing an appropriate treatment strategy.
- Referrals to specialists (ie, psychotherapy, sexual/couples counseling, gynecologic care, sexual health specialist) should be made if appropriate and available.
- Menopausal hormone therapy can lead to improvements in sexual function for sexual concerns that may be related to menopause (eg, vaginal dryness, discomfort, discharge, pain) 1.
From the Research
Treatment for Dysorgasmia
The treatment for dysorgasmia, or painful orgasm, may involve a multidisciplinary approach, including physical therapy, medical assessment, and psychological therapy 2.
- Pelvic floor physical therapy can potentially improve the treatment of various male sexual dysfunctions, including erectile dysfunction and dysfunction of ejaculation and orgasm 3.
- Physiotherapy management can resolve pain associated with dysorgasmia, while medical assessment is important to rule out potential pathologies and facilitate multidisciplinary management 2.
- Psychological therapy, such as sex therapy, can be integral in improving sexual outcomes for patients with dysorgasmia and their partners 2.
- Interventions targeting pelvic floor myalgia and central nervous system sensitization may help alleviate pain worsened by orgasm in patients with endometriosis 4.
Associated Factors
Dysorgasmia can be associated with various factors, including:
- Pelvic floor myalgia 4
- Central nervous system sensitization 4
- Endometriosis 4
- Female sexual dysfunction 5
- Erectile dysfunction and ejaculatory/orgasmic dysfunction in men 3
Management
Management of dysorgasmia may involve: