From the Guidelines
Treatment for dyspareunia should prioritize a multidimensional approach, addressing underlying physiologic, psychologic, and interpersonal issues, with options including pelvic physical therapy, integrative therapies, and prescription medications such as vaginal estrogen or ospemifene, as recommended by the most recent guidelines 1.
Overview of Dyspareunia Treatment
Dyspareunia, or painful intercourse, is a common issue affecting many individuals, particularly after cancer treatment. The treatment approach should be tailored to the specific cause of dyspareunia, considering both non-pharmacological and pharmacological options.
Non-Pharmacological Approaches
Non-pharmacological treatments include:
- Pelvic floor physical therapy to relax and strengthen pelvic floor muscles, which can help alleviate pain and improve sexual function 1.
- Integrative therapies such as yoga and meditation to address associated symptoms like anxiety that can impact sexual functioning 1.
- Cognitive behavioral therapy (CBT) to improve sexual functioning in breast cancer survivors 1.
- Vaginal moisturizers, gels, and oils to alleviate symptoms such as vaginal dryness and sexual pain 1.
Pharmacological Approaches
Pharmacological options include:
- Topical estrogen therapy to restore vaginal tissue health in postmenopausal women with atrophic vaginitis 1.
- Vaginal androgens (e.g., DHEA) for vaginal dryness or pain with sexual activity, although safety data in survivors of hormonally mediated cancers are limited 1.
- Ospemifene, a selective estrogen receptor modulator, for postmenopausal women without a history of estrogen-dependent cancers 1.
- Topical anesthetics like lidocaine to help with vaginal pain 1.
Multidisciplinary Approach
A multidisciplinary approach, combining several therapies and referrals to specialists if necessary, is often the most effective way to address dyspareunia 1. This approach should prioritize the individual's specific needs and underlying causes of their dyspareunia, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Treatment Options for Dyspareunia
The treatment for dyspareunia is directed at the underlying cause of the condition. Some common treatment options include:
- Pelvic floor physical therapy 2
- Lubricants to address inadequate lubrication 2, 3
- Surgical intervention for certain conditions such as vulvodynia or vaginal atrophy 2
- Vaginal dilatation and pelvic-relaxation exercises to help restore confidence and decrease anxiety 4
- Sex education and counseling to address psychologic factors and negative expectations 4, 5
Addressing Underlying Causes
It is essential to identify the underlying cause of dyspareunia to develop an effective treatment plan. Common diagnoses include:
- Provoked vulvodynia 2
- Inadequate lubrication 2, 3
- Postpartum dyspareunia 2
- Vaginal atrophy 2, 3
- Vaginismus 2, 3
- Endometriosis, pelvic congestion, adhesions or infections, and adnexal pathology 3
- Urethral disorders, cystitis, and interstitial cystitis 3
Importance of Patient-Provider Relationship
A trusting and safe relationship between the patient and provider is crucial in encouraging disclosure and improving outcomes for patients with dyspareunia 6. The provider should take a nonjudgmental approach to taking the patient's history and perform an educational pelvic examination to increase the patient's perception of control and improve self-image 2.