Painful Sexual Intercourse (Dyspareunia)

Prevention

Although some causes of dyspareunia, such as a history of sexual abuse or trauma, can't be avoided, other causes can be prevented:

• To decrease your risk of yeast infection, avoid tight clothing, wear cotton underpants and practice good hygiene. Change your underclothes after prolonged sweating. Bathe or shower daily, and change into dry clothing promptly after swimming.

• To avoid bladder infections, wipe from front to back after using the toilet, and urinate after sexual intercourse.

• To avoid sexually transmitted diseases, avoid sex or practice safe sex by maintaining a relationship with just one person, or using condoms to protect against sexually transmitted diseases.

• To prevent vaginal dryness, use a lubricant, or seek treatment if the dryness is due to atrophic vaginitis.

• If you have endometriosis, avoid very deep penetration, or have sex during the week or two after menstruation (before ovulation), when the condition tends to be less painful.

Treatment

Treatment depends on the cause of dyspareunia:

• If vaginal dryness is the problem, you can ease penetration and sexual intercourse with increased clitoral stimulation before intercourse or lubrication with an over-the-counter lubricant such as K-Y jelly, Replens or Astroglide.

• For vaginal yeast infections, you will be given antifungal medication.

• Antibiotics will be prescribed for urinary tract infections or sexually transmitted diseases.

• To relieve painful inflammation, try sitz baths, which are warm-water baths in a sitting position.

• For skin diseases affecting the vaginal area, the treatment will vary depending on the disease. For example, lichen sclerosis and lichen planus often improve with steroid creams.

• For vulvar vestibulitis, typical therapies include topical estrogen cream, low-dose pain medications, and physical therapy with biofeedback to lower the muscle tension in the pelvic floor.

• For atrophic vaginitis, estrogen therapy will be prescribed, either as a vaginal formulation or as a pill.

• If endometriosis is causing your dyspareunia, you may be prescribed medication or you may need surgical procedures to control or remove abnormal growths of uterine tissue.

• For dyspareunia that has no apparent physical cause or has lasted for months or years, you may need psychological counseling to address stress or anxiety regarding sexual intercourse.