DYSPAREUNIA (PAIN WITH INTERCOURSE)
PROBLEM
As many as 60% of women complain of pain with sexual intercourse, also known as dyspareunia. Pain may occur with insertion of and/or with deep penetration of the penis into the vagina.
CAUSES
There are physical causes, such as episiotomy scars; a short vagina, infections, and endometriosis; musculoskeletal causes, such as disk problems; vaginal dryness caused by hormonal causes such as the lack of estrogen in menopause; and/or not being aroused before sex, lack of foreplay, and poor communication with partners. Fear may also be a cause of pain; having a prior painful experience of having sex may interfere with being able to relax during intercourse.
PREVENTION AND TREATMENT PLANS
A.Inadequate lubrication:
1.More prolonged foreplay increases natural vaginal lubrication.
2.Use a vaginal lubricant such as Replens, K-Y jelly, Silk-E, or Astroglide prior to intercourse. Crisco oil is also a hydrogenated vegetable oil that is solid at room temperature and can be used effectively by applying this to the posterior vaginal area prior to intercourse to help prevent pain. Place a small amount of Crisco oil in a decorative jar next to the bedside for use.
3.Use a moisturizer gel with lactic acid on a regular basis to decrease vaginal dryness and pain with intercourse. Luvena is a vaginal moisturizer and lubricant that can help to improve symptoms.
4.Do not use Vaseline as a lubricant.
5.Do not use contraceptive creams for lubrication; they often cause dryness (dehydration) and may worsen soreness.
B.Pain on insertion of penis:
1.Try different positions that give you more control.
2.Guide the penis for insertion.
3.If menopausal, you may be prescribed estrogen cream to use on an intermittent basis.
C.Pain with deep penetration:
1.Use a side-lying position during intercourse; this may be more comfortable so that deep penetration is limited.
2.You may need to be referred to a gynecologist for further treatment and/or surgery if you have any masses or scar tissue noted on a physical examination.
D.If you have or suspect an infection:
1.Inform your provider.
2.A culture will be done.
3.Antibiotics will be prescribed for you and possibly your partner(s).
4.Refrain from sexual intercourse until all medications are gone (unless otherwise instructed).
E.If you have a very narrow vaginal opening, you may need to be evaluated for use of vaginal dilators.
F.Spasm of the muscles upon touching the vaginal area may be treated with medication, relaxation techniques, and Kegel exercises.
G.You and your partner may be referred to a sex counselor.
Medication:
You Have Been Prescribed: ___________________________________________________________
You Need to Take: ___________________________________________________________
You Need to Notify the Office If You Have:
A.No relief of your symptoms after your prescribed treatment.
B.Other: ___________________________________________________________
Phone: ____________________________
PATIENT TEACHING GUIDE