Depends on cause.
Management typically focuses on treating underlying causes where appropriate
Consider other issues which may cause pain:
- bowel problems, such as irritable bowel or colitis,
- bladder problems or fear of incontinence
- musculoskeletal conditions - advice on
- different coital positions
- regarding the timing of analgesics or the use of cushions may be useful
A penetration desensitisation programme is useful in dyspareunia and vaginismus
- encourage the patient to insert one finger, then two, and then three into her vagina, while relaxing the lower muscles
- clear instructions and regular follow up are important
Psychological therapy may be useful in some patients.
- sensitive assessment and exploration of the woman's fears and thoughts is important
- issues connected with the birth of the child may be discussed with a counsellor
- encourage the patient to talk to her partner and resolve any relationship difficulties they might have or refer them to a couples counsellor
- if psychosexual problems persist refer her to a psychosexual therapist
- patients partner should be involved at this stage (if not already seen them together)
Surgical treatment methods include:
- Fenton’s procedure - increase the dimensions of the introitus
- intramuscular injection of botulinum toxin
- surgical decompression of the pudendal nerve (3)
Reference: