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Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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:

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