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Dyspareunia

Updated : December 1, 2023





Background

Dyspareunia refers to persistent or recurrent pain experienced during sexual intercourse. It is a medical term that encompasses various types of pain, including genital, pelvic, or deep pelvic pain, which can occur before, during, or after sexual activity.

Dyspareunia can affect both men and women, but it is more commonly reported by women. Emotional factors like anxiety, stress, fear, or a history of sexual trauma can contribute to dyspareunia.

These can include medical conditions such as infections, pelvic inflammatory disease, endometriosis, uterine fibroids, ovarian cysts, or structural abnormalities.

Epidemiology

Dyspareunia is a common issue, but the reported prevalence rates vary. Research suggest that it affects a significant proportion of the population, with estimates ranging from around 8% to 21% of women experiencing pain during intercourse at some point in their lives.

Dyspareunia is often associated with various gynecological conditions. For example, women with endometriosis, pelvic inflammatory disease, or vulvodynia may be more likely to experience pain during intercourse.

Psychological factors, such as anxiety, depression, and a history of sexual trauma, can contribute to dyspareunia. Dyspareunia can have a significant impact on sexual relationships. It may contribute to relationship distress and that lead to sexual dysfunction.

Anatomy

Pathophysiology

Infections of the genital or pelvic region can cause pain during intercourse. Inflammation associated with conditions like pelvic inflammatory disease (PID) can also contribute.

Dysfunction or tension in the muscles of the pelvic floor can lead to pain during sexual activity. Conditions such as vaginismus, where the muscles involuntarily contract, can contribute to dyspareunia. Non-cancerous growths in the uterus can cause pain or discomfort during sex, particularly if they press on surrounding organs.

Insufficient lubrication can result in friction and discomfort during intercourse. This can be associated with hormonal changes, certain medications, or insufficient arousal.

Fluctuations in hormonal levels, such as those that occur during menopause, pregnancy, or breastfeeding, can affect vaginal lubrication and tissue elasticity, potentially contributing to pain.

Etiology

Infections such as chlamydia or gonorrhea can cause inflammation and pain in the genital area. Infections in the urinary tract can lead to discomfort during intercourse. The presence of endometrial tissue outside the uterus can cause pain during intercourse, particularly if it involves the pelvic organs.

Infections of the reproductive organs can result in inflammation and pain. Decreased estrogen levels during menopause can lead to vaginal dryness and thinning of the vaginal walls, contributing to pain during intercourse.

Hormonal changes during breastfeeding can also lead to vaginal dryness. Thinning, drying, and inflammation of the vaginal walls, often associated with reduced estrogen levels. Chronic pain or discomfort around the vulva, which can make intercourse painful.

Genetics

Prognostic Factors

Early diagnosis and initiation of appropriate treatment can positively impact the prognosis. Delay in seeking medical attention may complicate the condition and affect outcomes.

A thorough assessment that considers both physical and psychological aspects of dyspareunia can contribute to better outcomes. This may involve collaboration between healthcare providers, gynecologists, psychologists, and physical therapists.

Addressing and managing psychological factors such as anxiety, depression, or a history of trauma is important for a favorable prognosis.

Clinical History

Age Group:

  • Dyspareunia is often reported more frequently in women during their reproductive years.
  • Conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids, which are more common in this age group, can contribute to dyspareunia.
  • Vaginal dryness related to hormonal fluctuations, such as those occurring during the menstrual cycle, pregnancy, or breastfeeding, may also contribute to pain during intercourse.
  • Changes in hormonal levels during perimenopause and menopause, particularly a decrease in estrogen, can lead to vaginal atrophy and dryness.
  • Psychological factors, such as anxiety or a history of sexual trauma, may contribute to pain during intercourse in the teens and early 20’s group.

Physical Examination

Pelvic Examination: A pelvic examination is often performed to assess the health of the reproductive organs and surrounding structures.

Check Vaginal pH and Moisture: Measurement of vaginal pH can help assess the acidity of the vaginal environment, which may be relevant in cases of infection or hormonal changes.

Pelvic Floor Assessment: A pelvic floor assessment may be conducted to evaluate muscle tone and function. Pelvic floor dysfunction, including conditions like vaginismus, can contribute to pain during intercourse.

Age group

Associated comorbidity

Vulvodynia is a chronic pain condition affecting the vulva. It can cause burning, stinging, or sharp pain, and it may contribute to pain during intercourse. Endometriosis is a condition where tissue like the lining of the uterus grows outside the uterus. It can cause pelvic pain, including pain during sex.

Pelvic Inflammatory Disease (PID) is an infection of the reproductive organs, often caused by sexually transmitted bacteria. It can lead to inflammation and scarring, resulting in pain during intercourse.

This is a chronic condition characterized by pain and discomfort in the bladder and pelvic region. Symptoms may be exacerbated during sexual activity. Hormonal changes associated with menopause, breastfeeding, or certain medical treatments can lead to vaginal dryness and atrophy, contributing to dyspareunia.

Associated activity

Acuity of presentation

Sexually transmitted infections (STIs) or other infections of the genital or pelvic region can cause acute pain during intercourse.

Acute trauma to the genital area, such as tears during childbirth or injuries, can lead to sudden onset pain.

Changes in hormonal levels, such as those occurring during perimenopause, may lead to a gradual onset of symptoms like vaginal dryness and discomfort during intercourse.

Conditions like endometriosis or interstitial cystitis may cause symptoms that develop gradually over time.

Conditions like fibromyalgia or chronic pelvic pain syndrome may lead to long-term, persistent dyspareunia. Dyspareunia may occur after pelvic surgeries, such as hysterectomy, due to scarring or changes in pelvic anatomy.

Emotional factors, such as stress or anxiety, may contribute to the gradual or chronic development of dyspareunia.

Differential Diagnoses

Sexually Transmitted Infections (STIs): Infections such as chlamydia, gonorrhea, herpes, or trichomoniasis can cause pain during intercourse.

Gynecological Conditions: The presence of endometrial tissue outside the uterus can cause pelvic pain and dyspareunia.

Pelvic Inflammatory Disease (PID): Infections of the reproductive organs can result in inflammation and scarring, leading to pain.

Uterine Fibroids: Non-cancerous growths in the uterus may contribute to pain during intercourse, especially if they press on surrounding structures.

Vaginal Atrophy: Thinning and dryness of the vaginal walls, often associated with reduced estrogen levels, can lead to dyspareunia, especially during menopause.

Vaginismus: Involuntary muscle contractions of the pelvic floor can make penetration painful.

Pelvic Floor Tension Myalgia: Increased muscle tension in the pelvic floor may lead to pain during intercourse.

Peripheral Neuropathy: Nerve damage or dysfunction in the pelvic region can cause pain during intercourse.

Neuralgia: Conditions such as pudendal neuralgia may result in pain in the pelvic area.

Urinary Tract Infections (UTIs): Infections of the urinary tract can cause pelvic discomfort during intercourse.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Treatment of Underlying Conditions: Address and manage any identified medical conditions contributing to dyspareunia. This may include treating infections, managing gynecological conditions, or addressing hormonal imbalances.

Pelvic Floor Physical Therapy: Pelvic floor physical therapy is often beneficial for individuals with pelvic floor dysfunction. Therapists can teach exercises to relax or strengthen pelvic floor muscles, improving overall pelvic health.

Hormone Therapy: For postmenopausal women experiencing vaginal atrophy, hormone replacement therapy (HRT) may be considered to restore estrogen levels and improve vaginal health.

Psychological Support: Address psychological factors contributing to dyspareunia. Therapy or counseling, both individually and with a partner, can help manage anxiety, depression, and any history of sexual trauma.

Lifestyle Modifications: Implement lifestyle changes to improve overall health and well-being. This may include stress reduction techniques, regular exercise, and maintaining a healthy diet.

Vaginal Lubricants and Moisturizers: For individuals experiencing vaginal dryness, the use of water-based or silicone-based lubricants during sexual activity can help reduce friction.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of Non-pharmacological approach for Dyspareunia

  • Manage the Temperature: Ensure the bedroom temperature is comfortable. Being too hot or too cold can contribute to discomfort and tension. 
  • Lubrication: Have water-based or silicone-based lubricants readily available. Using lubricants can reduce friction and make sexual activity more comfortable. 
  • Proper Timing: Choose times for intimacy when you and your partner are both relaxed and not rushed. Setting aside dedicated time can reduce stress and anxiety. 
  • Perfect Positioning: Experiment with different sexual positions to find ones that are more comfortable and less likely to cause pain.  
  • Relaxation Techniques: Practice relaxation techniques, such as deep breathing or mindfulness, before and during intimacy to help reduce muscle tension and anxiety. 
  • Use of Heating Pads: Applying a warm compress or using a heating pad on the pelvic area before sexual activity may help relax muscles and reduce discomfort.

 

 

Role of Oral tricyclic antidepressants

TCAs are commonly used in the management of neuropathic pain conditions, including those contributing to dyspareunia. Neuropathic pain involves dysfunction or damage to the nervous system, and TCAs can help modulate the perception of pain signals. 

  • Amitriptyline and Nortriptyline:  These are one of the most prescribed tricyclic antidepressants. 

In conditions where there is central sensitization, such as vulvodynia or other chronic pain disorders, TCAs may be beneficial in reducing pain intensity and improving overall comfort during sexual activity. 

 

Topical Estrogen Therapy" class="tabcontent">

Role of Topical Estrogen Therapy

  • Topical Estrogen Therapy: For postmenopausal women experiencing vaginal atrophy, topical estrogen therapy is prescribed. It helps restore the vaginal lining, increase lubrication, and improve tissue health. 

It is available in the form of creams, rings, tablets, or patches with low-dose estrogen. 

Use of antifungals drugs

For individuals with yeast infections contributing to dyspareunia, antifungal medications may be recommended. 

  • Fluconazole: Fluconazole is an antifungal medication that inhibits the synthesis of ergosterol, a component of the fungal cell membrane. This disruption leads to increased permeability and ultimately the death of the fungal cell. 
  • Clotrimazole: Clotrimazole belongs to the class of azole antifungals and works by disrupting the synthesis of ergosterol, an essential component of the fungal cell membrane. 

 

Use of Hormone Replacement Therapy (HRT)

In postmenopausal women, systemic hormone replacement therapy (HRT) may be considered to address overall hormonal changes, including vaginal atrophy. 

  • Conjugated Estrogens: Conjugated estrogens, derived from the urine of pregnant mares, are a commonly used form of estrogen in HRT. Premarin is available in various formulations, including oral tablets and vaginal creams.  
  • Estradiol: Estradiol is a bio-identical form of estrogen and is available in different formulations, including oral tablets, transdermal patches, and vaginal tablets or creams.  

 

Use of Intervention with a procedure in treating Dyspareunia

  • Topical Treatments: Topical estrogen therapy: For postmenopausal women with vaginal atrophy, topical estrogen creams, rings, or tablets may be prescribed to improve vaginal health and reduce pain. 
  • Botulinum Toxin Injections: Botulinum toxin injections may be considered for individuals with pelvic floor muscle spasms. This can help relax the muscles and alleviate pain. 
  • Vestibulectomy: Surgical procedures, such as vestibulectomy or vestibuloplasty, may be considered for individuals with localized pain at the vaginal entrance. These procedures involve removing a portion of the vestibule to reduce sensitivity. 
  • Laser Therapy: Laser therapy, such as fractional CO2 laser or Erbium YAG laser, may be used for postmenopausal women experiencing vaginal atrophy. 
  • Surgical Interventions for Endometriosis: For individuals with dyspareunia related to endometriosis or uterine fibroids, surgical interventions such as laparoscopic excision of endometriosis or myomectomy may be considered to address the underlying conditions. 

 

Use of phases in managing Dyspareunia

  • Assessment and Diagnosis: A comprehensive medical history is obtained to understand the onset, duration, and characteristics of dyspareunia.  
  • Diagnostic Tests: Depending on the suspected causes, diagnostic tests such as swabs for infections, imaging studies, or hormonal assessments may be performed. 
  • Lifestyle Modifications: Lifestyle changes, including stress reduction techniques, regular exercise, and a healthy diet, may be recommended to enhance overall well-being. 
  • Education and Self-Care: Providing education on dyspareunia, its causes, and management strategies empowers individuals to actively participate in their care.  
  • Follow-Up: Regular follow-up appointments allow healthcare providers to monitor progress, make any necessary adjustments to the treatment plan, and address any new concerns that may arise. 

 

Medication

 

ospemifene 

60

mg

Tablet

Orally 

every day with food



prasterone 

Intravaginal

At bedtime, administer one vaginal insert using an applicator



estradiol vaginal 

The recommended initial dosage for this medication is 4 micrograms, which should be inserted into the vagina once a day for two weeks
After the initial two-week period, the dosage should be reduced to one vaginal insert every 3 to 4 days
For ongoing maintenance, the dosage can be either 4 or 10 micrograms, and should be inserted into the vagina every 3 to 4 days



 
 

Media Gallary

References

Dyspareunia – StatPearls – NCBI Bookshelf (nih.gov)

Dyspareunia in Women | AAFP

Dyspareunia

Updated : December 1, 2023




Dyspareunia refers to persistent or recurrent pain experienced during sexual intercourse. It is a medical term that encompasses various types of pain, including genital, pelvic, or deep pelvic pain, which can occur before, during, or after sexual activity.

Dyspareunia can affect both men and women, but it is more commonly reported by women. Emotional factors like anxiety, stress, fear, or a history of sexual trauma can contribute to dyspareunia.

These can include medical conditions such as infections, pelvic inflammatory disease, endometriosis, uterine fibroids, ovarian cysts, or structural abnormalities.

Dyspareunia is a common issue, but the reported prevalence rates vary. Research suggest that it affects a significant proportion of the population, with estimates ranging from around 8% to 21% of women experiencing pain during intercourse at some point in their lives.

Dyspareunia is often associated with various gynecological conditions. For example, women with endometriosis, pelvic inflammatory disease, or vulvodynia may be more likely to experience pain during intercourse.

Psychological factors, such as anxiety, depression, and a history of sexual trauma, can contribute to dyspareunia. Dyspareunia can have a significant impact on sexual relationships. It may contribute to relationship distress and that lead to sexual dysfunction.

Infections of the genital or pelvic region can cause pain during intercourse. Inflammation associated with conditions like pelvic inflammatory disease (PID) can also contribute.

Dysfunction or tension in the muscles of the pelvic floor can lead to pain during sexual activity. Conditions such as vaginismus, where the muscles involuntarily contract, can contribute to dyspareunia. Non-cancerous growths in the uterus can cause pain or discomfort during sex, particularly if they press on surrounding organs.

Insufficient lubrication can result in friction and discomfort during intercourse. This can be associated with hormonal changes, certain medications, or insufficient arousal.

Fluctuations in hormonal levels, such as those that occur during menopause, pregnancy, or breastfeeding, can affect vaginal lubrication and tissue elasticity, potentially contributing to pain.

Infections such as chlamydia or gonorrhea can cause inflammation and pain in the genital area. Infections in the urinary tract can lead to discomfort during intercourse. The presence of endometrial tissue outside the uterus can cause pain during intercourse, particularly if it involves the pelvic organs.

Infections of the reproductive organs can result in inflammation and pain. Decreased estrogen levels during menopause can lead to vaginal dryness and thinning of the vaginal walls, contributing to pain during intercourse.

Hormonal changes during breastfeeding can also lead to vaginal dryness. Thinning, drying, and inflammation of the vaginal walls, often associated with reduced estrogen levels. Chronic pain or discomfort around the vulva, which can make intercourse painful.

Early diagnosis and initiation of appropriate treatment can positively impact the prognosis. Delay in seeking medical attention may complicate the condition and affect outcomes.

A thorough assessment that considers both physical and psychological aspects of dyspareunia can contribute to better outcomes. This may involve collaboration between healthcare providers, gynecologists, psychologists, and physical therapists.

Addressing and managing psychological factors such as anxiety, depression, or a history of trauma is important for a favorable prognosis.

Age Group:

  • Dyspareunia is often reported more frequently in women during their reproductive years.
  • Conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids, which are more common in this age group, can contribute to dyspareunia.
  • Vaginal dryness related to hormonal fluctuations, such as those occurring during the menstrual cycle, pregnancy, or breastfeeding, may also contribute to pain during intercourse.
  • Changes in hormonal levels during perimenopause and menopause, particularly a decrease in estrogen, can lead to vaginal atrophy and dryness.
  • Psychological factors, such as anxiety or a history of sexual trauma, may contribute to pain during intercourse in the teens and early 20’s group.

Pelvic Examination: A pelvic examination is often performed to assess the health of the reproductive organs and surrounding structures.

Check Vaginal pH and Moisture: Measurement of vaginal pH can help assess the acidity of the vaginal environment, which may be relevant in cases of infection or hormonal changes.

Pelvic Floor Assessment: A pelvic floor assessment may be conducted to evaluate muscle tone and function. Pelvic floor dysfunction, including conditions like vaginismus, can contribute to pain during intercourse.

Vulvodynia is a chronic pain condition affecting the vulva. It can cause burning, stinging, or sharp pain, and it may contribute to pain during intercourse. Endometriosis is a condition where tissue like the lining of the uterus grows outside the uterus. It can cause pelvic pain, including pain during sex.

Pelvic Inflammatory Disease (PID) is an infection of the reproductive organs, often caused by sexually transmitted bacteria. It can lead to inflammation and scarring, resulting in pain during intercourse.

This is a chronic condition characterized by pain and discomfort in the bladder and pelvic region. Symptoms may be exacerbated during sexual activity. Hormonal changes associated with menopause, breastfeeding, or certain medical treatments can lead to vaginal dryness and atrophy, contributing to dyspareunia.

Sexually transmitted infections (STIs) or other infections of the genital or pelvic region can cause acute pain during intercourse.

Acute trauma to the genital area, such as tears during childbirth or injuries, can lead to sudden onset pain.

Changes in hormonal levels, such as those occurring during perimenopause, may lead to a gradual onset of symptoms like vaginal dryness and discomfort during intercourse.

Conditions like endometriosis or interstitial cystitis may cause symptoms that develop gradually over time.

Conditions like fibromyalgia or chronic pelvic pain syndrome may lead to long-term, persistent dyspareunia. Dyspareunia may occur after pelvic surgeries, such as hysterectomy, due to scarring or changes in pelvic anatomy.

Emotional factors, such as stress or anxiety, may contribute to the gradual or chronic development of dyspareunia.

Sexually Transmitted Infections (STIs): Infections such as chlamydia, gonorrhea, herpes, or trichomoniasis can cause pain during intercourse.

Gynecological Conditions: The presence of endometrial tissue outside the uterus can cause pelvic pain and dyspareunia.

Pelvic Inflammatory Disease (PID): Infections of the reproductive organs can result in inflammation and scarring, leading to pain.

Uterine Fibroids: Non-cancerous growths in the uterus may contribute to pain during intercourse, especially if they press on surrounding structures.

Vaginal Atrophy: Thinning and dryness of the vaginal walls, often associated with reduced estrogen levels, can lead to dyspareunia, especially during menopause.

Vaginismus: Involuntary muscle contractions of the pelvic floor can make penetration painful.

Pelvic Floor Tension Myalgia: Increased muscle tension in the pelvic floor may lead to pain during intercourse.

Peripheral Neuropathy: Nerve damage or dysfunction in the pelvic region can cause pain during intercourse.

Neuralgia: Conditions such as pudendal neuralgia may result in pain in the pelvic area.

Urinary Tract Infections (UTIs): Infections of the urinary tract can cause pelvic discomfort during intercourse.

Treatment of Underlying Conditions: Address and manage any identified medical conditions contributing to dyspareunia. This may include treating infections, managing gynecological conditions, or addressing hormonal imbalances.

Pelvic Floor Physical Therapy: Pelvic floor physical therapy is often beneficial for individuals with pelvic floor dysfunction. Therapists can teach exercises to relax or strengthen pelvic floor muscles, improving overall pelvic health.

Hormone Therapy: For postmenopausal women experiencing vaginal atrophy, hormone replacement therapy (HRT) may be considered to restore estrogen levels and improve vaginal health.

Psychological Support: Address psychological factors contributing to dyspareunia. Therapy or counseling, both individually and with a partner, can help manage anxiety, depression, and any history of sexual trauma.

Lifestyle Modifications: Implement lifestyle changes to improve overall health and well-being. This may include stress reduction techniques, regular exercise, and maintaining a healthy diet.

Vaginal Lubricants and Moisturizers: For individuals experiencing vaginal dryness, the use of water-based or silicone-based lubricants during sexual activity can help reduce friction.

  • Manage the Temperature: Ensure the bedroom temperature is comfortable. Being too hot or too cold can contribute to discomfort and tension. 
  • Lubrication: Have water-based or silicone-based lubricants readily available. Using lubricants can reduce friction and make sexual activity more comfortable. 
  • Proper Timing: Choose times for intimacy when you and your partner are both relaxed and not rushed. Setting aside dedicated time can reduce stress and anxiety. 
  • Perfect Positioning: Experiment with different sexual positions to find ones that are more comfortable and less likely to cause pain.  
  • Relaxation Techniques: Practice relaxation techniques, such as deep breathing or mindfulness, before and during intimacy to help reduce muscle tension and anxiety. 
  • Use of Heating Pads: Applying a warm compress or using a heating pad on the pelvic area before sexual activity may help relax muscles and reduce discomfort.

 

 

TCAs are commonly used in the management of neuropathic pain conditions, including those contributing to dyspareunia. Neuropathic pain involves dysfunction or damage to the nervous system, and TCAs can help modulate the perception of pain signals. 

  • Amitriptyline and Nortriptyline:  These are one of the most prescribed tricyclic antidepressants. 

In conditions where there is central sensitization, such as vulvodynia or other chronic pain disorders, TCAs may be beneficial in reducing pain intensity and improving overall comfort during sexual activity. 

 

  • Topical Estrogen Therapy: For postmenopausal women experiencing vaginal atrophy, topical estrogen therapy is prescribed. It helps restore the vaginal lining, increase lubrication, and improve tissue health. 

It is available in the form of creams, rings, tablets, or patches with low-dose estrogen. 

For individuals with yeast infections contributing to dyspareunia, antifungal medications may be recommended. 

  • Fluconazole: Fluconazole is an antifungal medication that inhibits the synthesis of ergosterol, a component of the fungal cell membrane. This disruption leads to increased permeability and ultimately the death of the fungal cell. 
  • Clotrimazole: Clotrimazole belongs to the class of azole antifungals and works by disrupting the synthesis of ergosterol, an essential component of the fungal cell membrane. 

 

In postmenopausal women, systemic hormone replacement therapy (HRT) may be considered to address overall hormonal changes, including vaginal atrophy. 

  • Conjugated Estrogens: Conjugated estrogens, derived from the urine of pregnant mares, are a commonly used form of estrogen in HRT. Premarin is available in various formulations, including oral tablets and vaginal creams.  
  • Estradiol: Estradiol is a bio-identical form of estrogen and is available in different formulations, including oral tablets, transdermal patches, and vaginal tablets or creams.  

 

  • Topical Treatments: Topical estrogen therapy: For postmenopausal women with vaginal atrophy, topical estrogen creams, rings, or tablets may be prescribed to improve vaginal health and reduce pain. 
  • Botulinum Toxin Injections: Botulinum toxin injections may be considered for individuals with pelvic floor muscle spasms. This can help relax the muscles and alleviate pain. 
  • Vestibulectomy: Surgical procedures, such as vestibulectomy or vestibuloplasty, may be considered for individuals with localized pain at the vaginal entrance. These procedures involve removing a portion of the vestibule to reduce sensitivity. 
  • Laser Therapy: Laser therapy, such as fractional CO2 laser or Erbium YAG laser, may be used for postmenopausal women experiencing vaginal atrophy. 
  • Surgical Interventions for Endometriosis: For individuals with dyspareunia related to endometriosis or uterine fibroids, surgical interventions such as laparoscopic excision of endometriosis or myomectomy may be considered to address the underlying conditions. 

 

  • Assessment and Diagnosis: A comprehensive medical history is obtained to understand the onset, duration, and characteristics of dyspareunia.  
  • Diagnostic Tests: Depending on the suspected causes, diagnostic tests such as swabs for infections, imaging studies, or hormonal assessments may be performed. 
  • Lifestyle Modifications: Lifestyle changes, including stress reduction techniques, regular exercise, and a healthy diet, may be recommended to enhance overall well-being. 
  • Education and Self-Care: Providing education on dyspareunia, its causes, and management strategies empowers individuals to actively participate in their care.  
  • Follow-Up: Regular follow-up appointments allow healthcare providers to monitor progress, make any necessary adjustments to the treatment plan, and address any new concerns that may arise. 

 

ospemifene 

60

mg

Tablet

Orally 

every day with food



prasterone 

Intravaginal

At bedtime, administer one vaginal insert using an applicator



estradiol vaginal 

The recommended initial dosage for this medication is 4 micrograms, which should be inserted into the vagina once a day for two weeks
After the initial two-week period, the dosage should be reduced to one vaginal insert every 3 to 4 days
For ongoing maintenance, the dosage can be either 4 or 10 micrograms, and should be inserted into the vagina every 3 to 4 days



Dyspareunia – StatPearls – NCBI Bookshelf (nih.gov)

Dyspareunia in Women | AAFP

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