women s health issues
Genito Pelvic Pain Penetration Disorder
Treatment of Genito Pelvic Pain Penetration Disorder
Treatment of the cause of the pain, if possible Lubricants, sometimes anesthetic (numbing) gels Pelvic floor physical therapy Sometimes psychotherapy Treatment may involve a team of clinicians, such as doctors, physical therapists, psychotherapists, and sex therapists. Which treatments for genito-pelvic pain/penetration disorder are best has not been determined, and treatments vary depending on symptoms. However, some general measures are recommended. Vaginal lubricants and moisturizers include food-based oils (such as coconut oil), silicone-based lubricants, and water-based products. Water-based lubricants dry out quickly and may have to be reapplied, but they are preferred over petroleum jelly or other oil-based lubricants. Oil-based lubricants tend to dry the vagina and can damage latex contraceptive devices such as condoms and diaphragms. They should not be used with condoms. Silicone-based lubricants can be used with condoms and diaphragms, as can water-based lubricants. Women can ask their doctor which type of lubricant would be best for them. General measures for vaginal health include wearing cotton underwear, possibly wearing no underwear while sleeping, washing only with water or a mild soap, and not douching or using over-the-counter vaginal deodorants. When treating genito-pelvic pain/penetration disorder, doctors or other team members often do the following: Encourage a woman or couple to develop satisfying forms of sexual activities that do not involve penetration and teach how to do it Discuss emotional issues contributing to and caused by the chronic pain When possible, treat any physical abnormality that contributes to pain (such as Endometriosis or Treat involuntary contraction of the muscles in the pelvis (pelvic muscle hypertonicity) Treat sexual interest/arousal disorders if also present Sexual activities that do not involve penetration can help couples attain mutual pleasure (including having orgasms and ejaculation). An example is stimulation involving the mouth, hands, or a vibrator. Spending more time in foreplay may increase vaginal lubrication and thus make intercourse less painful. For deep pain, using a different position for intercourse may help. For example, being on top can give women more control of penetration, or another position may limit the depth of penetration. Pelvic floor physical therapy can often benefit women with genito-pelvic pain/penetration disorder. It includes pelvic floor muscle training, sometimes with biofeedback, to teach women how to consciously relax their pelvic muscles. Physical therapists may use other techniques to improve the function of the pelvic muscles. Techniques include Soft-tissue mobilization and myofascial release: Using various movements (such as rhythmic pushing or massage) to apply pressure on and stretch the affected muscles or the tissues that cover muscles (myofasciae) Trigger-point pressure: Applying pressure to very sensitive areas of the affected muscles, which may be where the pain starts (trigger points) Electrical stimulation: Applying gentle electric current through a device positioned at the opening of the vagina Bladder training and bowel retraining: Having women follow a strict schedule for urination and recommending exercises to strengthen the muscles around the urethra and anus, sometimes with Biofeedback None Therapeutic ultrasonography: Applying high-frequency sound waves to the affected muscles (increasing blood flow, enhancing healing, and making tight muscles less tight) Levator ani syndrome (vaginismus) can be treated with progressive desensitization (done by hand or with dilators). This technique enables women to gradually get used to the genital area being touched. The next step is taken only when the woman is comfortable with the previous step. The woman touches herself daily as close to the vagina's opening as possible. Once her fear and anxiety due to touching her genitals has decreased, the woman will be more able to tolerate the physical examination. The woman inserts her finger past her hymen. She is instructed to push or bear down as she inserts her finger to enlarge the opening and ease entry into the vagina. She inserts specially designed dilators gradually increasing sizes. Leaving a dilator inside for 10 to 15 minutes helps the muscles get used to gently increasing pressure without automatically contracting. After she can tolerate the smallest size, she inserts the next larger and so on. The woman allows her partner to help her insert a dilator during a sexual encounter to confirm that it can go in comfortably when she is sexually excited. The woman should allow her partner to touch the area around the vagina's opening with his penis or a dildo but without its entering the vagina. Then the woman can get used to feeling the penis or dildo on this area. Eventually, the woman inserts her partner’s penis or a dildo partially or fully in the vagina in the same way that she placed the dilator. She may feel more confident if she is on top during intercourse. For superficial pain, pelvic floor physical therapy is key because involuntary contraction of the muscles around the vagina's opening is often part of the problem. Liberally applying a lubricant before intercourse may help. Sometimes doctors suggest applying an anesthetic gel. Psychological therapies, such as cognitive-behavioral therapy and mindfulness-based cognitive therapy, may benefit some women. Mindfulness involves focusing on what is happening in the moment, without making judgments about or monitoring what is happening. Such therapies may help a woman manage fear and anxiety about pain during sexual intercourse. Doctors may refer women to a psychotherapist, couples therapist, or a qualified sex therapist for psychological therapies. More specific treatment depends on the cause, as in the following: Thinning and drying of the vagina after Menopause : Estrogen or DHEA (dehydroepiandrosterone) inserted into the vagina Overview of Vaginitis (Vaginal Infection or Inflammation) : Antibiotics or antifungal medications, as appropriate Cysts or abscesses: Surgical removal An abnormality of the hymen or other congenital abnormality: Surgery to correct it Vaginal hormone therapy includes low-dose estrogen (as a cream, tablet, or ring or DHEA (as a suppository).Estrogenmay be taken by mouth or applied to the skin in a patch or gel, but these forms ofestrogenaffect the whole body and are usually only used if a woman also has other symptoms of menopause (such as hot flashes). Ospemifene(a selectiveestrogenreceptor modulator, or SERM) and estrogen affect vaginal tissues in a similar way. Like estrogen,ospemifenecan be used to relieve vaginal dryness and other symptoms that involve the vagina and/or urinary tract. Medications used to treat Adjuvant Analgesics (pain due to damage of the nervous system) can help lessen the pain in provoked vestibulodynia. They include the antiseizure medications Various creams that containsgabapentinandamitriptylinecan be applied directly to the vagina's opening. These treatments may help relieve the pain and have fewer side effects. Botulinum toxin type A, injected into the pelvic floor muscles, is usually used only to treat provoked vestibulodynia when no other treatments have been effective. It is used only for a short period of time. Vestibulectomy (removal of the area around the vagina's opening) is rarely done. It is usually done in women who have never had pain-free sexual intercourse. 