Treatment

Treatment options vary depending on the cause of the pain.

Medications

If an infection or medical condition contributes to your pain, treating the cause might resolve your problem. Changing medications known to cause lubrication problems also might eliminate your symptoms.

For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina.

The Food and Drug Administration approved the drug ospemifene (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining.

Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium).

Another drug to relieve painful intercourse is prasterone (Intrarosa). It's a capsule you place inside the vagina daily.

Other treatments

Certain nonmedication therapies also might help with dyspareunia:

• Desensitization therapy. You learn vaginal relaxation exercises that can decrease pain.

• Counseling or sex therapy. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you might also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.

  Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.