Discussion with a counselor or partner, engaging in noncoital stimulation, focusing on foreplay and arousal, and ensuring appropriate lubrication may help alleviate female orgasmic disorder. Dyspareunia Painful intercourse or pain with attempted intercourse. A general medical and sexual history and a physical and pelvic examination usually uncover the cause. Determining if dyspareunia occurs during foreplay, intromission, deep penetration, or certain positions can help in the differential diagnosis. For example, dyspareunia during deep penetration may indicate lesions of the uterus or broad ligament.
Management involves treatment of the underlying cause.
Because dyspareunia is often caused by atrophic vaginitis, a trial of topical estrogen or an estrogen ring is often warranted. Education and guidance in sexual techniques may also be helpful. Vaginismus may relate to dyspareunia. It may be triggered by fear of losing control or of being hurt during intercourse, by a vaginal infection, or by vaginal mucosal irritation. Observation of an involuntary vaginal spasm during pelvic examination confirms the diagnosis, but a pelvic examination may not even be possible in the presence of severe vaginismus.