In our last post, we discussed several reasons why genital pain occurs in both women and men. We’re following up that blog post discussing treatment plans for genital pain.

Treatment of Genital Pain

There are many treatments for people who experience genital pain including medical/surgical, physical therapy, psychological and sex therapy treatments.

Women often first speak with family physicians to receive medical interventions like topical applications, oral medications or surgery for genital pain. The most frequent topical medication utilized is Lidocaine and studies with provoked vestibulodynia (PVD) patients showed positive results. Medications can also be used for neuropathic pain, although this has not been empirically validated for vulvodynia.

Medical and Surgical Treatments

Vestibulectomy has been the most studied treatment for PVD, which success rates ranging between 65-75%. However, non-surgical interventions are recommended prior to patients receiving surgery for genital pain.

In a randomized treatment outcome study of PVD comparing vestibulectomy, group cognitive-behavioral therapy (CBT) and sex therapy with pain management and biofeedback, all three treatments had significant results at six months with pain during intercourse, but surgery resulted in twice the pain reduction.

In a two-year follow-up, surgery remained superior in its impact on pain during the cotton-swab test (rubbing a cotton swab on the affected area) but was equal to the CBT group for pain during intercourse.

Physical Therapy

Pelvic floor physical therapy involves education about the role of the pelvic floor musculature in the maintenance of dyspareunia as well as provides manual and insertion techniques. Research has shown that patients who undergo pelvic floor physical therapy had reduced pain during sexual intercourse and pelvic exams and improved overall sexual functioning.

Sex Therapy and Pain Management

Sex therapy and pain management have similar success rates compared to medical interventions but are largely absent from treatment considerations in the medical literature.

These interventions focus on reducing pain, restoring sexual function and improving romantic relationships. During sex therapy, clients are given psychoeducation about the multidimensional view of pain and its negative impact on sexuality, including psychological factors that maintain and exacerbate pain.

Self-exploration of the genitals to find the localized pain and a pain diary are utilized at this stage. As treatment progresses, psychotherapy and sex therapy aim at providing:

Sex-positive education
Treating complex trauma (if needed)
Reducing maladaptive coping strategies while increasing assertiveness
Reconnection with the partner through nonsexual emotional and physical intimacy
Expanding sexual repertoire away from intercourse
Facilitating experiences of desire, arousal, and sexual intimacy

At our clinic, we utilize all forms of treatment available and work in a multi-disciplinary fashion with urogynecologists and pelvic floor physical therapists in the treatment of genital pain. We have found that it is extremely important to treat all contributions of the pain and that medical interventions alone are not sufficient to treat genital pain. Knowledgeable and experienced sex therapists will not only treat symptoms of genital pain but will restore sexual functioning.

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