Dyspareunia is pain during intercourse. It is mostly experienced by women, and symptoms can be felt at different points of intercourse. The source of the problem can be medical, psychological, or both. Dyspareunia in menopause is frequently reported by women as being the primary reason for decreased sexual intercourse or low libido.

Whether a medical or psychological problem, there are treatment options to help alleviate dyspareunia symptoms:

1. Education
Knowledge is power. Educating a patient about her female anatomy, how to best care for her body, and what treatment options are available should be the first step. Knowing which chemicals to avoid when performing personal hygiene and learning ways to decrease mechanical micro-traumas can help alleviate dryness, pain or discomfort.

2. Counseling
Regardless of the source of the problem, counseling should be considered. Any patient experiencing dyspareunia may develop a fear of sexual intercourse and this needs to be addressed before a return to normal function can be expected. Counseling will be particularly important for the patient who has experienced sexual trauma. Although counseling is not a ‘quick-fix’, it has been shown to be effective for many patients.

3. Lubricants
With or without education and counseling, the best treatment option for mild to moderate cases of dyspareunia is the use of lubricants, particularly for women who consider hormone replacement therapy unacceptable. There are at least three different types of lubricants: water-based, silicone-based, and oil-based. Water-based and silicone-based should be preferred over oil-based due to the types of problems oil-based lubricants can bring such as vaginosis, or interactions with the use of condoms where the oil may decrease the protection the condom offers and cause it to break.

4. Hormone replacement therapy
Hormone replacement therapy can be used alone or in combination with lubricants. Hormone replacement therapy has been found to improve symptoms of dyspareunia associated with the thinning of the vaginal mucosa often encountered during menopause, due to the decrease in estrogen levels. It also lowers the vaginal pH, which tends to increase during the menopausal years. A lower vaginal pH will favor a healthy vaginal flora and will help prevent concomitant infections that may exacerbate the discomfort experienced during intercourse. Hormone replacement therapy can help alleviate other symptoms associated with menopause such as hot flashes. It comes in various forms: creams or rings applied intra-vaginally, tablets taken orally, patches applied on the skin, or a spray under the tongue.

5. Pelvic floor exercises
Pelvic floor exercises, also known as ‘Kegels’, are a specific set of exercises that aim to strengthen the muscles of the pelvic floor (the area from the anus to the front of the vulva). Studies report that these have been shown to significantly improve the symptoms of dyspareunia.