These pathways were developed to guide clinicians when managing dyspareunia
The pathways are not provider specific and so the guidance and forms apply to all providers.
Vulva, vagina and cervix visualised, bimanual performed.
If suspect cancer refer as appropriate
- Treat with sensitivity – this can very upsetting and difficult for women to talk about.
- Give general advice about good vulval skin care – see BAD.org.uk ‘care of vulval skin’ patient information leaflet - http://www.bad.org.uk/shared/get-file.ashx?id=74&itemtype=document
- Manage and treat any underlying cause.
- A trial of vaginal oestrogen can be considered if genitourinary syndrome of the menopause (GSM) is suspected
- General advice specific to superficial dyspareunia
- Advice on use of adequate over the counter or prescription lubrication – water, silicone or oil based (although beware condom use and oil based lubricants.)
- Vaginal moisturisers used regularly or prn can be helpful – e.g. Replens (licensed)
- Dilators can be prescribed or bought if symptoms persist after the underlying condition has been treated – e.g. prescribe Amielle comfort dilators(licensed). Advise to start with the smallest most comfortable dilator, insert for approx. 10 mins every day and move up to the next size when ready.
- Psychosexual counselling may be needed – refer as appropriate