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They can also tighten in response to genital pain. Pelvic floor physical therapy is relatively new, and there aren't much hard data on it yet, but experts consider it safe and effective. Avoid perfumed, multi-ingredient products such as bubble bath, douches, and some panty liners. Physical therapy can help reduce tightness and improve muscle function. That is unfortunate, because treatments are available for many of the problems that underlie this vexing condition. But your primary care provider or gynecologist may be able to refer you to someone with experience in treating dyspareunia.

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In treating vaginal atrophy, vaginal estrogen is preferred to systemic hormone therapy, which is taken in pill and other forms, with or without a progestin.

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Stress, anxiety, depression, guilt, a history of sexual abuse, an upsetting pelvic exam in the past, or relationship troubles can also be at the root of sexual pain. Your physical therapist will use hands-on techniques such as massage and gentle pressure to relax and stretch your tissues and promote blood flow, including when you're ready the interior of the vagina. The condition appears to have several different causes. Local low-dose estrogen helps most women with vaginal atrophy; it's also recommended in some cases of vestibulodynia and vulvar skin problems. In treating vaginal atrophy, vaginal estrogen is preferred to systemic hormone therapy, which is taken in pill and other forms, with or without a progestin.

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