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    Chronic sexual pain: a layered guide to evaluation


    Overall treatment principles

    Share with patients a written individualized treatment plan addressing each layer. The vulvar surface must be protected and strengthened, abnormal peripheral and central nerve activity suppressed, and the PF normalized with PT. Musculoskeletal abnormalities and pelvic organ pain require focused therapies, and underlying systemic conditions must be appreciated and treated. Depression, anxiety, and hopelessness are improved by supportive and cognitive behavioral therapy. Develop a relationship with a therapist who is knowledgeable about chronic pain and mind-body practices, which calm the ANS and physical consequences of pain and stress. 

    Anticipate pain flares and have a plan in place before they occur. Re-evaluate persistent or recurrent pain often, layer by layer. Address the side effects of medications preemptively and quickly. Avoid opioid pain relievers, which do not relieve chronic pain, but may cause bowel and bladder symptoms, endocrinopathies, sexual dysfunction, and mood and cognitive disturbances that may lead to overdose.28

    Patients trust ob/gyns with the care of chronic sexual pain. Our committed partnership with patients will improve their quality of life and provide an essential component of healing: hope for the real possibility of cure. 



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    Deborah Coady, MD, FACOG
    Dr Coady is Clinical Assistant Professor of Obstetrics and Gynecology at NYU Langone Medical Center, New York.


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