Painful Intercourse: Treatment Options and Insurance Coverage

Surgery for dyspareunia, covered by health insurance?

Hello Dr.
Wu: My boyfriend and I have been intimate for 4 years, and we recently decided to progress from "vaginal friction" to "vaginal penetration." However, I always give up due to intense pain.
(My boyfriend is very gentle, takes it slow, and I am quite lubricated.) I have consulted with a gynecologist, who after examination, suggested that my smaller pelvis and thicker hymen may be the cause.
The doctor recommended trying assistive devices or directly performing a hymenotomy.
I have tried the anesthetic prescribed by the gynecologist along with over-the-counter lubricants, and we have also elevated my hips during intercourse or taken a position where I am on top.
However, the sharp pain at the vaginal opening persists.
The suggestions from that doctor that I have not yet tried are: 1.
Purchasing a small dildo to insert into the vagina, even if it causes tearing or bleeding.
2.
Hymenotomy.
Could you please advise me, Dr.
Wu, regarding my situation: Is there any concern about using a dildo? There is very little information online about hymenotomy; will this sexual dysfunction be covered by health insurance? Where can I find more information? What would you recommend I do? Should I continue to follow the advice of that gynecologist, or should I seek another doctor? Thank you for your hard work!

Wei Xuan, 20~29 year old female. Ask Date: 2021/03/09

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
The use of a phallus prosthesis is outside the scope of medical advice, and appropriate guidance cannot be provided.
2.
Hymenotomy may be performed if deemed necessary by a physician.
Simple hymenotomy is covered by health insurance, but hymenoplasty requires out-of-pocket payment.
3.
If there are concerns, you may seek a second opinion from another obstetrician-gynecologist.

Reply Date: 2021/03/09

More Info

Understanding painful intercourse, or dyspareunia, can be a complex issue that involves both physical and psychological factors. In your case, it seems that the pain during penetration is primarily attributed to anatomical factors, such as a smaller pelvis and a thicker hymen, as noted by your gynecologist. It's important to approach this situation with care and to consider all available treatment options.

Firstly, the use of a small dildo or vaginal dilator can be a helpful method to gradually stretch the vaginal opening and help desensitize the area. However, it is crucial to proceed with caution. If you experience severe pain or bleeding, it is advisable to stop immediately and consult your healthcare provider. The goal is to make the experience as comfortable as possible, and forcing penetration can lead to further trauma and discomfort.

Regarding the hymenotomy (the surgical procedure to cut the hymen), this is typically considered when there is a significant anatomical barrier to penetration that cannot be resolved through other means. While this procedure can be effective, it is essential to have a thorough discussion with your gynecologist about the risks, benefits, and potential complications. It is also important to understand that surgery should not be the first option unless absolutely necessary.

As for insurance coverage, this can vary widely depending on your specific insurance plan and the medical necessity of the procedure. Generally, if a procedure is deemed medically necessary by your healthcare provider, there is a higher chance that it will be covered. It would be beneficial to contact your insurance provider directly to inquire about coverage for hymenotomy and any related treatments.

In terms of next steps, it may be worthwhile to seek a second opinion from another gynecologist, especially one who specializes in sexual health or pelvic pain. They may provide additional insights or alternative treatment options that could help alleviate your symptoms. Additionally, consider discussing the psychological aspects of painful intercourse with a therapist or counselor who specializes in sexual health. Sometimes, anxiety or fear surrounding penetration can exacerbate physical pain, and addressing these issues can be beneficial.

Lastly, communication with your partner is key. Ensuring that both you and your boyfriend are comfortable and understanding of each other's feelings can help alleviate some of the pressure associated with sexual intimacy. Exploring other forms of intimacy that do not involve penetration may also help you both feel more connected while you work through this issue.

In summary, while the suggestions from your gynecologist are valid, it is essential to approach them with caution and to consider seeking further medical advice. Understanding the underlying causes of your pain, exploring various treatment options, and ensuring open communication with your partner can all contribute to a more positive experience moving forward.

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