Treatment Treatment of cause when possible (eg, topical estrogen for atrophic vaginitis) Education about chronic pain and its effects on sexuality Psychologic therapies Pelvic floor physical therapy Progressive desensitization Management of genitopelvic pain / penetration disorder frequently includes the following: Encouraging and teaching the couple to develop satisfying forms of nonpenetrative sex Discussing psychologic issues contributing to and caused by the chronic pain When possible, treating the primarily physical abnormality that contributes to pain (eg, endometriosis, lichen sclerosus, vulvar dystrophies, vaginal infections, congenital malformations, radiation fibrosis) Treating coexisting pelvic muscle hypertonicity Treating comorbid sexual interest / arousal disorder Topical estrogen is helpful for genitourinary syndrome of menopause, atrophic vaginitis, and recurrent posterior fourchette tearing.