“Hullo…” went the female voice on the other end.
“Hullo” I answered. “Doctor, I read your article on erectile dysfunction on Saturday, and I am wondering whether you can help me”. In my mind, I knew this was one of the many caring wives consulting on her husband’s behalf. No!!Just like you, I was wrong!! Namagembe, as I later came to learn narrated how devastated she was with her sexual experiences. The 28 year old had endured painful intercourse right from the time she was 18. This had happened with several partners and now her husband was cheating because she had given up on sex.
Pain or discomfort should never be part of normal sexual intercourse. Sex should be enjoyable and comfortable and nature has catered for this.
Sexual pain disorders may be primary (pain present at first intercourse)or secondary (pain developing after previously pain-free intercourse). It may also be complete (with each sexual experience) or situational (with some experiences or partners, but not others).
From Namagembe’s story, there are high chances that Namagembe could be suffering from a condition known as dyspareunia. Dyspareunia is a medical term used to mean painful sexual intercourse due to medical or psychological causes.
Who does it affect and how does it manifest?
This condition can affect men, but is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. A high level research study done by the World Health Organization, reported that between 8%and 22% of all women have experienced painful sex at some point in their lives. Another study involving 3,017 women in Sweden showed the highest numbers of affected were in the 20–29 year age groups.
Sexual pain may occur before, during or after penetration. Women often do not bring this complaint to the attention of their health care providers. Pain during intercourse may be experienced at different points of the act. It can be;
• Only at sexual penetration
• With every penetration, even while inserting a tampon (complete or generalized)
• With certain partners or just under certain circumstances (situational)
• New pain after previously pain-free intercourse
• Deep pain during thrusting, which is often described as “something being bumped”
• Burning pain or aching pain
What causes painful sex?
Like most sexual problems, painful intercourse can occur for a variety of reasons ranging from physical to psychological/emotional. It has numerous causes – many of which are easily treatable.
Insufficient lubrication is just but one cause of sexual pain. This is often the result of inadequate foreplay and thus the woman is not physically and psychologically ready. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, during breastfeeding and childbirth. However, this may only last until the body reverts back to a non-pregnant state.
Like we all know, all drugs have side effects and certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
Injuryto the private parts, a birth defect, a tear or episiotomy (that generous cut you get during childbirth), can cause painful sex. Female circumcision (female genital mutilation) more often than not, results in painful sex. Many women get urinary tract infections and this can cause painful intercourse. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Anxiety, depression and concerns about your physical appearance (can women ever be comfortable with their shape, size, figure??) can be causes. If you have been brought up in a culture that “criminalizes” sex, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
Stress causes pelvic floor muscle tightening. This can contribute to pain during intercourse. Exercise not only helps you reduce your weight, it also helps with stress relief and muscle relaxation. A history of sexual abuse (rape or defilement), can also be a cause of dyspareunia.
Once a woman experiences this pain once, it may lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain, in this case, sex.
Treatment options will vary, depending on the underlying cause of the pain. Like other sex issues, treatment of dyspareunia requires encouragement and an understanding partner. However, even without their cooperation, you can make it.
If an infection or medical condition is contributing to your pain, treating the underlying cause may resolve your problem. Low estrogen levels at menopause can be treated with a prescription of hormone replacement.
Lifestyle and home remedies
Vaginal relaxation and pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse may be recommended.
If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.
Vaginal lubricants like KY gel or a local anaesthetic may also be helpful. The most effective treatment for vaginismus is a combination of behavioral modification, vaginal dilatation, and emotional counseling. Vaginal dilatation is not a mechanical procedure, but a process of learning that something can be inserted into the vagina without causing pain.
Modification of sexual technique may help to reduce pain with intercourse. Increasing the amount of foreplay and delaying penetration until maximal arousal will increase vaginal lubrication and decrease pain with penetration.
Until vaginal penetration becomes less painful and bothersome, you and your partner might find other options to be more comfortable, more fulfilling and more fun than your regular routine. Sensual massage, kissing and whatever else is culturally/religiously acceptable to you can all be good alternatives to intercourse.
If you experience pain during sex, do not be afraid to tell your partner. Normally, your partner will not know what you are going through unless you talk about it.Treating the problem can help your sex life, your emotional intimacy and your self-image
Dr. Phionah Atuhebwe can be reached on: [email protected]