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Media article: Painful intercourse – what’s wrong?

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(Written 8/98 for an online women’s health magazine www.herhealth.com)

All of us have watched movies, television shows and read books describing lovemaking and sex as the most wonderful act. The bodies are compatible and in rhythm, each partner knows exactly how and what to do, both enjoy it simultaneously, and it seems so easy…

Unfortunately, reality is not quite so, and many of our patients (and their partners) will come in upset that their own sexual experiences are disappointing and do not meet their expectations. Many complaint of satisfying affection and intimacy but painful intercourse regardless of the partner’s effort to be gentle, causing them to avoid sexual encounters in fear of continual pains.

The medical term for this condition is Dyspareunia; it has many possible causes, some of which are rather simple and easy to address:

  1. Sex Education: Understanding the anatomy and physiology of our bodies and how they function. Emphasis should be placed on the need to learn the different sexual preferences and attitudes between the men and women so that sexual compatibility can be established. For example, intercourse does not necessarily mean orgasm for the woman, not every woman can have multiple orgasms, the vagina is not an endless tube, there is more to sex than just orgasm, etc.
  2. Experience: Unless bound by religious/cultural restrictions, most adults will have experimented sexually as adolescents with masturbating, thereby learning their own body, then moving on to recognizing the body’s reactions and the feeling associated with sexual attraction toward another person; and, finally, intimately exploring sexual feelings and desires with a others. Such experiences establish one’s own sexual preferences and knowledge about the needs and options available for pleasurable sex.
  3. Positions: Sexual intimacy is not limited to one position! Couples need to explore different positions in order to facilitate a pain-free penetration. For example, placing a pillow under the woman’s buttocks if she is on her back or trying intercourse from a side-lying position and, if necessary, placing a pillow between the woman’s knees for further comfort and to increase pelvic opening. Understanding the direction of the vaginal canal will avoid pain by physically guiding the penetration and by expressing preferences to the partner, i.e. move up, down, etc. One more note about positions: having sex in the same position all the time will lead to boredom; make sex fun and exciting!
  4. Lubrication: As the woman becomes aroused, her body will produce natural lubrication for the vaginal canal to ease penetration. The hormone estrogen is essential to the process of lubrication and women of any age who have hormonal problems, taking the “pill”, or women who have gone through menopause will suffer with noticeable vaginal dryness that may cause pain during intercourse. Additionally, prolonged use of antibiotics may lead to vaginal dryness and painful intercourse. There are many vaginal lubricant products available in your drug store to be used during sex with repeated application as soon as you feel the slightest friction upon penetration and/or thrusting. To use them, put some on your partner or into your vagina before any insertion. Some of the lubricants are sold as pre-loaded into an applicator and may be applied intra-vaginally for prolonged comfort regardless of sexual activity. Note that other causes for vaginal dryness may be swimming in chlorinated pools and emotional stress.
  5. Skin chaffing in vaginal canal: Repeated penetrations prolonged thrusting, sensitive skin and chronic use of antibiotics may turn intercourse into a wounding experience, like a terribly scratched skin inside. Due to the vaginal proximity to the urethra (the tube for urination), urinary symptomology such as burning and frequency may be present as well. To prevent chaffing, use vaginal lubricants and let several hours/days pass between intercourse for your skin to heal. Additional solutions are available from your healthcare provider.
  6. Emotional stress/trauma: Our state of mind is a key factor in determining if sex will be pleasurable and satisfactory or an upsetting, painful experience. Our state mind will also determine how tight and resistant the vaginal opening may be and how much, if any, lubrication will be produced by our body. Therefore, don’t feel you have to have sex if you are not into it. You have the right to say NO!
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