Painful Intercourse

The American mythologist, writer and lecturer, Joseph Campbell, best known for his work in comparative mythology and comparative religion once said: “Find a place inside where there is joy, and joy will burn out the pain.”

I guess these are life experiences to teach us how to find the inner strength and positive vibes in life when facing pain of obstacles. Of course, this is easy when we are given the guidance and wisdom from someone we trust, especially the ones who have walked the walk and able to talk the talk.

When it comes to sexual health, the taboo and embarrassment of the issues often pose a barrier for open discussion, even for the most liberal amongst us. Some had advocated the more open-minded approach in sex education for youth in order to avoid sexually transmitted infections and unwanted pregnancies.

Can sex education help the inexperienced to avoid pain and discover the joy of sexual experience? This is our issue of contention for a reader.

Dear Dr G,

My name is Jon and a newly wed.

I am 26 and my wife is 25. We got married the beginning of this year after one year of courtship.

My wife and I are firm believers of no sexual intimacy before marriage and we have kept our promises until after we got married.

I have been having problems with our sexual relationship, as my wife is constantly complaining of pain upon penetrative sex.

We have tried several lubricants and still encounter this major problem.

With very limited sexual education, I really do not know what have I done wrong and how we can rectify the problem.

My wife has never had a previous relationship. I have asked my wife to go and see a doctor, but she is too embarrassed to do so.

We really do not know whom to turn to and would like to ask for your help.

Is it normal for my wife to experience pain on penetration?

Is my penis too big or the vaginal too tight?

Can something be done to help? Does it need an operation?

Please help. We are sexually naïve!

Regards

Jon

The medical terminology for painful intercourse is dyspareunia. This is defined as the persistent pain of the female partner upon, during and after penetrative intercourse. Dyspareunia can be the results of a variety of causes; this can both be physical or psychological in origin.

The sufferers of dyspareunia typically describe pain on penetration or even the insertion of object like a tampon. The pain can range from mild discomfort to deep throbbing pain. Occasionally, the pain can even last for hours after intimacy.

The common cause of painful intercourse is usually insufficient lubrication. This may be the result of inadequate foreplay or estrogen depletion.

Certain medications such as antidepressants or antihistamine, may potentially reduce sexual desire and are also known to result in diminish vaginal lubrication. The involuntary spasm of the vaginal muscles is called vaginismus. This is also a common cause of dyspareunia.

The infection or inflammation of the genitalia can also result in painful intercourse. Fungal infection or eczema of the external genitalia can induce painful excoriation. Other inflammatory causes may also include trauma and injury. The trauma of the vagina can be the result of penetration of vaginal with congenital anomaly.

Of course, the emotional issues are also intertwined with sexual behavior. Psychological problems such as anxiety, depression, fear of intimacy and low level of sexual arousal are known to be related to painful intercourse. This is because emotional stress can tighten the pelvic floor muscle rendering pain upon entry of penis.

In many couples, the initial painful penetrative sex can lead to the fear of recurring pain. Such trepidation will result in a vicious cycle of inability to relax leading to more pain. This might become the real reason for avoiding sexual activities completely as sex is associated with painful experience.

Ospemifene is a medication recently approved by the FDA as the therapy for moderate to severe dyspareunia. This drug acts like estrogen on the vaginal lining to enhance the lubrication. The advantage of this medication is that has minimal oncogenic potential of breast and endometrial cancers for women.

On the other hand, psychological intervention such as desensitization therapy with the aim for vaginal relaxation can ease the pain. Otherwise, sexual counselling and cognitive behavior therapy can have the impacts of changing the negative thoughts of sexual experience.

Greek philosopher Aristotle once said: “The aim of the wise is not to secure pleasure, but to avoid pain.”

Although sexual education may enrich Jon’s mind on the pain and pleasures of sex, however, only through love and open communication will help him to “find a place inside where there is joy, and joy will burn out the pain”.