Why is it uncomfortable when I have sex after my period?

Q. Please tell me why I feel uncomfortable when having sex soon after my periods.

A. The menstrual cycle is the normal, cyclic, shedding of the uterine lining, the endometrium, in response to the interactions of hormones, and occurs in three phases.

The first half of the cycle is known as the follicular phase and the second half of the cycle is considered the luteal phase. Midway through the cycle between days 12 and 16 ovulation occurs, known as the ovulatory phase.

If the egg is not fertilised, levels of estrogen and progesterone decrease and without the high levels of hormones to help maintain it, the thick womb lining that has been built up starts to break down, and the body sheds the lining. This is the start of a period and the beginning of the menstrual cycle.

The most common cycle length is between 23 and 35 days and this varies between people.

Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. On day 1 of the menstrual cycle, estrogen and progesterone levels are low. A drop in estrogen levels reduces the amount of moisture available.

During the follicular phase, the oestrogen levels rise as the new egg grows. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic.

When the dryness is sustained beyond the menstrual cycle it could result from a number of other different causes such as breastfeeding, radiation or chemotherapy treatment for cancer, menopause, surgical removal of the ovaries, some medications used to treat uterine fibroids or endometriosis, allergy and cold medications, certain antidepressants, douching, and not enough foreplay before sex.

Vaginal discomfort and dryness may affect arousal and the ability to reach orgasm. Using a water-based lubricant can make all the difference and is a great part of a healthy sex life.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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