Q. I enjoy sex but find it extremely painful. What could be the reason?
A. The medical term for painful sexual contact is dyspareunia and can happen as a result of physical and psychological problems that lead to recurrent and in some instances persistent pain.
The symptoms may include pain only at penetration by a finger, tampon, sex toy or a penis as well as pain during oral sex. Deep pain can be throbbing or burning experienced during thrusting. Burning pain can last hours after sex.
There are several emotional factors that might worsen the experience of pain. Persistent pain can also lead to decrease in libido and arousal and has an impact on pleasure and intimacy. Pain and discomfort during sexual activity does not mean a history of abuse or bad sexual experiences. However, if those exist, the anxiety, trauma or fear may worsen the negative experience and the ability to experience pleasure.
A decrease in oestrogen levels after menopause or childbirth or during breast-feeding can result in less lubrication, making the discomfort at penetration worse. Some antidepressants, high blood pressure medications, sedatives, antihistamines and certain contraceptive pills can have a negative effect on sexual desire and lubrication.
Deep pain may be due to endometriosis, pelvic inflammatory disease, uterine fibroids, postpelvic surgery scarring from hysterectomy or pelvic cancer treatment.
Vaginismus is the involuntary spasms of the muscles of the vaginal wall and pain of the vulva which make penetration painful and sometimes impossible. Intersex people may have varying degrees of congenital genital structural problems.
Other birth defects where there may be a membrane that blocks the vaginal opening or where there is an incompletely formed vagina.
It is recommended to seek medical advice in order to identify the causes to best manage and if needed seek help from a sexologist for therapy. Some treatments could include medication, psychotherapy or surgery.
• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.
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