Q: Please Doctor find time to give me a response. God bless you

I am 29 after an active sexual life I stopped having sex but just last year after 11 months the last time I had sex, resuming sex practice has been painful for me which after having sex I have pain and my vagina suffers inflammation on the body of the two inner closure of my private part and it is becoming disturbing to me and my partner. Please what could be the cause or prevention to it?

A: Pain during sexual intercourse is more common with women but can also happen in men. The first question above was sent in by a woman and the second one was sent in by a man. This condition is called dyspareunia in medicine.

Dyspareunia is a condition in which one experiences pain during or after sexual intercourse. In women, the cause may be due to:
• Vaginismus: a condition in which the vaginal muscles go into spasms when an attempt is made at penetration.
• Lack of adequate lubrication eg due to hasty foreplay etc. This will be discussed some more at the end of this post.
• Infections of the vagina (like candidiasis as mentioned in the question) or urinary tract can also cause pain during sexual intercourse.
• Injuries/wounds to the vagina
• Emotional issues like stress or emotional disconnect from partner.
• Fibroids around the vagina or cervix

In men, the cause of this problem could be due to:
• Infection of the urethra (the tube which conveys urine from the bladder out of the body and also conveys semen out during ejaculation)
• Infection of the prostate gland.
• Infections, some of which may be due to STI
• Emotional issues may also be involved eg feelings of guilt.

Treatment depends on cause. If due to infections, they have to be treated. If it’s due to lack of lubrication, that has to be handled. Some lubricating gels may be suggested. If no physical cause can be seen and the problem appears to be emotional, some counseling may be required. Understanding that when people get married, they are actually two ‘strangers’ trying to get to know each other, should form part of the incentive for slowing down and trying to find out what pleases each member of the union.

For related topics, please click on https://chatwithdrketch.com/2014/08/22/daily-health-tips-why-am-i-not-into-my-husband/

I will spend a little time on vaginal dryness or inadequate lubrication. Vaginal dryness can occur due to variety of reasons and at any age. Usually the vagina has a thin film of fluid that coats it. This fluid helps lubrication during sexual intercourse, maintains the normal environment of the vagina preventing the overgrowth of organisms like fungi, flushing out dead cells and menstrual blood. The level of this fluid/moisture varies with the level of estrogen released in the body. During sexual intercourse, there is increased blood flow to the vaginal area leading to an increase in the volume of moisture. During menopause, however, the level of estrogen is very low leading to vaginal dryness, loss of elasticity and thinning.

The main consequence of vaginal dryness is the fact that it affects sex life such that these women experience significant pain and sometimes, bleeding. Other problems that vaginal dryness could cause include soreness, itching and burning around the vaginal area, recurrent urinary tract infections and frequency of urinating etc.

There are other conditions, other than menopause that can lead to low estrogen and consequent vaginal dryness. They include childbirth, breast feeding, cigarette smoking, some medications (like anti-estrogen drugs used to treat cancer) and douching. Douching refers to the practice of cleaning the vagina with a ‘cleansing’ fluid. For more on this topic, please click on this link: https://chatwithdrketch.com/…/daily-health-tips-what-is-dou…/

Other very common causes of vaginal dryness include a lack of foreplay during sexual intercourse, feelings of guilt, relationship issues, allergy etc

Treatment depends on cause. If it’s due to low estrogen, the focus would be on replacing this either through Hormone Replacement therapy or through the insertion of estrogen pessaries (tablets, cream or ring) into the vagina) should help. If due to rushed foreplay, there should be a conscious effort to slow down allow enough time for foreplay and sometimes, discussion with the partner may be helpful. Avoid heavily perfumed products like sanitary towels, tissues etc which may lead to irritation of the vagina and subsequent dryness etc.

Use of vaginal moisturizers can also help. Vitamin E may be useful as a vaginal moisturizer with the gel rubbed on the vagina.

Please discuss these with your doctor and don’t be embarrassed to discuss your symptoms with him 😀

I hope this helps.