Dr. Sylvester Ikhisemojie
Dyspareunia is a big-sounding word that is also the medical term for painful intercourse. It goes beyond that and actually describes a situation of painful, recurrent, and persistent pain suffered by someone in the course of performing sex. It happens to both men and women but is far more common among women. It is alternatively described as genital pain that is experienced just before, during or after sexual intercourse. It is a condition that may, therefore, be due to medical, physical or psychological causes. The vulva and vagina can develop a long-standing reaction to something that comes into contact with that area even if it is a product or device that has been used for a number of years. This includes even condoms which are capable of causing chronic irritation and pain.
Such irritation may be superficial in which case the vulvae are involved in it or it may affect the vagina in which case the pain is often deep-seated. In summary, therefore, pain in the course of sex can be caused by several things such as an illness; an infection; a physical problem or a psychological issue as we already have mentioned above. However, men are more likely to discuss this kind of problem and seek treatment than women are even though nearly one-quarter of all women everywhere suffer from this problem.
Painful sex in a woman that is felt within the vagina can be caused by an infection such as thrush, which is a yeast infection or by chlamydia, gonorrhoea, and herpes. These are sexually transmitted infections that can also affect the mouth in those people who engage in oral sex. Furthermore, during menopause, a woman may experience painful intercourse because of a dry vagina caused by changes in hormone levels. The major hormone responsible for this problem is oestrogen, the level of which falls in the blood, and is experienced by women after the age of 55 years in the majority of cases. In addition, a condition known as vaginismus can be responsible for this debilitating problem that even makes some women afraid of engaging in any sexual act. Vaginismus is a situation where muscles within and around the vagina contract strongly enough to almost completely shut tight the vagina such that sex is made uncomfortable, painful, and undesirable. Such women become so terrified of the experience that they become likely to go into a cruel spiral in which the fear of experiencing such pain as described above promotes more vaginal spasms and more pain. Any substance which irritates the genitals like soap, chemicals used for douching, spermicides and rubber condoms can cause this problem. Finally, a lack of sexual desire at any age can be responsible for it.
Pain felt inside the pelvis during sexual intercourse can be caused by pelvic inflammatory disease in which pelvic organs mainly the uterus, fallopian tubes and the ovaries undergo an abnormal enlargement of their respective tissues beyond certain limits and cause pain. This happens in response to an infection by microorganisms. Besides, endometriosis in which tissues from the uterus are deposited elsewhere in the body can provoke intense pain in the pelvis during sex. The same is true of irritable bowel syndrome in which the agitated intestines cause a sympathetic inflammation of the same pelvic organs mentioned above to cause pain. Very often, even the lining tissue of the pelvis known as the pelvic peritoneum becomes involved in the inflammatory process. Now, fibroids growing close to the cervix or the vagina can similarly cause pain during coitus and in some truly conservative, traditional societies around the world women bear these pains in silence and submit to husbands without ever considering the possibility that something may actually be responsible for it. In some women with poor stooling habits that engender constipation, they can similarly suffer from pelvic pain during sexual intercourse.
In men, sexual intercourse can be painful due to the presence of infections which can cause some soreness and itching in and around the penis such as thrush. Certain sexually transmitted infections such as herpes can similarly cause pain. Pain and swelling within the testes can sometimes be caused ironically by sexual arousal which is not accompanied by ejaculation. This can occur when a cohabiting couple is forced to break off suddenly by an intruder who frustrates the process, or it may be a sign of an infection such as chlamydia. Chlamydia is notorious for causing most cases of inflammation of the urethra not due to gonorrhoea. Inflammation of the prostate gland due to an ongoing infection can also cause such pain. Men who are not circumcised face peculiar problems in this aspect and have to suffer intense pain when the foreskin is tight and is difficult to push back when it is ready to enter a vagina. The same thing happens when the uncircumcised foreskin sustains small cuts and tears usually during cleaning but also during routine dressing when the zipper of one’s trousers can injure the prepuce. The pain is a sharp, stinging one similar to when soap or pepper touches a wound.
The symptoms of this malady are various and numerous. There may be pain initially only with penetration of a vagina. But over time, there may develop a situation in which every kind of penetration can cause pain. This can occur whether it is penetration by a finger or by a tampon. Sometimes, the pain is of a different kind being that it would occur deep in the vagina or pelvis in the course of thrusting. Some women will endure this punishment for fear of causing offence while some others will cease to participate actively in the encounter thus prompting the man to either slow it down or stop altogether. Such pain may be burning in character if it is an infection or aching if it is due to some other causes like fear, anxiety or the presence of fibroids. When the pain is of a throbbing kind, it may endure for several hours after intercourse. Sometimes, there may be a vaginal discharge which helps to direct attention to the possibility of infection being responsible for it. However, there can be no substitute for diligent examination in an attempt to determine where the problem lies and every effort must be made to relieve the discomfort every man or woman might suffer as a result of this problem.
In women, the vagina becomes less tight when they are sexually aroused. Paradoxically, men are often less pleased by this development due to a profound lack of understanding of what it means. When a vagina is tighter than usual, it means the owner is not sufficiently aroused sexually or not aroused at all. She is, therefore, likely to become less comfortable, have less pleasure and be more likely to be in pain than when she is fully or properly aroused. Infection or inflammation can be responsible for this. But after menopause, certain changes in the body can make it difficult to get properly aroused, difficult to get naturally wet, and painful to have intercourse. Getting an orgasm may even be impossible. And while inadequate lubrication may be largely responsible in younger women as a result of inhibited arousal, oestrogen deficiency is the predominant reason in the older, post-menopausal woman. The latter can be educated on different methods of vaginal lubrication while the younger, inhibited woman can be educated on different foreplay techniques. The understanding of the possible causes is critical to making an informed intervention on behalf of the patient.
Treatment of cases depends on the cause. In men, this is often far more straightforward than in women. Once the responsible part of the male genital organs is identified, relevant tests are done and treatment can successfully be carried out. In the case of women, the issues are somewhat more complex and identification of the probable cause is not a guarantee to successful treatment. In the elderly woman with lubrication issues, items ranging from vaseline to K-Y jelly and to lidocaine gel are often used. These are frequently without prescription. A substance like lidocaine gel is a local anaesthetic agent apart from being a lubricant but its effect may be such that it removes all sensations from the vagina and could paradoxically increase sexual frustration. For the psychologically troubled woman and the one who is post-menopausal, the application of oestrogen cream is perhaps the best locally effective agent to improve vaginal response to sexual intercourse.
Questions and answers
Dear doctor, I am a regular reader of your column in Sunday PUNCH. My nephew was shot in the right thigh some weeks ago which also broke his leg. There was a big open wound at the side of the thigh and even though he has been taken two times now to the theatre, the bullets were not removed. The doctors removed about 13 of the bullets but the remaining ones are not less than 10 according to the X-rays but the doctors are telling us that removing those still in the flesh is not important and can be left alone. Is this not too dangerous to the life and health of that young man? We need your opinion, please. Thank you. 0810xxxxxxx
The fact that you said there were many bullets tells us that what he has in his body are pellets and not a bullet. One individual is unlikely to have more than one bullet in their body and still be alive; the damage from that ordinance is just too much and the consequence is often fatal. Besides that, any individual who is found to have a bullet on X-rays, which is usually conical in shape, would be spared no effort to have it removed in a properly resourced hospital. This is done because a bullet contains much lead, is a projectile fired at high speed, and it is likely to continue to damage tissues around the body if left in place. Pellets, however, are another matter. Most are made from lead as well, iron, zinc, tin or even plastic. They are typically round and small and have low projectile power so that they must be fired at short range to cause the sort of injuries you described. The two different operations may have been done to clean the wound properly rather than to look for the pellets. Doing so could cause more unwarranted damage to the tissues and with no guarantee that such an effort would succeed. Over time, some of these pellets would find their way to areas just beneath the skin from where they can easily be removed.
Dear doctor, I learnt that anything to do with pregnancy is a risk. True or false? It seems true. My prayers go to all pregnant women. Thank you and cheers.0903xxxxxxx
Frankly, this is a false premise. Not everything to do with pregnancy is a risk because, in the end, it is a biological need that a woman is built to fulfil. However, if you are relating pregnancy and its associated risks to the kind of country we live in, you are correct to a large degree because Nigeria is one of the few countries in the world where women are most likely to die from the complications of pregnancy and where it is most risky to have a baby. That said, many, many pregnant women still do not even go to a hospital when they are in labour because such facilities are too far away from them, or it is too dangerous to attempt the journey or they are too poor to afford such care. These are the contributors to that risk you talked about.
Dear doctor. Firstly, I thank you for the regular medical advice being enjoyed weekly. May God Almighty continue to bless and protect you in Jesus name, Amen. I am a 79-year-old woman. My issue of health bothers me because of my sudden inability to stand straight to walk about a month ago, and any attempt to avoid being bent to walk would amount to severe pain for me. Meanwhile, I used to have joint pains occasionally and I have been to the hospital for it. Thanks in advance for your response and if possible for the drug or measure to take. It would be highly appreciated, sir. 0803xxxxxxx
Thank you very much for your prayers madam, to which I say a big Amen. It is not abnormal to experience such pains around your body at your age and my advice would be that you should return to the hospital where you initially complained about your joint pains so that the doctors there can re-examine you. Possibly, and in all probability, these two events are related and it should be fairly easy to find suitable medication for your pain.
Dear doctor, to be a doctor is not easy. When someone dies, they would start blaming doctors. Michael Jackson’s doctor was sent to jail. Please, be careful at your job. 0806xxxxxxx
Thank you for your contribution, and thanks a lot more for your advice. In some countries, doctors are not referred to by their names in court whereas in others, like the UK, Nigeria and the US, the doctors are named usually. In both cases you mentioned, the prosecution was able to establish that professional negligence had a huge role to play in both deaths; in the case of Michael Jackson, the doctor administered a powerful anaesthetic agent to help achieve pain relief and stepped onto an adjacent balcony to chat with his girlfriend.
Dear doctor, I have been feeling some body pain, pain in the stomach, weakness in my joints, a little headache and drowsiness. I cannot really eat much even though I do feel hungry. And if I don’t urinate when I need to, the stomach pain becomes too much. Sometimes, I sleep late at night, maybe when I am watching a film or so, and at other times I might just sleep off but the sleep is not deep and I end up sleeping during the day so well that I might even find it difficult to get up from the bed. 0806xxxxxxx
I sympathise with you. I believe you may have two different tendencies in your body. The various pains you feel around your body may be due to specific ailments and it will be in your best interest to see a doctor for examination and investigations. The results retrieved will guide your treatment and that should solve the problems you might have now. As for the sleep disturbances you experience, it will be good to also complain about that so that the doctor can advise you on how to reset your sleeping hours. The best and most natural time to sleep is at night and not in the daytime. While this is increasingly difficult to achieve in the modern era, it must be emphasised that there is no alternative to it.
Dear Doctor, I have read many of your articles in Sunday PUNCH. I have confided in you to relate what I have been with for years. I noticed a growth (like a lump) on my buttock around 2013. Up till now, it is still there, it doesn’t increase nor decrease in size. It’s not painful as well. I need to get rid of it, sir. How may you help me? Warm regards. [email protected]
Well, a growth as you referred to in your question is likely to be a benign growth. This means that it is most likely to be a non-cancerous growth. However, the best thing to do as always is to get a doctor to examine it and have a fairly clear idea of what this might be and proceed to remove it. That removal is usually a minor operation performed under the cover of an agent that will just numb the area where the growth is located and it can then be removed painlessly. You can go back home soon afterward.
Dear doctor, greetings to you. My mom, now 71-year-old, has a dark patch on the front part of her leg that started like an insect bite. It has grown wider and longer over the last three years and it is not showing any sign of stopping. Nothing hit her there and she has been using neurogesic balm two times a day for the greater part of three years. But it does not show any sign of going. It itches her slightly but that is all. 0803xxxxxxx
It is curious but judging from the picture, it could be what is known as discoid eczema or it could be a fungal infection. Whatever the case may be, she would be best served if she sought an audience with a dermatologist who is an expert on skin diseases and would let her know what this problem is after due examination and determine what kind of treatment she should be given.
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