When sex is just too painful to bear
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Johannesburg - They have been married for seven years. She is 34, he is 39.
Their marital difficulty? They are unable to conceive. But not for the reasons one would imagine.
The couple have not consummated their marriage because she experiences extreme pain when trying to have sex.
Her diagnosis: primary provoked vestibulodynia and vaginismus, a condition that makes her unable to have sex or experience vaginal penetration without severe pain.
Dyspareunia, or rather, pain during intercourse, is a condition that will affect approximately 20 percent of women during their lifetime, and according to psychiatrist Dr Careen Rascher and physiotherapist Hester van Aswegen, the condition is more common than people think.
Rascher and Van Aswegen made presentations on types, causes, symptoms and treatments of the vulvodynia and vaginismus at Wits University Donald Gordon Medical Centre, in the hope of demystifying a historically taboo issue, never truly spoken about, especially in conservative communities.
“Provoked vestibulodynia is characterised by severe pain in the vestibule (entrance) of the vagina in response to a non-painful stimulus. Vaginismus is characterised by involuntary spasm of the muscles surrounding the outer third of the vagina”, Rascher explained.
“Painful intercourse can be due to anatomical, physiological or psychological causes. The causes can be superficial or deep, and detract from feeling pleasure during intercourse, which leads to decreased lubrication and vaginal dilation, and ultimately difficulty with penetration.”
The most common psychological causes of pain during sex, Rascher noted, were fear of pain, feelings of guilt and shame, ignorance of one’s sexual anatomy and traumatic past experiences.
The most common medical causes were infections, tissue injuries, hormonal causes and bladder irritation.
“Many women on oral contraceptives can also develop oestrogen deficiency, which leads to a thinning of the vaginal mucosa that leads to dryness and thus to painful intercourse,” she added.
“Sex therapy is often misunderstood to be about a couple having sex in front of a therapist or having a sex surrogate, which doesn’t happen in South Africa. Sex therapy is really a form of talk therapy and most therapists are mental healthcare providers.
“In managing pain during intercourse, we need to determine and treat underlying causes, and identify and treat psychological issues. Often, the problem is poor communication between the couple and an inability to talk about sex.”
This treatment involved a multidisciplinary team that includes physiotherapy.
Rascher said people often had unrealistic expectations of what intercourse should be like from watching porn.
With sex therapy, the goal was to initiate sensate focus exercises between couples to make the experience more comfortable. She said they taught couples mindfulness training as well as alternative forms of sexual expression.
“Many women will experience pain during intercourse, or rather, dyspareunia, and we need to continue talking about sex.
“Recurring pain during intercourse can result in repeated disappointment and loss of self-esteem as well as a loss of intimacy,” said Rascher.