Experiencing pain during sex? Here is what you need to know

Dear EVE,

I got married this month but when I try to have sex with my wife, she cries, says it’s painful and asks me to stop. Up to now we have not consummated our marriage. What can I do? Help me please

Dear Reader,

Thank you for writing me about this issue. Just reading your question gives the impression that this has been a source of stress and strain on you, your wife and probably even your marriage.

Painful sex for a woman can be caused by a number of different factors. These can include insufficient vaginal lubrication. The solution to this could be as simple as applying an over-the-counter lubricating gel before penetration; your bodies won't know the difference especially once intercourse begins and it's a simple enough place to begin. In terms of medical issues, these can include conditions such as vaginismus (an involuntary contraction of vaginal muscles), endometriosis/adenomyosis (when uterine tissue grows into/outside of the uterus), cysts, fibroids, PID (Pelvic Inflammatory Disease), Vulvodynia (pain that is located on a woman's genital area), other vaginal infections such as BV (Bacterial Vaginosis, a simple imbalance of good/bad bacteria), STIs, ectopic pregnancies (a pregnancy that happens outside of the womb e.g. in the fallopian tubes; please note that this is a medical emergency and a hospital should be contacted immediately) or even a simple UTI (Urinary Tract Infection). Having sex too soon after childbirth or other medical interventions such as surgery, any current or previous sexual trauma, or even negative sexual attitudes can also contribute greatly to painful sex. Even menopause and perimenopause can cause vaginal dryness, which can cause painful sex.

Where do we begin?

First, your wife will need a proper medical assessment by a gynecologist or other medical doctor to determine whether there is a physical reason for the pain she experiences during sex. You can expect a physical examination, especially if you' visit a gynecologist. The exam will likely last only a few minutes and will allow the doctor to determine specific characteristics of the pain e.g. whether it's all over or only in a specific area, if anything makes it better or worse, etc. The doctor may even recommend additional tests such as pap smear, blood and/or urine test especially if they have already formed a suspicion of what the problem could be.

What next?

If she is deemed to have no physical reason for the pain, then please visit a qualified therapist for a non-medical assessment. Expect them to ask personal questions such as her and your sexual history and other such details. While the content of your conversations might feel intrusive or uncomfortable, your confidentiality is assured so please be honest so that they can have all the relevant information. Keep in mind that you may request/require separate sessions. You can also expect to have some homework to do in between sessions as part of your therapeutic process. Some of it may be for her to complete on her own while some of it may be for both of you to complete together. Please do it and complete it as your progress will depend on your commitment to the process. Additionally, make note of what positive or negative outcomes occur as a result of the homework e.g. if it makes one of you feel particularly vulnerable or it's funny or exciting or brings up resentment, make note of that and be honest with your therapist about that.

Something to remember:

As her sex partner, you may be tempted to think that since this is 'her issue', then she's the one that needs to go to a doctor/therapist, get treated and then return to you ready for sex. Fortunately, or unfortunately, this approach is likely to draw out the length of treatment and unlikely to be successful. Sex is an act between two people so when there's an issue, it affects both people and therefore when there is treatment, it is more effective to involve both people. There's bound to be an enormous amount of stress on you as a couple and as individuals so let me encourage you to exist in honesty instead of painting a veneer of happiness while resentment is bubbles under. A team effort is likely to have a better outcome.

In the meantime, what do I do? A man has needs!

It's true that indeed a man does have a normal, natural desire for sex. Consider too that a woman's desire is just as present. Keeping this in mind may help you resist the temptation to blame her (body) for failing to satisfy you as you had planned. I am a big believer in that we do reap what we sow. My hope for you both is that you will treat the season between seeking help and finding an intervention that works will be a season of great adventure and learning. You could, for example, find other ways to experience sexual pleasure knowing that they won't necessarily replace intercourse but rather form part of the fabric of your sexual vocabulary. I therefore urge you to choose wisely as you walk the journey towards sexual success