Ask Dr. Craig: Having Painful Sex

Dr. Craig is a BellaNaija columnist and one of the doctors who writes for BN Doctors’ Lounge {Get familiar here}. The idea behind ‘Ask Dr. Craig!‘ is for BN readers to get quick sharp answers to niggling medical issues that they have. This does not in anyway mean that readers should not go to their doctors. However, sometimes you just need a human face to give answers to those fast, burning medical concerns our readers have.

Send your questions for Dr. Craig to features(at)bellanaija(dot)com stating your full name and where you are writing from. (Your name will never be published) The editor reserves the right to edit submissions for content brevity and clarity. We regret that we cannot provide individual answers to questions sent in and cannot state at which exact date answers would be published.

***

Dear Dr. Craig,
I got married in January; and since we were both virgins I and my husband decided to wait until we after our wedding to have sex. As you can imagine we were looking forward to our wedding night, but when the time came to do it we were unable to. Maybe I should say, I was unable to. It was just too painful. We tried several times, but as soon as he started to enter I would feel a sharp pain that made it literally impossible to continue.

After about three weeks of trying unsuccessfully I decided that my pain was no excuse to deny my husband the pleasure he had graciously waited all these years for. So, I braced myself to bear it. I had spoken to other married friends who assured me that the pain was temporary and that if I only endured for a short while I would see that the pain turns to pleasure. When he started to enter me I felt the sharp pain as usual, but I closed my eyes and tried to ignore it, hoping that as I was promised, pleasure would soon overtake it.

The pleasure never came; instead the pain grew worse and worse until all of a sudden I felt like a knife was cutting through my vagina. I couldn’t bear it any longer and I screamed out in pain, only to look down and see a pool of bright red blood soaking our bedsheet. I know that women bleed when they lose their virginity but this was different. No matter what we did, the bleeding didn’t stop. By the time I began to feel dizzy, my husband decided that it was best we go to the hospital.

The night doctor confirmed that I had sustained a tear down there and I had to get stitches to stop the bleeding. After getting treatment, the doctor prescribed Sitz baths and advised that we abstain from sex for two weeks to allow the wound heal. I don’t think I have ever been so frightened or embarrassed in my entire life!

Fast-foward two weeks. My husband had not tried to touch me after the hospital incident but I saw Valentine’s day as an opportunity to make it up to him and was determined to try and get us past this. We tried again on Valentine’s morning and twice again in the evening but nothing we did seemed to work. I felt like I was going to die from the pain.

What am I doing wrong? Why can’t I have sex with my husband? Could it be that the wound hasn’t healed? Or is there something wrong with me? Why can’t I be like normal women? Maybe if I had experimented with previous boyfriends like all my other friends I would not have this problem now. I feel like a failure, like my husband is going to leave. I feel like I’m constantly letting him down.
Help me, please, I don’t know what else to do.
Unhappy Bride,
Yaba Lagos

***

Dear Unhappy Bride,

First of all let me say how sorry I am that you have had to go through such a terrible ordeal. I myself am a strong advocate of celibacy and I applaud you and your husband’s decision to wait till you were married, to have sex.

Sex should not be painful. Even the first time!
Unfortunately, excruciatingly painful first sex has been accepted as a normal rite of passage into womanhood. I am of the opinion that it should not be so. There may be some slight discomfort, yes, but if done correctly a woman’s first sexual experience should never be so painful that it becomes unbearable.

After two weeks it is very likely that your wound has healed. I cannot give you a definitive answer as to why you have had this difficulty, because I am unable to ask you further questions or to properly examine you. However, the most common cases of Post Coital lacerations occur because the couple have had one or more of the issues I will briefly discuss below.

Click here to view image illustration.

1. Improper approach
The vagina may seem like a fairly long slit nestled between a woman’s legs when viewed in conventional diagrams, but in reality the opening that allows for penetration is less than 1/5 of the apparent extent of the vulva.

Attempting to enter the vagina anywhere other than at the opening (ie at the perineum, labia, urethra etc) will not yield much success, and is sure to cause you pain. It is, therefore, important that your husband can see where he is going and what he is doing. I suggest that you keep the lights on and explore, until you both are familiar with the terrain.

Many first timers may also not know that the vagina is not perpendicular to a woman’s spine; and since the missionary position is the most common choice for first timers, it is not uncommon to have men trying to push straight down instead of going at a slight 45° angle.

If he visualises the vagina as though it were a tunnel starting from between your legs and pointing down to your back stopping just under the belly button then the angle of penetration will be less askew and less likely to cause abrasions.

Lying flat on your back is also very likely to cause the pelvic muscles to tighten and close off the opening of your vagina. Propping a pillow under your hips will create a slight tilt that puts the pelvis in a more neutral angle and opens up the vaginal entrance for easy acess.

2. Hymen
The hymen is a thin membrane that partially covers the enterance to vagina but has openings to allow for menstural flow. Some women have horizontal slits, others have a small round (annular) hole. Some others have many small (cribiform) holes spread across the membrane. In rare cases there may be no opening at all in the hymen (Imperforate Hymen) or the hymenal tissue may have become thickned by fibrosis. Click here to view image illustration.

It is important that in cases where the hymenal opening is too small to accomodate the penis, the couple employ other means of gently and gradually widening the opening before attempting intercourse. This can be done using the partner’s fingers – starting from the smallest and gradually adding one after another.This is because forcing the penis through a relatively small hymenal opening will definitely cause pain and may cause bleeding. Alternatively your doctor can perform a hymenectomy which is the surgical removal of the hymen.

3. Penovaginal disproportion (PVD)
This occurs when the muscular walls of the woman’s vagina, at their current most relaxed state, are unable to accomodate the size of her partner’s penis. This is often seen in child/early marriage or in couples where a larger than average man pairs with a petite woman. As alarming as this may sound, it is quite often temporary. This is because the vagina is able to adapt and stretch to accomodate sizes as large as a baby’s head.

The treatment of this employs the use of a medical devices known Amielle Trainers. These are available in a pack of five graduated dome tipped dilators that the woman inserts into her vagina starting with the smallest to the largest over a period of days or weeks to help maintain at least a 1/2 inch clearance at full relaxation. Click here to view image illustration.

It is also important that you learn how to consciously tighten and relax the vaginal muscles so that during penetration you are able to relax and let your husband in. If you alternate squeezing and relaxing as your partner introduces his penis, then you are able to control the penetration and let it progress at your pace. Kegel exercises are very helpful in learning how to voluntarily control the vaginal muscles and have the added benefit of increasing the chances of orgasm.

BenWa balls and other such devices are available that can help women practice their kegel exercises and develop the pelvic floor muscles

4. Lubrication
Even where there is no PVD, it is still possible to tear the lining of a woman’s vagina if the man attempts to penetrate without adequate lubrication. The vagina produces a natural lubricant when a woman is aroused. The quantity of production, however, varies from woman to woman. On one hand, some may only feel a slight wetness; and on the other hand, a few women report a more pronounced flow ranging from a trickle to a gush.

A good tip to prevent dryness is to avoid directly facing the fan during intercourse as this can dry natural vaginal lubrication very quickly. Supplement natural wetness with water based lubricants, if you are using a latex condom or other barrier forms of child spacing. If you have an implantable or injectable, then oil based lubricants like Coconut oil can be used. If you are trying for a baby and need the extra lubrication, then rapseed oil is preferred, because it does not interfere with sperm motility.

It is also important to mention that if a woman’s partner is not gentle and patient even with adequate lubrication she will most likely feel more pain than is necessary.

5. Vaginismus
Most cases of Vaginismus occur after a traumatic experience related to sex (i.e attempted rape) and in a bid to protect herself, a woman’s subconscious mind can control the muscles of the vagina and clamp it tightly shut. In severe cases of Vaginismus even a cotton bud is unable to pass through and if not treated agressively with psychotherapy, traumatic post coital lacerations like the one you had can lead to Vaginismus.

Was there some other sexual experience in your past that could have already caused you to clamp shut? Or has this experience made it even more impossible for you to relax and enjoy sex with your husband? I would suggest that you speak with a Sex Therapist or relationship counsellor to help with whatever feelings of fear that may still be lingering in your subconscious.

6. Vulvodynia
This is the medical term for pain in the vulva and its cause may range from conditions like thrush, pelvic inflammatory disease, urinary tract infection to scarring from female genital mutilation. It is important to treat any medical cases that may be responsible for pain. If you have experienced any of these it is important to see your doctor.

So, in a nutshell:
Put on the lights. Explore. Lots of lube. Slow and steady.
Hymen is too tight, coax it open first before going all in.
Too small? Partner too big? Train your vaginal muscles.
Emotionally scarred? Talk to a counsellor.
Infection? Get it treated.

Sex is beautiful and is part of the special bond that married couples share. Follow the tips outlined above and with some patience and lots of practice I am confident that you both will be on your way to a happy and fulfilling sex life.
I hope this helps.

Disclaimer: This column is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.

Photo Credit: Vulva Anatomy | Pelvic Exam | Hymen types | Amielle Comfort | Kegel exercises | Vaginismus