Pain reduces pleasure
After my children were born, I have not enjoyed sex at all. I am protected against getting pregnant again, so I feel that’s not a problem. Also, I enjoyed sex a lot before children. Sometimes, I think it’s all in my head, that if I could let myself enjoy it, I wouldn’t feel any pain; yet I know there’s something wrong down then. My gynecologist has not been able to figure anything out.
This kind of report typifies a woman, who is eager for a sexual experience, but is finding each encounter to be more and more negative, because of the intense pain, she experiences during each sexual act. Pain during intercourse is technically called dyspareunia. It has a number of different sources. Whatever the source, when pain is experienced, sexual enjoyment will be greatly reduced, if not eliminated altogether.
PAIN AND THE NEW BRIDE
For the new bride who is a virgin, it is not surprising, if there is a small amount of pain. Most women experience at least a little. This can be due to the opening in the hymen being tight and small. In the great majority of situations, it is due to a combination of new, excitement and anxiety, which prevents the woman from relaxing. When the necessary physical changes do not take place (the opening up and laying flat of the major lips, plus lubrication), then the entry is going to be more difficult and the pain more intense. Entry under these conditions increases pain and reduces the possibility of pleasure. Once the woman feels pain, tension is likely to set in. This tension will inhibit arousal and block any kind of release. While many couples begin in this way they usually get past the sequence quite quickly. But the sequence can be avoided, to begin with.
If you are an engaged couple or if you counsel engaged couples, attending to a few small details will reduce much of the anxiety and potential for pain. The first six weeks to two months before the wedding date the woman should be examined by a gynecologist or qualified general practitioner. In this experience, the doctor should be able to communicate to her, whether her physical anatomy is normal and whether there are any particular barriers of which she should be aware. The couple and the physician should discuss birth control methods.
In the weeks before the marriage, every time the bride-to-be takes a bath, she should use her fingers to stretch the hymen, until she can insert three fingers into the vagina and pull it apart slightly. This stretching procedure will prepare the vagina for entry and will also help the woman become familiar with some of the sensations of having the vagina stretched. As the wedding comes closer this might be done several times a day.
The couple should be encouraged to take along a lubricant that is not sticky (not Vaseline). K-Y jelly or Lubrifax are recommended for genital use. For use over the whole body as well as genitally, a non-allergic lotion without lanolin such as Allercreme is good. The couple should plan to use the lubricant for all entry experiences, whether they think they need it or not. The lubricant protects the woman, in case she dries up during the excitement. It also provides a distraction from the focus on the entry. A small amount of lubricant should be applied to the head and ridge of the penis and to the opening of the vagina.
A final word of instruction to the new bride and groom is to move slowly. No matter how many times they tell themselves to proceed slowly, they will still most likely move ahead too quickly. If a couple can plan to move into their first experience with a great deal of gentleness, patience, ease, and relaxation, they are most likely to create a positive beginning to a life of love.
STRESS BRING PAIN
All of us show our tension in our own unique way. Some women, as they experience tension surrounding the sexual experience, will tend to tighten up their genital muscles involuntarily. In fact, they may not even be aware that the tensing is happening, since this is counter-productive to a fulfilling and releasing sexual experience. It is not surprising that these women end up frustrated. But, even more than the frustration as a result of the tension, they may experience palm, For example, if the tightening occurs before entry, it may cause pain upon entry. Sharp, spasmodic contractions after entry may also cause pain. The extreme form of this tension is called vaginismus.
Vaginismus is the involuntary tightening of the muscles, in the outer area of the vagina, which prevents the insertion of the penis. This contraction can be so severe that it is impossible to insert even your small finger. It can become a permanent state rather than just occurring as a result of the initiation of sex play. Because it is impossible for the man to enter, vaginismus is easily identified. Should this be your situation, consult a gynecologist immediately and specifically explain your situation. If he or she is not familiar with the usual treatment procedures ask for a referral either to another physician or to a sex therapist. This professional must be competent to guide you in the use of a series of dilators that are graduated in size and designed to eliminate these involuntary spasms. Be encouraged that this condition is extremely responsive to treatment in a relatively brief period of time. However, there should be some attempt also to understand the events leading to the vaginismus, so that his pattern will not be repeated.
Infections and irritations will obviously reduce pleasure. Whether the infection is in the external genitalia, causing pain during clitoral stimulation, or is inside the vagina, causing pain during intercourse, it will hinder freedom and enjoyment. Any kind of infection should immediately be dealt with by a physician. Sexual activity should be limited, according to the instruction of the physician. Sometimes, an infection provides the opportunity for the couple to focus on the rest of the body for those often bypassed, special pleasures. Just because there is an infection does not mean the couple should abstain from all sexual activity. If it is comfortable for both, the man can be stimulated to orgasm at the end of a total body experience without ever having contact with the woman’s genitals.
PHYSICALLY BASED PAIN
Infections and irritations will obviously reduce pleasure. Whether the infection is in the external genitalia, causing pain during clitoral stimulation, or is inside the vagina, causing pain during intercourse, it will hinder freedom and enjoyment. Any kind of infection should immediately be dealt with by a physician. Sexual activity should be limited, according to the instruction of the physician. Sometimes, an infection provides the opportunity for the couple to focus on the rest of the body for those often bypassed, special pleasures. Just because there is an infection does not mean the couple should abstain from all sexual activity. If it is comfortable for both, the man can be stimulated to orgasm at the end of a total body experience without ever having contact with the woman’s genitals.
Irritations are troublesome because there is no specific identifiable disease present. Yet an irritated vaginal opening or vaginal barrel can cause as much distress and pain during lovemaking as an infection. The best antidote to irritation is the generous use of a lubricant. Some women experience a thinning of the vaginal walls. Sometimes, this happens with age, particularly around the time of menopause because of a reduction of estrogen. If the walls of your vagina are thinning, again consult a physician to determine the cause, and then always use a lubricant to reduce friction. Even if the walls of the vagina are becoming thin, pleasurable activity need not cease.
Pain can also be the result of tears either in the opening of the vagina or small cuts (fissures) inside the vagina itself. Tears in the hymen usually cause pain on entry. Some women can identify pain at a very specific spot inside the vagina. Their report usually goes something like this: “It feels as if it is in the lower left hand and comes about an inch inside the vagina and it hurts exactly the same way every time. I feel I can even reach in and put my finger on it.” When the pain is this specific, it is usually not the result of tension or the thinning of the vaginal walls, but rather the result of a small tear inside the vagina. Because of continued sexual activity and the moist environment, healing is slow. When consulting a physician be sure to identify the exact location of the pain. Show the doctor, so that he can carefully warn it and determine the nature of the problem. As a rule, these tears can be treated with an ointment.
Some women report pain only during deep thrusting. There are three main sources of this kind of pain. The most commonly reported discomfort is the result of a lipped or retroverted uterus. When the muscles that suspend the uterus are weakened, the uterus drops so that the cervix, the opening to the uterus falls into the upper end of the vagina. As deep thrusting occurs the penis strikes the cervix, causing sharp, stabbing pain. It may cause a woman to cry out. Relief can be found immediately by a slight shift in position. For many women, a small pillow or folded towel under the lower back (if she is under the man) will shift the uterus enough so that deep thrusting can be enjoyed.
Other internal pathologies such as endometriosis or a misplaced IUD can also cause pain upon deep thrusting.
Finally, there may be pain as an outgrowth of trauma from childbirth. One such pain occurs in the sensitive scars from the episiotomy, the incision that is made between the vagina and the rectum to assist the birth process. There also may be tears in the ligaments that hold the uterus in place, in the vaginal wall, or around the opening of the vagina. Tears are more likely to occur with a difficult birth. This was true for us after the breech (feet first) delivery of our first child. For those resuming sexual activity after the birth of a child we would issue the same encouragement given to the newly married couple: move carefully and slowly, haste will only hurt; be generous with the lubricant.
MANAGING PAIN
Whenever you experience pain, the first thing you should do is talk about it with your husband. Never grit your teeth and bear it. Define exactly where the pain is located and when in the lovemaking process it occurs. Even, before you get to the physician, you may be able to avoid the situations that cause the pain, if you guide the penis for entry and shift positions to make adjustments. Except for pain from deep thrusting, lubrication will almost always reduce some of the intensity, even if it is from an infection. Then, discover what is pleasurable and focus on that for the time being. Avoiding entry for a few lovemaking sessions may be necessary. It is important not to continue the activity that triggers the pain. Whenever a negative sensation like pain is associated with a pleasurable activity like sexual play or intercourse, the pleasurable event will begin to take on the negative feelings. Even, after the physical reason for the pain has healed, a woman may continue to tense up or avoid the sexual activity that was linked with the pain. Her pulling away and tightening up has become a conditioned response. Sometimes the pain will continue because of the tension. In dealing with this, use the same approach as you would for any emotional hesitancy or avoidance. Begin gradually, letting the woman take the lead until the tension concerning the pain has been reduced. An increasing number of women, particularly young women, are reporting pain during intercourse. If you are among these, seek help after talking about it with your partner. Pain does not have to be tolerated. In fact, pain cannot be allowed to continue If you are going to enjoy sexual pleasure.