Painful intercourse is for many a difficult subject to discuss and many persons suffer silently due to fear of rejection or offending their partner.

The medical term for painful intercourse is dyspareunia - which is defined as "persistent or recurrent genital pain during or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus and causes marked distress or interpersonal difficulty". The word is derived from the Greek word, dyspareunos, which means "difficulty mating" or "badly mated".

Painful sex affects about 15 per cent of sexually active women and five per cent of men

Why do men feel pain?

Men experience pain during sex because of physical or psychological reasons.

The primary psychological causes are anxieties and guilt or a rare condition called post- ejaculatory pain syndrome.

Why do women feel pain?

Because of obvious anatomical differences, women are more prone to experiencing pain than men.

The psychogenic causes are usually secondary to deep underlying sexual phobias, strong religious hang-ups regarding sex, fear of pain, a past history of sexual abuse or a condition called vaginismus which is characterised by involuntary spasm of the muscles of the pelvic floor making sex quite painful or impossible.

Diagnosing the problem

Your doctor will take a thorough medical history, perform a pelvic and rectal examination and do comprehensive laboratory and radiological investigations to identify the cause.

Treatment

Your treatment depends on the underlying cause of your pain and may include:

Improved hygiene habits - discontinuing the use of perfumed soaps, douching, vaginal perfumes, bubble baths, scented or tinted toilet papers, panty liners or tight synthetic undergarments such as panty hoses.

Switching of positions - Try the female dominant position (woman on top) during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels comfortable.

Improve communication - Talk about what makes you feel good and what hurts.

Longer foreplay - This can help to stimulate your natural lubrication. Delay penetration until you feel fully aroused.

Using lubricants - A water-based lubricant, such as K-Y jelly can make sex more comfortable.

Treating underlying conditions - If an infection or medical condition is contributing to your pain, treating the underlying cause will resolve your problem.

Vaginal dilators and oestrogen - can alleviate vaginal strictures (an abnormally tight vagina)

Oestrogen therapy - using creams, tablets or flexible vaginal rings will improve lubrication.

Desensitisation therapy - teaches you vaginal relaxation exercises, discuss this with your doctor.

Counselling or sex therapy - might be necessary for those afflicted with psychological dyspareunia.

Peyronie's diseases can be corrected with surgery.

A fractured penis is a medical emergency which requires urgent surgical treatment.

Don't suffer silently. Dyspareunia is an eminently treatable condition. If you cannot enjoy sex due to pain, seek help from a health professional and begin to experience the true joy that sex brings.

Dr Alverston Bailey is a medical doctor and immediate past president of the Medical Association of Jamaica. Send comments and questions to editor@gleanerjm.com or fax 922-6223.

CAUSES OF PAIN IN SEX FOR MEN

Trauma from the dangling string of an intrauterine contraceptive device

Infection or inflammation of the glans (head) of the penis, the urethra or prostate

Peyronie's disease - a bent penis

Vigorous intercourse which tears the delicate tissue under the glans of the penis called the frenulum or in some instances even fracture (break) the penis.

CAUSES OF PAIN IN SEX FOR WOMEN

The physical causes can be deep or superficial. Superficial pain can be caused by:

Infection or irritation of the external genitalia or vulva called vulvitis due to irritation from soaps, detergents, sanitary pads, female hygienic products, yeast, herpes and other STIs.

Vigorous or rough sex can also tear the delicate lower part of the vagina called the fourchette.

Deep pain is also caused by rough sex which results in forceful contact of the penis against the cervix, the uterus or the ovaries which might be in the pelvic floor.

Genitourinary disorders such as endometriosis, pelvic inflammatory disease, uterine prolapse (the womb descend into the vagina), a retroverted uterus (the womb is bent backwards), uterine fibroids, cystitis, irritable bowel syndrome, haemorrhoids (piles), ovarian cysts, chronic cervicitis and pelvic congestion.