Dr. Raman Chopra

Dyspareunia (Painful Coitus)

Recurrent or persistent genital pain associated with sexual intercourse in either male or a female.

In females, the pain may be superficial during penetration or deep during penile thrusting. The intensity of pain may range from mild discomfort to sharp pain. On examination, no genital abnormalities are seen. Repeated genital pain during coitus may result in the avoidance of sexual activity, disrupting existing sexual relationships.

Females : Dyspareunia can be of psychogenic or organic in origin.

Pain in vaginal outlet and clitoris : If the hymen is intact, this is a source of irritation. Episiotomy scar can cause pain. Smegma accumulated under the foreskin of clitoris

Irritates the area and causes intense burning.

Pain in the vagina : One of the common causes is the failure to lubricate. This happens when the women have no affection, respect or understanding for her husband. Because of various fears like fear of pregnancy or of coitus, her natural response will be inhibited. Many women does not lubricate because of aging. Thin walls of vagina crack and bleed easily during the intercourse, causing discomfort that lasts for hours to days. Homosexual women will not lubricate in heterosexual activity. Infections of the vaginal or urinary tract will give rise to burning, itching or pain in the vagina. When there is itching and burning but no infection, sensitivity to the rubber of condom is a possibility.

Pain deep in the pelvis : Laceration or tears in the ligaments which support the uterus, caused by gang rape or criminal abortion may result into pain deep in the pelvis. It is associated with a backache, throbbing in pelvis, tired feeling

And painful menstruation . Endometriosis, infection in the cervix, uterus, and tubes cause pain during thrusting . Infection can be due to gonorrhea or of E.coil.Hysterectomy, tumors, and ovarian cysts can cause pain deep in the pelvis.

: Some men do not retract the prepuce during masturbation. Their glans of penis remains hypersensitive to touch. They find pain during coitus. In men with poor hygiene, the smegma accumulates on the glans, causing pain during coitus. Phimosis can cause pain during coitus. Allergy to condom rubber, jellies, foams and douching materials can give hypersensitivity reaction to the males. Infection of vaginal canal causes burning and itching. Fibrosis of penile tissue following a trauma causes pain during masturbation and intercourse.
: Reassurance, countering myths and misconceptions and supportive psychotherapy will be helpful in dyspareunia of psychogenic origin. Insufficient foreplay may lead to failure of lubrication in females. Thick hymen will need excision. Accumulation of smegma needs cleaning daily. Senile vaginitis requires hormonal replacement. Homosexual women are not amenable to any treatment.

Making love brings an intimacy between the couple that connects them in all ways, not just physical. Couples who do not have a great love life usually do not have a very fulfilling relationship. Though not openly admitted to, sexual problems are very common. Given the private nature of the issue, not many frankly talk about it though. However, sexual problems are quite common and can be attributed to a combination of physical and emotional reasons.

Sexual problems can be threatening to the health of the relationship and can break relationships too. Read on to know some of the most common sexual problems in men and women and simple but sure ways to deal with them.

Common Sexual Problems in Men

1. Impotence: This is defined as the inability to attain and/or sustain an erection long enough for a satisfying intercourse. Quite a common problem, it can be due to relationship issues, hormonal problems, or performance anxiety. A frank talk with the partner and if required a counseling session can help identify the cause, and the problem seems to disappear.

2. Loss of Libido: This is a loss of arousal or reduced sex drive. This again has a strong physical and psychological component to it. Hypertension, diabetes, stress, hormonal issues, performance anxiety, and relationship issues are some of the reasons for loss of drive.

3. Ejaculation Disorders: Premature ejaculation is the early release of sperm. Retrograde ejaculation is when the sperms are released in the reverse direction back into the bladder. Delayed ejaculation is where there is delayed the release of sperms. There is often an underlying physical reason for this, which if corrected, helps in correcting the issue.

Treatment: For most sexual problems, acknowledging is the first step towards effective treatment. There are medications and hormonal supplements which are quite effective. Sex education, frank communication with the partner, and if required counselling is quite effective. Other therapies include hormone replacements, vacuum devices and penile implants.

Common Sexual Problems In Women:

1. Decreased Libido: Reduced sexual drive is more common in women than men. This could be due to hormonal issues (menopausal), strained relationships, vaginal and gynecologic infections, pelvic pain, painful sex, uterine disorders, etc.

2. Dyspareunia: Painful sexual intercourse is very common in females, and as much as 75% of women have experienced this during their sex life. Very commonly caused by vaginal dryness, vaginal infections, uterine disorders, UTIs and menopause. This again contributes to reduced libido. Lubricants, topical antibiotics and hormonal supplements can be used in addition to treating the underlying condition.

Treatment: For most sexual problems, as noted already, acknowledging and admitting is the first step. Treatment involves addressing underlying physical issues like hormonal imbalance, antibiotics, topical lubricants, etc. Counselling and involving the partner are most effective. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

There are some commonest misconceptions about infertility, and these misconceptions should be eliminated as soon as possible so that the actual facts can be known. There are many online sites where you can find detailed information on the scientific explanations regarding infertility, and you can follow them.

List of myths and facts regarding infertility:

1.Myth: The menstrual cycle of a woman is for 28 days.
Fact: Normal cycle ranges between 21-36 days.

2.Myth: A woman can have pregnancy on the day one of menstrual cycle.
Fact: The released eggs remain viable for almost 12-14 hours, and a woman can get pregnant after an intercourse done two-days after ovulation and five-days before ovulation.

3.Myth: Infertility occurs due to stress.
Fact: Ovulation can surely get delayed due to hormone suppression, but infertility does not occur due to stress.

4.Myth: Sperms stay active for few hours.
Fact: Sperms stay alive at least for five days.

5.Myth: Men with a higher sexual-drive will have a normal sperm-count.
Fact: No relation is there in between fertility and virility. Sometimes, it has been found that men having a higher sex-drive do not produce sperms.

6.Myth: Women have to wait for three months to conceive after stopping the usage of contraceptive pills.
Fact: As soon as a woman stops pill usage, hormonal levels go back to normal condition, as a result of which ovulation begins immediately.

7.Myth: Only females have infertility troubles.
Fact: Both women and men suffer from infertility troubles as per the current scientific studies.

8.Myth: Ovulation occurs in a woman on the 14th day of menstrual cycle.
Fact: Ovulation can be calculated by counting 14 days backwards from the past menstrual cycle's last day.

9.Myth: Daily sex can increase conceiving chances.
Fact: During ovulation, having sex each day, especially in between 12-16th day of the cycle can be the best timing.

10.Myth: Fertility troubles occur at 35.
Fact: Peak fertility timing in a woman's life is 20, and this might continue until late 30s. Fertility troubles might even arrive at a younger age. With age, conception chances get declined, especially after 35. If you wish to discuss about any specific problem, you can consult a Gynaecologist.