What are the causes of painful sexual intercourse?

SINGAPORE - Q: I am a woman in my late 50s. I am physically well and not on any medication. I consume royal jelly capsules as a health supplement periodically.

For the past three months, I have been experiencing discomfort and pain during sex. It is becoming unbearable, even with gentle touching.

I tried using cream but did not like it. Are there any food or medication that can improve my situation?

A: The medical term for painful sexual intercourse is dyspareunia.

This condition can affect arousal and desire for sexual intercourse.

The discomfort and pain you experienced during sex could be related to vaginal dryness and vaginal atrophy. Vaginal atrophy is when the vaginal tissue becomes thinner, drier, less elastic and more fragile.

If you are not getting sufficient lubrication during foreplay, this could result in vaginal dryness.

You may want to obtain a water-based lubricant from a pharmacy and apply it before having sexual intercourse.

You have not mentioned the type of cream you have used.

For vaginal dryness and vaginal atrophy that is related to menopause - when menstruation stops for good - plain lubricant cream may not be sufficient to relieve the pain.

Menopause can result in vaginal atrophy because during menopause, the level of a hormone called oestrogen falls.

Oestrogen is important for the normal maintenance of the vaginal wall, muscle and nerves. It contributes to vaginal lubrication in general and more so when a woman is sexually aroused.

Menopause also results in a decline in the level of another hormone called testosterone.

Testosterone in women plays a role in sexual desire, arousal, orgasm and satisfaction.

In general, balanced support from hormones can also improve energy and contribute to the individual having a positive mood.

The majority of women would have had menopause between the ages of 50 and 55.

When it is "unbearable even with gentle touching", this could also mean that you are having a condition called vulvodynia, which is persistent pain in the outer genitals characterised by burning, stinging or raw sensations.

The cause could be vulvovaginitis, inflammation or infection of the vulva and vagina by bacteria or viruses; or vestibulitis, inflammation of the skin around the vaginal opening and the mucus-secreting glands found in the skin.

Another possibility is that the root cause of pain before or while engaging in sexual intercourse is psychological in origin.

Sexual dysfunction in general requires counselling of the affected person and the partner on interpersonal relationship matters, which play a role in sexual intimacy among couples.

As it is possible that you are in a menopausal state, you may want to consider seeking professional consultation to check your hormonal levels, in particular, your oestrogen levels.

Your gynaecologist will also assess whether your pain during sex is superficial or deep-seated, and if any infection, inflammation or other medical conditions are contributing to your dyspareunia.

If there are other factors, they should be treated accordingly.

Several plants have been used for overcoming sexual and certain menopausal symptoms, such as gingko biloba which increases blood flow; red clover, a phytoestrogen or plant-based oestrogen; and L-arginine, an amino acid.

However, research supporting their use is still limited.

Products containing royal jelly, omega3 and 6 fatty acid, coenzyme Q10 or CoQ10 (an antioxidant in the body that helps convert food into energy), barley grass juice, aloe vera, ginseng, maca root (tuber native to Peru), muira puama (shrub native to the Amazon rainforest), catuaba bark (from a plant native to Brazil) and saw palmetto (palm native to the United States) are also not evidence-based remedies for managing menopausal symptoms.

Professor P. Ganesan Adaikan,

clinical sexologist at the National University Hospital Women's Centre


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