| Pain outside the vagina can be caused
by skin conditions such as lichen planus. This is usually diagnosed
by doing a biopsy of any abnormal appearing tissue. It is usually
treated with a topical steroid cream. A yeast infection or a sexually
transmitted disease, such as gonorrhea or chlamydia, can also cause
discomfort—both outside and inside the vagina. These infections
can be treated with the appropriate anti-fungal or antibiotic. Vulvar
vestibulitis can also cause inflammation and discomfort near the bottom
part of the vagina (posterior fourchette). This may require a topical
anesthetic or other oral medications to ease symptoms.
Another condition, known as vulvodynia, refers to
pain anywhere on the vulva (the labia majora, labia minora, etc).
Unlike vulvar vestibulitis, it does not necessarily worsen with touch,
such as in intercourse. Rather, the pain can occur at any time and
is often associated with sensations of burning. Treatment options
include topical medications and oral medications. Rarely, surgery
may be prescribed if the symptoms cannot otherwise be treated and
the patient’s quality of life is affected.
Vaginismus, to address your question, is an unconscious tightening
of the vaginal muscles during attempts at intercourse. Sometimes the
muscle spasms are strong enough to cause severe pain and can prevent
penetration. It may be that women who experience vaginismus have some
deep seated negative feelings about sexual intercourse. This could
be due to prior trauma or sexual abuse, a strict upbringing, or sexual
inexperience. For some, evaluation by a psychologist or sex therapist
may be helpful in understanding and overcoming the underlying causes
for vaginismus. Dilators can also be used to help train the vaginal
muscles to relax with penetration.
You didn’t happen to mention whether you have previously been
sexually active. If you are a virgin, your hymen may still be intact.
(Please keep in mind that just because a woman’s hymen is intact
does not mean that she is a virgin. Tampon use, for example, will
disrupt the hymenal ring.) So, getting back to your situation –
penetration of the intact hymen can be painful for some women. You
may find it less painful if you first try penetration with something
that is not as wide as a penis. Let’s say, first try your partner’s
pinky finger, then move up to the wider index finger, then middle
finger. Or, you can use the aforementioned dilators purchased at an
adult store or over the internet. Rarely, a woman may not have an
opening in the hymen to begin with; this condition is known as an
imperforate hymen. Again, this is rare, but if you continue to have
problems, it is worth being evaluated by your doctor.
Also, be sure you are well lubricated. If you feel that dryness is
a problem, you can use over the counter gels such as KY Jelly. Keep
in mind, though, that some women are sensitive to products such as
detergent, soaps, lotions and so on. Try to use mild soaps in the
area and wear non-clinging cotton underwear. If you and your partner
use latex condoms, try switching to non-latex, in case you have a
latex allergy. Be sure to follow up with your doctor for an exam.
There is help out there!
Remember to also communicate with your partner so that he knows what
is or isn’t working. Reassure him, as well, that he is not at
fault. Just be sure to keep an open dialogue!
QUESTION
I am in love with a Pakistani man, and we are planning
on getting married soon. I am terrified because he is currently in
Pakistan and I am South Indian; he is Muslim, and I am Christian.
I have been sexually active for years, and he is a virgin, and wants
to save himself for marriage. I am scared that things might not be
as spectacular as they could be, considering the fact that I will
not know until the day we get married. We have so many different things
going on, so many different beliefs, but I love him dearly, and do
not know what to do.
ANSWER
Well, you’re certainly not going into this
marriage with blinders on. You seem very aware of the differences
between your fiancé and you. I imagine that you weighed the
good and the bad very carefully before agreeing to a lifetime commitment.
Though we’d all like to believe in the illusion that love conquers
all, once you have your heart broken a time or two you begin to realize
that maybe it’s not that simple. People say that love is blind,
but it seems a little difficult to be blind to differences such as
religion and ethnicity—especially since they help influence
our outlooks on politics, marriage, child rearing, and so on. This
is not to say, of course, that people from different parts of the
world (religions, ideologies, etc.) can’t believe in or agree
on the same things. We all come from diverse backgrounds and experiences
that help shape who we are and who we want to become.
One of your concerns is that you have not had sex with each other.
Since you have previously been sexually active, you probably know
that there is good sex and there is bad sex. You’re obviously
keeping your fingers crossed that you and your fiancé will
fall into the good sex category. Of course, you won’t know until
you try. And, even then, it may take some time to fall into a rhythm
together.
Let’s say the sex IS terrible – then what? Hopefully,
your fiancé will be open to suggestions, whether it be fantasizing
together or watching explicit videos. For some couples, therapy may
be helpful. If it’s a lost cause, you need to regroup and think
about your priorities in this marriage and in your life. If you cannot
live without a satisfying, exciting sex life, then maybe it’s
best for both of you to part ways.
Remember, although you have had sex before, each partner is different.
You still need to learn the likes and dislikes of your fiancé.
Just because he is a novice at this, don’t write him off! Remember
this is the love of your life. Hopefully, he’ll surprise you,
time and time again.
Dipika Dandade, 31, is an obstetrician/gynecologist practicing in
the Los Angeles area.
ABCDlady does not provide medical advice, diagnosis or treatment. See
additional information.
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