When sex is a pain By Dr Peter Chew
Publisher:The Straits Times - Publication Date: 14-05-2008

Many months ago, a women's magazine article on the non-consummation of marriage examined the sexual experiences of Singapore's brides and grooms. A small proportion of married couples were still fumbling lovers, it said.
Annulment statistics indicate some truth in this observation. In 1996, there were 178 cases and the figure soared to 412 in 2006, according to the Statistics Singapore website. Many cases were attributed to women being unable to have intercourse or who did so with difficulty, a condition medically known as vaginismus.
Many such marriages could have been saved through medical intervention and sexual counselling. Unfortunately, these couples may be too shy or believe there is no solution.
Below is an abstract from the journal of my patient,
Ms G, a 30-year-old housewife who was successfully treated for vaginismus within two months.
"My husband and I had decided not to have sex until we got married. We approached our wedding night with excitement. But this was shattered when we tried to consummate it. A beautiful wedding gave way to a painful honeymoon. We failed miserably every time we tried. I ended up weeping uncontrollably every night. No matter how much I wanted to have sex, it was just too painful. I felt like a failure as a woman. Shameful. Guilty. Alone.
"What was wrong with me? I was well educated. Although I was raised in a traditional Chinese family, my Mum was comfortable talking about sex. 'Sex is painful, especially in the first few months", she used to tell me.
"I started to read voraciously on vaginismus. We tried several methods but failed. My hubby was always very supportive, encouraging and patient.
After a few months of futile attempts, he suggested seeing a gynaecologist. 'How humiliating if other people found out,' I thought.
"The gynae's clinic was rather intimidating. I could not even allow the doctor to examine me. When I was introduced to the dilators, I almost freaked out as I had to insert those plastic 'tools' into my vagina. I cried.
"The gynae recommended that we see a sex counsellor. It proved fruitful. I realised that my 'problem' was fear of pain.
"Initially, I just could not bring myself to use the dilator. Conjugal union was meant to be beautiful. The use of the dilator was so barbaric, crude and degrading. I felt that if I were to use it, I would be an animal of sorts.
"I looked at my hubby and I knew I had to do it for him. He had waited for me all this while, never demanding anything from me and loving me with all my 'defects'.
"After much coaxing and encouragement, we finally had our first marital union. It was happy and emotional. And we are expecting our first child this year."
Vaginismus is the involuntary muscle tightening around the vaginal opening in anticipation of penetration. The muscles go into spasms because of pain or fear of pain. Penile penetration becomes difficult or impossible.
We don't know the exact number of women suffering from vaginismus, but it is estimated that for every woman who seeks help, 10 suffer in silence.
We also don't fully understand the causes. The majority are linked to fear of pain or dislike of sex. For some, it may be the result of being sexually abused, assaulted or raped.
One physical cause is an inflammation of the vagina.
A very strict upbringing where sex was never discussed or unhelpful messages leading to feelings of guilt and shame can be causes. Religious or cultural taboos or the fear of getting pregnant are other possibilities.
Psychosexual counselling using behaviour therapy is the preferred treatment. Couples also benefit by solving their interpersonal problems through communication.
Surgery is seldom suggested. It cannot cure a psychological condition and it may inflict further trauma.
Recently, botulinum toxin (botox) has been used to paralyse the vaginal muscles allowing almost immediate penetration. But this does not deal with any of the psychological issues.
With psychosexual therapy and the use of a dilator, success is almost 100 per cent if the couple is motivated and committed to resolving their problem.
Dr Peter Chew is a senior consultant gynaecologist and obstetrician at Gleneagles Medical Centre. He is the founder of aLife, a charitable organisation with a mission to nurture and promote healthy family life.

really, the answer for most people is

Foreplay and Lube.

They do wonders.

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