Dear Dr G,
Thank you for reading my email. I feel embarrassed putting Dr G on the spot, but I hope you can help me.
I am Jake and I am 22 years old.
I started a sexual relationship with my 21-year-old girlfriend, but unfortunately, we are encountering some problems.
My girlfriend kept telling me that she experiences pain during penetration.
Initially, I thought it might be due to lack of foreplay that caused her to feel the discomfort, however, I tried to prolong the foreplay and we are still having the same issues.
I know she is sexually inexperienced, but I am just concerned that sex is simply impossible at the moment.
I am very puzzled. My last girlfriend was older than me and I did not encounter any problems with her.
Do you think my girlfriend's vagina is too small? Can this be fixed?
Or do you think my penis is too big? (I would like to think that, of course) If so, how to fix it?
I am worried, because I really care for her and hope this relationship will flourish.
Let's hope Dr G will solve our issues on painful penetration.
Painful penetration is also called dyspareunia. This is a common medical condition that can affect both men and women.
However, the prevalence is more in women, as dyspareunia has been reported to affect between 8% and 21% of women at some point of their lives.
The experience of pleasure or pain during sexual intercourse is influenced by numerous factors. These may include physical, psychological, social upbringing and relationship matters.
Therefore, it is well recognised that dyspareunia can be induced by both medical and psychological causes.
The key for solving the couples’ issues of painful penetration depends on understanding the nature, circumstantial, location, and duration of pain during sex.
Typically, the pain is encountered on the external surface of the vulva or vagina, or deeper in the pelvis upon deep pressure against the cervix.
Some women may experience dyspareunia on the outer and inner genitalia, and others may even find it difficult to describe the exact location and nature of the pain.
It is not unusual for many women who experience pain during their first intercourse to sort out medical attention as the pain improves with further sexual encounters.
However, others may continue to feel pain either through menstruation or menopause.
Apart from psychological barriers, the causes of pain can be congenital, anatomical or physiological.
These may include vaginal or urinary tract infections, lack of lubrications, and scar tissues from previous injuries or even abnormal growth in the vagina.
Common infections affecting the genital tracts may include yeast infections, herpes, chlamydia or trichomoniasis.
Hormonal deficiency is also a common etiology of dyspareunia. Estrogen depletion can be related with vaginal atrophy that can cause painful frictions during penetrations.
This can be associated with changes during menopause, menstruation and hormonal birth control.
When the causes of dyspareunia are identified, the treatment of the condition is straightforward.
The infections can be resolved with antibiotics or antifungal, and the hormonal imbalance can also be treated with medications or lubrications.
However, when no physical causes are identified, the psychosomatic reasons of pain, such as fear of infections and pregnancy, will require in depth understanding to resolve the matter.
Cognitive behavioural therapy can also help to decrease negative thoughts during intimacy.
Desensitisation therapy is a well-recognised treatment for dyspareunia. The women will learn to relax the vagina with pelvic floor exercises or other distraction techniques.
Otherwise, counselling or sex therapy may also be necessary to help couples to communicate more openly.
Although most men would like to think their manhood is too big for the vagina, however, the organ is called birth canal for an obvious reason.
If the size of the penis is less than a baby’s head (which most are!!), then a large penis is obviously not the reason for dyspareunia.
The role of men helping to overcome pain on penetration is vital. Longer foreplay can help to stimulate natural vaginal secretions as lubrication.
Sometimes, switching sexual position might also help, as women being on top can allow better control for them to regulate the depth of penetration that is comfortable for them.
Dr G’s advice to Jake is that the key for an enjoyment in sexual intimacy is communication and patience. Therefore, don't rush and take your time to experience the magic, soon enough you will turn pain into pleasure!