DOCTOR'S ADVICE - My love life is a pain

Q Doctor, I really need your advice on a problem between my husband and I. We are both in our early 30s, and will soon be celebrating our 10th wedding anniversary. We love each other very much. He is the centre of my world.

However, in the last few months our sex life has run into big trouble. The problem is that whenever he penetrates me, I feel a 'deep' pain, and I have to tell him to stop. If he didn't immediately, I would scream. He does not like this, and says that the problem must be "all in my mind". He has been suggesting that I no longer want to have sex with him, which is not true.

Last night, when I was in so much pain, I had to jump out of bed. He became very angry and said that maybe I am doing this because I have been cheating on him! But I have not. I am a faithful wife, doctor. What do you think? Could it be "all in the mind"?

A. I am sorry to hear about all this. No, I do not think for a moment that this pain is imaginary. It is true that the mind can affect the sex organs. And in younger women, stress and tension can make the muscles around the vagina contract, with the result being very painful intercourse.

But in women like you who are over 30, I would say that it is very rare for psychological factors to cause pain during intercourse. In your age group, there is almost invariably some physical problem which is creating the pain,

Among these problems the commonest ones are:

1. Fibroids. These are extremely common in Jamaica. They are little 'balls' of fibrous tissue which develop in the walls of the womb. Some of them are tender, so there can be pain on deep penetration.
   
2. Endometriosis. This is a common disorder in women over 30. Little pieces of the womb lining turns up in the wrong place. If they are hit by the thrusting of the man's organ, that can be very painful.
   
3. Disorders of the cervix. The cervix (or 'neck of the womb,' as older people often call it) is at the very far end of the vagina. So it tends to be struck by the tip of the penis during deep penetration. If there is something wrong with the cervix, like an erosion (which is a 'raw' place) that can also be very painful.
   
4. Ovary problems. Generally, the ovaries are a little beyond the reach of the man's thrusting. But in certain positions, and particularly if he penetrates very deeply, they can be 'jostled' each time he goes far inside. And if there is some problem in the ovary, like an ovarian cyst, these repeated knocks may hurt.

There are various other conditions which can cause deep pain during intercourse, but you can probably guess what I am going to say next. You need to be examined in order to find out precisely what is wrong.

The doctor will examine you manually (i.e with her fingers), and then put in a speculum, which is a special instrument that lets her see the cervix and the inside of the vagina. Only then will it be clear what is wrong with you. Please show your husband my answer. I hope he will then understand that this pain is not "all in the mind".

Q I am a 33-year-old man and I am considering getting married later this year. But I had mumps when I was 16. And I notice that you have said that that infection can cause sterility in males. So do you think I am infertile, doctor?

A. Mumps only affects a man's fertility if the virus actually attacked his testicles. If that happened to you, you would remember it because the inflammation makes the testicles swollen and intensely painful. So if you have no recollection of such a thing occurring when you were 16, then I am sure you have no need to worry. However, if you do recall having severe testicular pain, then I think you should now have a sperm count done on your seminal fluid. A doctor can arrange this for you.

Q At the age of 33, I have very heavy menses. They make me exhausted, doctor. I have tried various medications from the doctor, but still I lose enormous amounts of blood each month. Should I take a hysterectomy? I must add that I do not want any more children.

A. Something must be done about these very heavy periods, which are clearly affecting your health. If you have tried all the available medications, then clearly surgery has to be considered.

Hysterectomy, which is removal of the womb, is an option, but that is quite a big operation. Another possibility is the newer operation of 'endometrial ablation' which involves 'stripping' the entire lining out of the womb, so that it is very unlikely to bleed again. I am sure that what you need to do now is to see a gynaecologist and talk over the possibilities with him or her.

Q I am 38 years old, and my husband is 36. We have both been married before. My husband has a 10-year-old son, and I have two children, ages 13 and 18, by my first husband. We have been trying to have a child for over a year, and I am not getting pregnant! My 'biological clock' is ticking away, so I need for this to happen now. Also, is there any truth in the story that if I get pregnant at my age, I will have a child with deformity?

A. Let me deal first with this question of 'deformity'. It is true that older mothers (by which I mean those over about the age of 35) have a slightly increased tendency to produce a child with Down's syndrome. But at your age, the chances of that are only about one in 214. And I hope that when you get pregnant, you will have prenatal tests to detect Down's syndrome.

Now, how are you going to defeat this current fertility problem?

Both of you have proved your fertility in the past, But something may have happened during recent years to make either of you less likely to become a parent.

Therefore, I think both of you should now go to a doctor and have a physical check-up. Your husband should have a sperm test, and you need tests to find out exactly when you are ovulating. Once you have that information, you must concentrate your efforts on having sex around the 'ovulation day'.

You may also need tests to find out if your tubes are blocked. If by chance they are, then you will need to ask the gynaecologist about the possibility of curative surgery. Good luck.

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