Doctor's Advice - Why is sex so painful?

Q. Doctor, sex with my husband has always been great. But since I turned 30, it has caused me a lot of pain especially when he thrusts. This is a source of great distress to both of us. I remember that I experienced some pain with my first boyfriend when I was around 19. But he was a very big guy, and my husband is more normal-sized. A friend who works at the Kingston Public Hospital told me that it might be 'dyspareunia'. That sounds bad! Is it serious, Doc?

A: Well, the word 'dyspareunia' just means 'painful intercourse'. So, I don't think you should worry about what your friend has told you.

Now, when a woman in her early 30s suddenly starts feeling such pain during intercourse, I strongly feel that might be a problem with her cervix, or her womb, or her ovaries. It is essential that you find out what that problem is very quickly.

Statistically, the likely diagnosis is the common female condition called endometriosis. That is caused when pieces of the womb lining are in the wrong place.

Other possible diagnoses include:

• Pelvic inflammatory disease (PID), caused from an infection earlier in life;
• Fibroids, which are fibrous swellings in the womb;
• Cervicitis, which is inflammation of the cervix;
• Cysts on the ovary;
• Prolapse (descent) of the womb;
• Pelvic congestion syndrome, a condition in which varicose (that is, wide) veins develop near the ovaries
• Bladder problems;
• Occasionally, malignancy (i.e. cancer).

All of these conditions can be successfully treated. So what you should now do is to see a doctor who can examine your womb using special instruments. You may very well need treatment from a 'gyno'. But do not worry, I am sure that everything will work out ok for you and that you will eventually be able to enjoy pain-free sex with your husband.

Q. Doc, I am a Jamaican living in the United States. Earlier this year, I was diagnosed with the HTLV-1 disease. I have lost 50 pounds and I am in a lot of pain. I understand that HTLV-1 is a form of cancer. I'm currently on medication, but it's not working very well. The doctor who I'm seeing in America says that HTLV-1 is often found in Caribbean islands like Jamaica. So what I would like to know is: do you have a cure for this disease in Jamaica?

A: Well, I am sorry to hear that you have been so sick. HTLV-1 is actually a virus. But, unfortunately, it can occasionally cause a form of cancer known as 'adult T-cell leukaemia/lymphoma'. It can also cause serious nerve disease.

People often get confused between HTLV-1 and HIV (the virus which causes AIDS), but they are quite different organisms.

Your doc is quite right in saying that HTLV-1 is common in the Caribbean. It also happens in Japan and other countries.

Now, I am sorry to tell you that no one in Jamaica has so far discovered a cure for HTLV-1, but scientists all over the world are working on it.

In your case, it sounds like your doctor is doing a good job. So I feel you should stick with his advice and follow his treatment. But it would also be useful to get an opinion from an oncologist, which means a doctor specialising in cancer therapy. Please talk to your present doctor about that. My thoughts are with you.

Q. How reliable is that coil as a form of birth control, Doc? I am 29 and thinking of trying it. Also, what are the side effects?

A: The coil, or intrauterine device (IUD) is a very good method of contraception, but it is not quite as effective as the Pill.

Its success rate is around 98 per cent, which means that if 100 women used it for a year, only about two would get pregnant.

As it relates to side effects, the possible ones are:

• heavier menses;
• longer menses;
• painful menses;
• occasionally infection, especially in women who have numerous partners;

Rarely, perforation of the womb - the IUD makes a hole in the wall of the womb - occurs.

Also, you have to bear in mind that coils do quite often fall out. So you have to be watch for anything 'coming down'.

Having said all that, the fact is that worldwide hundreds of thousands of women are very happy with their IUDs.

Q. I heard that oral sex could lead to throat cancer, Doc. Is this just a myth?

A: Sadly, it isn't. Research now shows that some cases of throat and mouth cancer are caused from a virus which is picked up during oral sex.  However, it is largely promiscuous oral sex that is likely to be dangerous. If a husband and wife do it only to each other and never to anyone else, then the risk is likely to be very low.  Please note that smoking of any kind is also a risk factor for throat cancer.

Q. I am a little worried because, late one night after a party, I had sex with my wife in a swimming pool. Could this have harmed her, Doc? Could it also hurt me?

A: A surprising number of couples do occasionally have sex in the water. Some years ago, I checked with a group of distinguished gynaecologists and they all agreed that this activity would not harm a woman.  You will also be glad to know that I can think of no medical reason why it would harm a man either.

Q. My husband recently left me and I became very depressed. In an effort to seek some sort of consolation, I briefly had sex with my 17-year-old nephew. He is not my blood relative, but a nephew by marriage. Is what I have done illegal?

A: No, it is not illegal under the Jamaica Incest (Punishment) Act of 1948 and subsequent legislation. But it is a very bad idea!

Sex with relatives can lead to all sorts of psychological difficulties, so I hope that that young man has not been harmed by the experience of sleeping with his aunt.  I am sure that you need a course of counselling. If there is a counsellor or psychotherapist anywhere near you, please make an appointment to speak with them.

Also, I imagine you are still depressed. So you should see a doctor and get some antidepressant medication. Please do not delay.  Meantime, it would be wise if you do not have sex with anyone else until your emotions have returned to normal.

Q. I haven't been very successful in making my wife orgasm. Would a vibrator help, Doc?

A: Probably, as long as she is happy with it. The great advantage of these things is that they vibrate faster than a man's fingers ever could.