My husband and I have been married six years and have a good sex life. But I always experience pain at the moment of penetration. We take things slowly, and after the initial pain things go well. But what can I do about that early discomfort?

God intended sex in marriage to bring pleasure. When that pleasure is interrupted because of pain, the entire process of "becoming one" is affected.

Unfortunately, pain is often difficult to relieve because the reason for it can't be identified. To help you and your doctor determine why you are having discomfort, for the next four or five times you have intercourse, write down a description of the pain. Describe exactly when you feel the pain begin and when it lessens, the exact location of the pain, and the type of pain (stinging, burning, jabbing or a feeling of pressure).

It's also helpful to write down information from a genital self-examination. In a comfortable position, using a vaginal lubricant and holding a mirror, examine the opening of your vagina for redness, irritation, rash or sores. Is there tightness or pain when you insert a finger? Note any sensations you feel when tightening or relaxing your vaginal muscle around your finger or when pressing your finger against your vaginal wall. Using a Q-tip, tap around the opening of your vagina. Note any particular spot that elicits pain when tapped. Write down what you discover.

Once you have written data, schedule an appointment with your physician. If he or she still can't help, try to locate a medical doctor who is both a gynecologist and a urologist who specializes in treating painful intercourse (dyspareunia). A resource for locating such a specialist can be obtained by calling and joining the Vulvar Pain foundation at 336-226-0704. You may also contact them on the Web at www.vulvarpainfoundation.org. Inflammation or irritation of any of the structures of the genital area will cause pain and will require medical attention. Chronic infections such as genital warts or herpes also can cause pain upon entry.

As sexual therapists, we treat a common cause of painful intercourse called vaginismus, the involuntary spastic tightening of the muscle controlling the entrance to the vagina. To relieve vaginismus, the woman uses a series of graduated dilators to stretch and relax the muscles that control the opening of the vagina. She begins by daily inserting the smallest dilator that she can comfortably insert, using the same process as recommended for vaginal self-examination. She leaves the dilator in place for 15 to 30 minutes while tightening and relaxing the vaginal muscle. When she feels ready, she tries the next larger dilator. She continues to graduate to larger dilators until she is able to comfortably insert a dilator of the same or larger circumference as the head of her husband's erect penis. You are fortunate to have a good sex life in spite of your initial discomfort. But you need to pursue a solution that will enable you to have entry without any pain.

For more information you may want to visit the following web sites:

• www.vaginismus.com
• www.nva.org
• www.vulvarpainfoundation.org
• www.stoppelvicpain.com

For Further Exploration:
Restoring the Pleasure

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