Ask Dr. Annie K.: Pain

I’m 22 years old and haven’t had sex yet. I’ve had close encounters, but every time I try I experience a lot of pain. Actually any sort of penetration brings severe pain and discomfort (tampons, fingers etc). i’ve had a basic exam from my gynecologist who reports everything is healthy and normal down there. What can I do to finally have an enjoyable sex life?

Over 75% of women experience pain from vaginal penetration at some point in their lives. You are not alone. 12% have severe pain the first time having intercourse. Many women will benefit from you asking about this very important (and painful) topic. Thank you for not being afraid to ask – Dr. Annie K is here for you.

What you are describing is called primary dyspareunia, a.k.a. painful penetration. From your gynecologic exam (which I bet was painful) it sounds like there was nothing visible externally that would indicate an infection or some kind of skin problem.

So what could it be and what to do? When it comes to painful sex, it is never “all in your head.” There is always a cause.

When I hear women talk about pain from inserting a tampon or finger as you describe, my first thought is vaginismus. Vaginismus is is considered a vagina in panic. There is an involuntary tightening of the muscles around the vagina, usually in response to penetration, or even from expecting penetration. Some women describe it as a ripping feeling or a sharp burning pressure that can last for hours or days. Anxiety is common along with frustration.

Although it may sound unusual, the first treatment recommendation is physical therapy. There are therapists specifically trained in pelvic floor anatomy. The entrance to the vagina is through pelvic floor muscles – there is no way around them! The treatment has a very high success rate in women like you who are highly motivated.

When talking sex let’s not forget the basics.

When the time comes, be sure you are with a partner you feel close to. Communication with your partner can be a game changer when a women has pain. This is a medical problem – you are working on it and sex is a priority. This may even bring you closer as a couple.

Technique is important. Allow for adequate foreplay – that part is fun! Most women achieve orgasm by stimulation of the clitoris, not penetration. No medical therapy can make up for a sexual partner who doesn’t like to play.

Lubrication can help many women who have pain with sex. Inadequate lubrication happens. It is ok to use K-Y jelly or go natural and use organic coconut oil or saliva.

Women who have experienced trauma may have painful sex as it may trigger PTSD. Work with a therapist is crucial in solving those issues and being able to move on to have a fulfilling sex life.

Whatever your age, when you have sexual pain, it can affect your self-esteem. Know that it is treatable but may take time. Start with finding the right physical therapist.

Unfortunately the first time is rarely like it looks in the movies. But it gets better! You are on your way to a healthy sex life.

The Lifeguard

In honor of the end of summer, here is a little short story about summer love.

The Mediterranean sea is unusually rough. The waves vigorously clap the sand, sending a salty mist into the ocean breeze. The white sand, like sifted flour, surrenders to the harsh waves, and is enslaved by the powerful water. Sailboats in the distance struggle their way toward the horizon. Topless women casually soak up the sun’s rays. Conversations and reading are light, as the scenery takes precedence.

She never tires of watching him as he scans the crowded beach. His eyes alert as he concentrates, to discern any hint of danger amid the playful sounds resonating from the water. Her eyes follow his large footprints sinking in and molding the sand. She marvels at his bronzed muscular calves laboring under his broad, sculpted torso. How gracefully he strolls along the beach, for such a large mountain of a man.

Every few minutes, without a pattern, he breaks his intense focus on the surf and glances back at her. Aware of the stirring she provokes, he fights the distraction and his gaze returns to the water, back to his duty.

A quickening of her breath and a flash of warmth envelop her body each time their eyes meet. Images of previous meetings bring a rosy tinge to her cheeks. Her body is aching, alert, wanting. She lusts for the physical closeness, so different from the touch she is familiar with at home. She craves the full weight of his body on hers, allowing her to feel small and protected.

She is suddenly ashamed. Her actions and their unspoken implications flood her mind, trap her and suffocate her. A revolting taste of guilt fills her mouth and her body grows limp. A glance from him reins her in and she allows herself once again to feel and not to think. She chooses expansion over contraction, upheaval over order, and freedom over settling.

When the crowd thins out and darkness creeps in, she carefully climbs the steep steps to the lifeguard station, clutching her sarong tightly. It feels like a treehouse -secluded and private. It is their sacred space. When the beach is clear he joins her, carrying two small glasses of Arak. Their lovemaking is slow and deliberate. The air swells with the scent of sex, salt, sweat, anise, and desire.

How Hard Can It Be? Understanding Erectile Dysfunction

As part of my series on the Aging Male, Love and Medicine will tackle erectile dysfunction (ED) – failure of the penis to remain erect in order to reach sexual satisfaction. Most men have experienced this at one time in their lives.  Men are embarrassed, anxious and depressed when their penis isn’t working.  They report frustration because they can’t please their partner. For men in healthy relationships, their partner’s needs matter a lot.

I interned in a sleep lab in graduate school. Sleep studies were used to differentiate psychogenic ED from physiological ED. A normal man spends about two hours in a tumescent state while asleep, having three to four erections a night. A man with psychogenic ED would probably be not far from the norm; a man with physiological ED would remain soft. Diabetic men spent nights in the sleep lab while erections were recorded and it was there that the first correlation between ED and diabetes was discovered.

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Magic Dust & Artichokes

When my year of no shopping ended, like a prisoner released from captivity, I couldn’t wait to bust out and buy something. I fell right into the trap! What a sucker. You wouldn’t believe what my first purchase was: Dust. I did not know that Gwyneth Paltrow touted it in her painfully misguided bullshit celebrity retail outlet called Goop. I read about it on a blog I once respected, called Cup Of Jo. There was one line…

“Psst, my friend says this …really works,”

…with a handy hyperlink directly to the Nordstrom website. For $39 I was the proud owner of a tiny jar. My partner just heard me reading this aloud and mumbled, “That useless shit was $39”?

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Why We Need To talk About Sex

Love+Medicine Pillows

The Pelvic Health Collaborative invited me to present a lecture about the importance of talking about sex with patients. I passionately believe it should be an integral part of an evaluation of an individuals’ overall health and well-being. Any discussion with adult patients tends to be site/disease specific, i.e., after prostate surgery or heart attack. But what about patients with Crohn’s disease, arthritis, anxiety or obesity that are not considered directly related to sex? Are we asking these patients about their sex lives? We need to be. Because everything can affect sex and sex can affect everything.

An article was published in the New York Times entitled “When Did Porn Become Sex Ed?” Kids are not talking to their parents, their friends, or their doctors, so they turn to the Internet. The access is so easy and anonymous – straight from the smart phone. This is where they are learning how it is done. Is it any wonder performance anxiety is on the rise? What happens to expectations after watching internet porn? While some strides were made during the last administration in promoting comprehensive sex education, it was removed from the 2018 federal budget.

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