Help! I find sex extremely painful

Dear Eve,

I find sex extremely painful. I'm really not enjoying it lately and it's affecting my marriage. What could be the problem?

Schola.

Dear Schola,

Sex is one of the most important and fun ways for married couples to connect. Painful sex, however, is no one's idea of a good time. Painful sexual intercouse, also known as dyspareunia, is the persistent pain that occurs during or after sexual intercourse.

Dyspareunia can occur as a result of a variety of issues such as insufficient lubrication, trauma, surgery or physical conditions such as vaginismus, endometriosis or adenomyosis.

Endometriosis is caused when tissue that lines the uterus grows outside of the uterus, while adenomyosis happens when uterine tissue grown into the uterine wall. Both of these conditions can interfere with sexual intercourse.

While the presence of endometriosis or adenomyosis can interfere with a couple's sexual pleasure, there is no need for sexual intimacy to cease altogether. So what's a couple to do?

Communicate:

-It may sound cliché but it's absolutely true. It's important for a couple to communicate openly and honestly about what is happening in their marital bed. Even going for doctor visits together would be helpful in allowing male partners to hear the information directly from a qualified medical professional, which may increase their understanding and empathy for their female partners.

- It is also important to allow room in the marriage for honesty: room to speak honestly about the challenges of having to deal with a condition, irritation at having to avoid certain sexual positions that you would want to try but can't because of the pain to the partner, the guilt or shame that is common with partners who feel like they are being denied the sexual adventures they imagined they would have. Remember that these feelings are about the situation, not the person. The bottom line is that openness and honesty will be crucial if a couple is to enjoy their sex life.

Lose it

Lose the guilt, because none of this is your fault, and even when/where you could have done better, now you can because now you know better. Lose the blame; again, this serves no purpose in enhancing the intimacy in your marriage. Accept that this is the situation that you're in, find a competent doctor to work with you and move forward determined to enjoy your sex life together, inspite of a diagnosis of endometriosis/adenomyosis. Lose the bad attitude; it's going to destroy your sex life, which will in turn negatively impact other aspects of your marriage. Lose anything and everything that will interfere with your ability to connect as a couple. If you need more support, more information, or additional medical intervention, all you ever have to do is ask, so ask! Your doctor will advise you on all the options that are available. Lose the pressure to be perfect; sex is about connection, intimacy and fun not an Olympic performance with a score board. Relax into it; remember that you are not alone, and there is help and support to be found for those who take the time to seek.

Attitude

When it comes to sex, attitude is everything. Even without the added challenges of endometriosis or adenomyosis, the attitude a couple has about the kind of sex they want to have really does make all the difference. Instead of seeing these conditions in a strictly negative light, try to challenge yourselves on all the positive things that can come out of this, for example, the sexual positions that you hadn't even thought to try might be exactly what you need in order to have sex life that you want.

Experiment and Have Fun:

Sex should be fun, so make it fun and experiment. As a couple, be open to different sexual positions, for example, while the missionary position may be painful for some women, it may be easier for you but you'll never know unless you try. In addition, begin to figure out what sequences work best and which ones are best left alone e.g. some women find it easier to begin with one sexual position and then move on to other positions while some find that maintaining a single position is easiest on them.

The point is, experiment! Make a game of it by coming up with a funny ranking system that you can both look forward to contributing to; be sure to add an exciting reward system ;)

- Part of experimentation is understanding that sexual intercourse is not the only way to enjoy sexual intimacy. In other words, what are your sexual limits? What are you willing to try, even once? Developing your own sexual 'playlist' as you seek to increase your repertoire can be a fun way to take the pressure off by focusing on what feels good, not what 'should' feel good. With the right attitude, the issue may no longer be what the couple can't do but instead be all the things they haven't - yet. The sexual repertoire is endless so experiment and find out what works best for you.

- A happy healthy sex life is vital for any couple and despite having a diagnosis of endometriosis/adenomyosis, it is achievable with communication, the right attitude and a sense of fun.

Maggie Gitu is a Marriage, Family & Sex Therapist. She can be reached at [email protected] and via her Facebook page: Maggie Gitu