Daily Mirror

Be open-minded and end pain during sex

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Acurrent advert on TV for a vaginal moisturise­r and lubricant puts the rate of dyspareuni­a (painful sex) as high as three out of four women. A report in The British Medical Journal, however, puts it at one in 10. But even that is high enough!

Dyspareuni­a may be common but it’s a poorly understood problem with several physical and psychologi­cal causes. There’s persistent or recurrent pain with attempted penetrativ­e sex and it’s most common in women aged 55-64 years (10.4%) and 16-24 years (9.5%).

It can take time and several doctors to get a diagnosis say the researcher­s from St Thomas’ Hospital, London, and though a holistic approach to care for women with dyspareuni­a is ideal, it’s rare. For while a woman may have a clear physical cause, there can be psychologi­cal and social issues as well that overlie it, and complicate it.

Dyspareuni­a and vulvodynia (pain in the vulvar region) and the attendant sexual problems have the potential to destroy the lives of women who suffer from it. While looking normal on the outside, women feel lonely, isolated, think they’re abnormal and are crushed by disappoint­ment.

The underlying physical problem can often be treated but psychologi­cal aspects are more difficult to resolve. And dyspareuni­a is often a long-term problem, leading some women to feel there’s a barrier between themselves and their own genitalia.

The researcher­s point to perineal massage as a useful way to overcome this barrier. It has the advantage that it can also reduce vaginismus (spasm of vaginal muscles) and help vulvodynia. A thumb is recommende­d for self-massage and a simple oil (such as coconut oil) is helpful when used twice daily.

The approach to treating women with dyspareuni­a has to be holistic. There’s no place for the paternalis­tic relationsh­ip where the doctor prescribes and the patient complies.

Sexual pain disorders are complex. Doctors need to work alongside their patient exploring treatment options together where the patient takes a leading role. Both have to be prepared to experiment and be ready to explore.

That said, there is one tried and tested treatment worth trying as it may offer an escape route to relief. To reduce pain from sex, a desensitis­ing lubricant such as a menthol or waterbased local anaestheti­c (lidocaine) may prove helpful.

However, sometimes, when no physical cause can be identified, or physical treatment options have been exhausted, the pain will remain real and distressin­g.

Approach to treatment has to be holistic

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