Difficulties and worries about sex have been a common theme in questions to Ask Dr Amy. Today, we are going to talk about those concerns and where to go to for help if you need it.
It’s unfortunate, but the stigma or shame around talking about sexual health can make it feel like you’re alone in having trouble with sex. The fact is that sexual dysfunction is common, can happen at any time and is often treatable.
So what is sexual dysfunction? The term sexual dysfunction is used to describe problems that prevent someone from having or enjoying sex, and this is undesirable to the person experiencing it. This experience can be frustrating both mentally and physically.
Painful sex for people with a vagina
Pain on penetration of the vagina is a common problem and there are a number of different names for it.
Dyspareunia is a term to describe painful intercourse, usually penis in vagina sex. But pain can occur with inserting fingers, sex toys, or even tampons.
Vulvadynia is a term that mean the vulva (or outer genitals) are sensitive to any touch and people can feel burning or stinging even with the lightest touch or just from clothes/underwear touching the vulva.
Vaginismus is a term for when the pelvic floor muscles are overactive and can have involuntary spasms. This can mean that inserting tampons or having sex with penetration is very painful or impossible.
People can have one or more of these conditions.
So why does it happen?
There are many factors that can contribute to painful sex.
Some of these include:
- not using enough lubricant
- sexually transmitted infections (STI)
- an infection such as thrush or a urinary tract infection
- a skin irritation such as dermatitis or reaction to soaps/perfume/bubble baths
- medical conditions that contribute to painful sex, such as endometriosis or pelvic inflammatory disease
- not feeling aroused during sex, particularly if you are stressed or worried about something
- previous traumatic or painful sex
- feeling anxious about having sex
Painful sex can be primary, meaning it has always happened, or secondary, meaning that you might have previously had no pain and now suddenly it has started to hurt. Either primary or secondary pain can be triggered by the above factors or not have an obvious reason at all.
What can you do about it?
The first thing to remember is that these are physical issues. Pain during sex doesn’t mean you are ‘frigid or don’t feel attracted to/like/love your partner/s. The second and most important thing is to stop having sex if it hurts. You can’t “push through the pain” and in many cases this will make the problem worse and may trigger a longer-term problem. You can still have other types of sex that don’t hurt, such as oral sex, but anything that causes pain needs to be stopped until you have talked to a health professional.
You can see a GP experienced in sexual health issues or pelvic pain. You may also need to see other health professionals such as a physiotherapist, counsellor or psychologist but your GP can refer you to these.
There are a lot of treatments available, but everyone is different so it’s best to work with your GP to figure out what’s causing the pain.
Sexual dysfunction in people with a penis
People with a penis can also experience discomfort and pain during sexual intercourse. This can be due to an STI, hypersensitivity of the penis, allergic reaction to latex, or a physical condition.
What is premature ejaculation?
Premature ejaculation (PE) is when you have trouble controlling your orgasm, and you ejaculate at a time that you or your partner feels is too fast or too early. PE is generally considered to occur within 1 minute of penetration but there is no specific time that is “too soon”. PE depends on whether it is affecting you or your partner’s enjoyment of sex.
Why does PE happen and what can you do about it?
There are several reasons why someone may have PE. Some people have a chemical imbalance that means they need less stimulation to orgasm. The other most common cause of PE is performance anxiety. This may be because of feeling anxious of performance but also other worries, such as being in a new relationship, or feeling embarrassed or nervous about sex in general.
Treatment can include medication, counselling and techniques to reduce physical sensation/reaction to stimulation.
What about erectile dysfunction?
Erectile dysfunction occurs when the penis has difficulty getting or keeping an erection. Erectile dysfunction is a common occurrence and may affect up to 1 in 4 people under 40 at some point in their lives.
Factors that commonly contribute to erectile dysfunction include:
- drugs and alcohol
- performance anxiety
- diabetes and high blood pressure
- anxiety and depression
- some medicines
Difficulty in getting or keeping an erection does not immediately mean that something is wrong. This may occur from time to time for some of the reasons listed above. However, if this is a recurring issue the best thing you can do is book an appointment with your GP.
How do I start enjoying sex?
If you’re finding that your sexual concern is preventing you from having or enjoying sex then getting support from your GP or local sexual health clinic can help you understand why it’s happening and how to get the help you want.
Remember that your GP has heard it all before, so there is no need to feel ashamed when talking about your sexual health.
It would be a great idea to keep a journal or write down a few notes in your phone that explain the issue you’re facing. This way when you go to your GP appointment you will be able to share more information and determine if there is a contributing factor. It is easy to go to the doctors and suddenly forget what to say when it may be key information.
Your notes should include descriptive words of the pain, emotions, activities before hand, if you had consumed alcohol, etc. If you have a regular partner who is also feeling affected then relationship counselling may also help or you could bring them to your GP appointment when you are ready.
I’m way too embarrassed to talk to my sexual partner/s about this, what should I do?
If one partner is struggling with a sexual difficulty then it’s likely to impact their partner/s experience too. They may be worried about hurting you or that they are the reason for your difficulty. Sex isn’t about pleasing just one person, it should be an enjoyable experience for everyone.
By communicating the challenges you’re experiencing, it may help with some of the anxiety felt about future sexual encounters. You might find it will bring you closer together as you work through what works and doesn’t work for your sexual encounter.
You can also create a connection through other methods that do not involve sex, for example massages, having showers together, sexting or cuddling. There is no rule that you must be having a particular type of sex such as penetrative sex.
SHINE SA is always here to support your relationship and sexual health wellbeing. You can book a sexual health check or call our free Sexual Healthline on 1300 883 793 for further support.
– Ask Dr Amy, SHINE SA
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