Dear Doctor,

I am a 24-year-old virgin and planning to get be married in December this year. However, silly as this might sound, I am scared of the thought of having sex for the first time. I have heard that it is painful and honestly, that is what scares me. I told my friends about this and they laughed at me but my phobia is getting stronger. There must be something that can make the experience less painful right?

Diana, Nyarutarama

Dear Diana

Technically, the act of sexual intercourse involves penetration of the male penis into the female vagina. It is potentially painful but has been described by all experienced persons to be a pleasurable pain. Actually the insertion of any foreign object in the vagina is potentially painful. But due to the soft texture of the vagina, its rich blood supply, lubrication provided by secretions from the glands of vagina and endocervix, the vagina is adapted to receive the male organ, thus reducing the pain as much as possible.

Moreover release of endorphins locally and chemicals like melatonin, serotonin from the brain, make this pain pleasurable. Being very close to somebody you love, gives perception of pleasure. This act which is ultimate in intimacy also brings two people closer.

In certain conditions sex can really become painful and devoid of pleasure. Pelvic infections, including sexually transmitted diseases, where there is inflammation of vagina, cervix (lower part of uterus) uterus, and or fallopian tubes can cause pain during intercourse, a condition called dyspareunia. The pain may be so severe that one would avoid sex altogether. Dryness of the vagina which occurs due to depletion of estrogen in advancing age can also make intercourse painful.

Medicines like anti depressants, certain birth control pills, among others reduce the desire for sex and can make the act feel painful.

Trauma either due to direct injury or some surgical intervention, skin conditions like eczema, can cause a lot of pain during sex. Painful intercourse can also occur due to the presence of an ulcer over the vulva, vagina or cervix. Emotional component is also implicated in causing painful intercourse. Sex after marital disputes, forced sex as in rape, mental stress due to domestic or work place problems and others can be painful.

But apart from these conditions, sex is mostly pleasurable. Instead of becoming very intimate at the very first occasion, one can try to come closer just by hugging and kissing. Foreplay in the form of fondling intimately also increases ones desire and makes sex pleasurable and acceptable. Gradually, as the desire enhances, a woman will crave for and shall be physically and mentally prepared for the ultimate act in love making that is penetration. In such a situation, it shall always be painless and pleasurable.

A word of caution here, it is always important to maintain good personal pelvic hygiene to prevent pelvic infections and consequent painful intercourse. This includes good hygiene during menstruation and also after sex. During menstruation one should try to keep herself clean and dry always, otherwise there is increased risk of infections. After intercourse it is advisable to pass urine and wash the genital parts. This ensures that no disease causing germs remain on the vaginal surface, which can cause pelvic infection.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.