Dear Doctor,It has been two years since I got married. My marriage is however on the verge of ending because my husband is frustrated with our sex life. He has been complaining about my being so ‘dry’ since we got married. He only becomes mad at me every time we have sex. He is threatening to find another woman who can gratify his sex life. How can I fix this problem to restore happiness in my marriage?Pascaline 26, Nyarutarama

-------------------------------------Dear Pascaline,I am sorry about the problems you have had to encounter immediately after marriage, as this is supposed to be the most blissful period in a couple’s life.You have not mentioned your age. Normally the vagina of a young woman is always well lubricated. This occurs due to secretions of the glands of the cervix (lower part of the womb). During sexual arousal, secretions from Bartholin’s ducts and other glands increase lubrication and also add to the perception of pleasure. These secretions are influenced by the female sex hormones. With advancing age, as support of hormones reduces, the lubrication of a woman’s private parts is reduced and dryness sets in. Due to lack of sufficient foreplay before intercourse, necessary amounts of secretion are not produced from glands located in and around vagina resulting in dryness and painful intercourse. In a young woman as well, sometimes lack of estrogens or deficiency of estrogens leads to dryness of the vagina.  This could be due to endocrine disorders. At times during pregnancy and breast feeding, the estrogen levels drop causing dryness of vagina and painful intercourse. Excess douching of the vagina is also harmful in this regard as it can also induce dryness,   Use of strong soaps, bubble baths and use of deodorants can also induce dryness.At times, local urinary tract, as well as pelvic infections can also cause dryness and soreness over vagina.Anti cold medications, anti depressant drugs, e.t.c. can cause dryness of other linings of the body including the vagina.Drugs used to treat endometriosis and uterine fibroids can also lead to drop in estrogen levels causing troublesome dryness. The surgical removal of ovaries, radiotherapy and chemotherapy are other conditions related to treatment which can cause dryness of the vagina.Certain simple measures can help overcome this problem. Avoid using deodorants, strong antiseptic solutions and excess douching over the vagina. Try having intercourse when you are absolutely relaxed physically as well as mentally to make it more enjoyable.  Sufficient amount of foreplay will help lubricate the vagina. The use of simple lubricating substances like petroleum jelly, if applied regularly, more so before intercourse will be useful in preventing the dryness of the vagina.If you feel soreness, pain and or itching over the private parts, it is better to consult your doctor and get the infection diagnosed and treated. In case of middle aged or elderly women, it is good to use estrogen containing ointments locally to prevent the dryness. The only thing is it should be started with the advice of a doctor and there should be no medical situation where use of estrogens can be harmful like endometrial cancer or unexplained vaginal bleeding.Dr. Rachna Pande is a Specialist of Internal Medicine-Ruhengeri Hospital