1. I have been married for 6 months. Every time I have intercourse with my husband, I feel pain. What could be the cause?

   For women, pain can occur in the pelvic area during sexual intercourse. This is called dypareunia. The pain may be superficial at the entrance of the vagina, or deep with penetration on penile thrusting. Some women may also experience severe tightening of the vaginal muscles with penetration, a condition called vaginismus. If left untreated, it may lead to loss of interest (libido) in sexual activity.

   Common causes include:

   • Endometriosis: a common cause for pain during sexual activities. Sexual intercourse causes movement and stretching throughout the pelvis. Normally this movement is comfortable. However, with endometriosis, the thickened tissues surrounding the womb and the ovaries generate pain instead.
   • Vaginismus -- involuntary contraction of the vaginal muscles usually resulting from psychological trauma of sexual abuse or rape.
   • Vaginal dryness or inadequate lubrication from insufficient foreplay.
   • Intercourse too soon after surgery of vagina or child birth.
   • Vaginal infection including herpes sores, genital warts, or other sexually transmitted diseases such as Chlamydia and gonorrhea. They can remain dormant (asymptomatic) and go undiagnosed for years, only to cause damage and pain later. They affect the fallopian tubes and the ovaries and can render a woman sterile.
   • Ovarian tumor or cyst: If the tumor is hit with thrusting during deep penetration, it causes pain.
   • Urinary tract infections
   • Allergic reaction to condom, clothing, spermicides or douches
   • Menopause (vaginal lining loses its normal moisture and becomes dry and thin)
   • Genital irritation from soaps, detergents, douches, or feminine hygiene products.

    

2. I am 32 years old and my wife is 28 years old. We have been married for 2 years and only thinking of having a baby 2 years later. What is the best age for a woman to have a baby if there is such an "age"?

   There is no such a "magical age" for woman to conceive. However, the age of the wife can certainly affect the chances of conception considerably. This is because the quality of egg decline significantly in the 30s and faster in the 40s. Statistics have shown that the optimal age for conception in the females is between 22-26 years old. Fertility decreases steadily after 30 years old with a rapid decline after 40 years old. However, these statistics serve only as a general guideline and there are exceptional cases. It is estimated that one in every 3 couples in which the wife is aged 35 and above will have problems with fertility and 2/3 of women will not be able to conceive after 40 yrs of age. From the above studies, I would advise you not to delay starting a family.

    

3. I delivered my daughter 2 years ago and am still breast feeding. I found that I have lost interest in sex with my husband. What shall I do?

   To understand the lack of interest in sex in woman, we must understand her sexual responsiveness. This is quite complex and depends on many factors such as her background and childhood experiences; her self-image; her compatibility with the husband and the husband's capacity and willingness to arouse and stimulate her sexually.

   Fatigue and exhaustion is a common cause of female sexual unresponsiveness - particularly so if the woman's primary responsibility is breast feeding and raising her children. It is very difficult to find time to be spontaneous about sex. Gradually work, family matters, household chores take their toll. Over time, sex would be relegated to the last thing before bed, something to do on weekends. It then becomes a routine, one-sided or half-hearted. The spontaneity and romance have disappeared.

   If the woman is breastfeeding, her female hormone, estrogen is also reduced. This can cause dryness in the vagina and therefore pain during sexual intercourse. Thus her desire, libido will be lowered further. After a while of just not being in the habit of having sexual relations she loses the habit.

   Finally, if the child is sleeping with the mother, she may constantly worry about privacy. This will also affects her desire.

   These problems are not amenable to medication. What is needed may be is to take time off, away from the child for a while, and be alone with her husband without any distraction.

Questions on this page are answered by Dr Peter Chew, Consultant Obstetrician Gynaecologist, Chairman of the Board of ALife. Please visit www.alife.org.sg for more information.