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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Mental Health
Satisfied Customers: 31614
Experience:  Specialist is sports medicine psychology. Certified in yoga, relaxation techniques and meditation.
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I am engaged to be married. I have facing some problem with

Customer Question

Hi
JA: Hi. How can we help?
Customer: I am engaged to be married. I have facing some problem with my fiancé with respect to intimacy
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: So the problem is with her and not me
JA: Anything else in your medical history you think the psychologist should know?
Customer: No
Submitted: 1 month ago.
Category: Mental Health
Customer: replied 1 month ago.
I had sexual intercoarse with my Fiancé and she said later to me that she hated it. She feels she can never do it again. She explained that it was very painful for her since it was her first time. The pain lasted for 2 weeks. The other thing is she has been very distant from topics related to sex and porn so she used to feel disgusted when someone talks about them. She says everytime we kissed or made out she used to feel bad later as if she did something wrong or why I am doing this. We have good chemistry and we love each other a lot but she never understood why she feels this way after making out. My question is why is she feeling this way, is this normal? Will it be a problem after marriage when we do again? Because she is now scared and disgusted to do it again and she feels she may never do it again with anyone. Is there a disorder for this? I am a very passionate person and I think this is very important for me to sustain the marriage in future. Is this something serious and cannot be resolved through counselling?
Expert:  Dr. Arun Phophalia replied 1 month ago.

Hello! My name is***** to JustAnswer. I'm reviewing your question now, and will post back with the reply momentarily.

Expert:  Dr. Arun Phophalia replied 1 month ago.

Let me at the outset tell you that feeling of guilt after kissing etc can be resolved gradually by counseling. This may be significant psychological issue which need attention by a psychotherapist. This may have come by the painful experience she had due to sex. That may been a physical issue, which secondarily induced the fear psychosis. Once that is addressed, the fear and guilt too would go away.

Pain during intercourse is called as dyspareunia. The main causes are;

1) Inadequate lubrication

2) Deficiency of estrogen hormones; predisposes for inadequate lubrication

3) Urinary tract infection

4) Vulvovaginitis; various infections

5) Vestibulodynia

6) Retroverted or prolapsed uterus

There are host of other reasons too; infections, vaginal spasm and inadequate lubrication are one of the commonest out of them One of the main and important cause is vulvar vestibulodynia / vulvodynia. Vulvar vestibulodynia can be treated, reduced or prevented with topical xylocaine application. It is available over the counter. You should discuss this possibility with your gynecologist and than discuss various possibilities of the treatment as following (some combination can be determined for the first step of the treatment and if it is less effective, next treatment can be considered);

a) initial treatment of vulvodynia is amitriptyline, nortriptyline. Gabapentin or pregabalin may be considered as adjunctive therapy in addition to these medications.

b) Local provoked vulvodynia (called as vestibulodynia) refractory to other treatments, surgical excision of the vestibule may be considered.

c) In vulvodynia and sex-related pain, pelvic floor muscle dysfunction should be evaluated and treated. Techniques to desensitize the pelvic floor muscles are very helpful. The treatment is following;

1) electrogalvanic stimulation,

2) biofeedback training,

3) digital massage of the levator ani muscles

4) sacral nerve stimulation

5) physical therapy for the pelvic floor muscles.

d) Acupuncture may be considered, which is helpful in a significant number of women.

e) For provoked vulvodynia (sexual pain), intralesional injections may be considered.

Please read these excellent authentic resources on painful intercourse (Dyspareunia);

http://www.mayoclinic.com/health/painful-intercourse/DS01044

http://www.emedicinehealth.com/pain_during_intercourse/article_em.htm

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