Why do I feel pain during intercourse?

Dear Doc,

I am a 34-years-old woman married for the last seven years and I have been having a problem with my partner. Whenever we are intimate, I feel a burning pain after intercourse, and this happens every time. This has really affected my sexual relationship with my partner because I always don’t feel like being intimate because of the pain. What could be the problem and how can I get help?

Nancy

Dear Nancy,

Pain during intercourse can be due to several reasons including: poor lubrication due to hormonal changes during pregnancy/breast feeding, hormonal contraceptives and inadequate foreplay; physical injury, surgery or female circumcision; genital or urinary tract infection, bladder infection and pelvic inflammatory disease other illnesses in the pelvic organs such as uterine fibroids, endometriosis, ovarian cysts, painful haemorrhoids, irritable bowel syndrome, vulvar vestibulitis and inflammatory skin conditions;  vaginismus, where the muscles of the vagina involuntarily contract before or during intercourse; psychological reasons such as anxiety, stress, fear of pain, relationship issues and history of sexual abuse can lead to poor lubrication and contraction of vaginal muscles

Reduce the likelihood of injury or excessive friction during intercourse by relaxing and using lubricants, especially if you are using condoms. It is also essential to have good communication with your partner to prevent recurrence of the pain and to ensure mutual satisfaction.

It would also be beneficial to see a doctor/gynaecologist for examination and relevant tests, followed by appropriate treatment depending on what is found.

Dear Doc

What causes a smelling mouth? I have used all manner of prescribed drugs including mouthwash but still the problem persists. Could it be an internal problem, or what is it and how do I get help? This is affecting my kissing life!

Maurice

Dear Maurice,

Bad breath, also known as halitosis, can be caused by problems with dental hygiene due to the bacteria in the mouth. It can also be due to gum disease or food particles retained in the mouth.

You should brush and floss your teeth after meals, at least twice a day, and also brush your tongue or use a tongue scraper. You can also use a mouthwash or gargle after brushing your teeth.

It is also advisable to visit a dentist to have your teeth checked, cleaned and treated because plaque, tooth decay and cavities can contribute to bad breath.

Having a dry mouth can also lead to bad breath. This is because saliva helps wash away food particles and bacteria. During sleep, the production of saliva slows down, allowing multiplication of bacteria. This is what causes bad breath in the morning. To deal with this, in addition to brushing your teeth in the morning, you should also eat a meal in the morning. You may still have bad breath even after brushing your teeth if you do not eat.

Prolonged hunger and fasting can lead to bad breath, and so can some foods such as onion and garlic, so reduce the amount of such foods. Take a lot of water, every day, as well as plenty of vegetables and fruits.

Health conditions that can contribute to bad breath include sinusitis, recurrent throat infections, tonsil stones, recurrent heart burns and stomach infections, diabetes, and liver or kidney failure.

Other causes of bad breath are smoking, consumption of alcohol, snoring, dieting and hormonal changes. If any of these are the cause of the bad breath, dealing with the underlying problem should get rid of it.

Dear Doc,

My name is Erick. I am 32 years old and of late I have been struggling with erections. I have felt something soft in my testicles and since then I have been having erection problems. What could be the cause? Is the erection failure caused by the soft tissues in my testicles? What should I do? Please advise.

EK

Dear EK,

Having a problem with achieving an erection once in a while is not a cause of concern. However, if it persists, it may be due to either a physical and/or psychological issue.

It may be due to psychological issues like stress, anxiety, depression, relationship issues and performance anxiety. You may also have a physical problem that is affecting the quality of your erections, including reduced testosterone levels, heart disease, high cholesterol levels, blocked blood vessels (atherosclerosis), diabetes mellitus, hypertension, nerve problems, some hypertension medicine, sleep disorders, obesity, alcoholism, smoking or other drugs, injuries to the spinal cord or pelvic region and peyronie’s disease (formation of scar tissue in the penis).

It is advisable to see a urologist for proper examination and relevant tests so that the exact source of the problem can be identified and dealt with. It may also be beneficial to see a mental health professional to explore any possible psychological causes of the dysfunction. Your partner also needs to be very supportive, and they may be included in the sessions.

In the meantime, maintain a healthy diet, exercise regularly, get adequate sleep (seven to eight hours a day), avoid alcohol and cigarettes, and find a way to manage the stress.

You may also benefit from pelvic floor exercises: contract the pelvic muscles as though you are stopping the flow of urine. You can practice this to identify the specific muscles by stopping the urine mid-flow when you are urinating. Contract these muscles for about 10 seconds, 10 times in one set for six to 10 sets in a day.

Having a mass in the scrotum is a cause of concern. It may be a hydrocele (a build-up of fluid within the scrotum), a varicocele (dilated blood vessels), a hernia (part of the bowel that comes into the scrotum after passing through a passage called the inguinal canal), a spermatocele (fluid-filled sac in the epididymis that may contain sperms), a cyst, or cancer. If it is very painful, it may be due to an infection, trauma and accumulation of blood from a tear, or testicular torsion (twisting of the testes).

To get an accurate diagnosis, you need to be examined by a doctor and a scrotal ultrasound scan done. Further management will depend on the findings.

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