Sexual Health Issues: Seeking Solutions for Discomfort and Apathy

Could you please provide more specific questions regarding sexual health?

Hello Dr.
Tsai Meng-Ju, I have plans to walk down the aisle with my boyfriend, but we are facing some issues in our sexual life that I would like to consult with you about.

1.
Every time we have intercourse, even though my boyfriend is very attentive during foreplay and I achieve clitoral orgasm, my vagina remains very dry, making the insertion process uncomfortable.
I believe I am fully engaged in the experience and there are no psychological factors involved.
Could you please explain what might be the reasons for not producing vaginal lubrication? Is there a possibility of an underlying medical condition (such as a gland issue)?
2.
Since my genital area does not get wet during intercourse, I use KY lubricant for assistance, but I still experience pain upon entry, feeling as if I am being torn apart.
This discomfort occurs even when we engage in sexual activity daily, and it always starts with pain (despite using KY for adequate lubrication).
Could you advise if there are any physiological factors (such as inflammation or a narrow vaginal opening) that could be causing this situation?
3.
I can achieve clitoral orgasm through stimulation, but I feel no sensation in my vagina, whether during foreplay or intercourse.
Although I feel emotionally satisfied, there is no physical pleasure.
Could you help me understand the reasons for this? Is there a way to treat it? Thank you for addressing so many of my questions.
Given that there are no psychological issues, I hope to find a solution for the physiological problems.

Lastly, could you please advise which type of specialist I should consult for these issues? Should I see someone for premarital check-ups, marriage counseling, gynecology, or family medicine? I want to ensure that my lack of vaginal sensation is not due to psychological factors and explore potential treatments.
If points 1 and 2 are resolved, I hope that point 3 will naturally improve as well.

Manman, 20~29 year old female. Ask Date: 2008/08/10

Dr. Cai Mengru reply Family Medicine

Dear Manman,
Hello, your issue is somewhat difficult to categorize, as it seems there are no psychological problems involved.
Physiologically, you are still experiencing clitoral orgasms, but there is less response from the vagina.
This may be considered a type of sexual arousal disorder; however, sexual arousal disorders typically still allow for normal physiological responses after arousal, which does not quite fit your situation.

The sexual physiology of women is much more complex than that of men and is not limited to a single aspect.
As you mentioned, you are psychologically satisfied, and as long as there is no discomfort physiologically, that may be sufficient.
Regarding seeking medical assistance, it is advisable to consult a gynecologist to check for any localized issues in the vulva and vagina.
Wishing you peace and health,
Dr.
Tsai Meng-Ju
Attending Physician, Family Medicine Department
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2008/08/10

More Info

Hello, thank you for your detailed inquiry regarding your sexual health concerns. It’s great that you are seeking information and guidance on these important issues, especially as you prepare for a significant step in your relationship. Let’s address your questions one by one.

1. Lack of Vaginal Lubrication: The absence of natural lubrication during sexual activity can be attributed to several factors. Hormonal changes, particularly those related to estrogen levels, can significantly impact vaginal moisture. Conditions such as hormonal imbalances, menopause, or even certain medications (like antidepressants or hormonal contraceptives) can lead to decreased lubrication. Additionally, stress and anxiety can also affect arousal and lubrication, even if you feel mentally engaged. It’s essential to consult with a healthcare provider to rule out any underlying medical conditions, such as vaginal atrophy or other gynecological issues.

2. Pain During Intercourse: Experiencing pain during penetration, despite using a lubricant like KY, can be distressing. This discomfort could be due to several reasons, including vaginismus (involuntary tightening of the vaginal muscles), anatomical factors (such as a narrow vaginal opening), or inflammation/infection. It’s crucial to have a thorough examination by a gynecologist who can assess for any physical abnormalities or infections that might be contributing to your pain. They may also suggest pelvic floor therapy, which can help with muscle relaxation and improve comfort during intercourse.

3. Lack of Sensation During Intercourse: The experience of achieving orgasm through clitoral stimulation but not feeling pleasure during vaginal intercourse is not uncommon. This could be due to anatomical differences, where the clitoris is not adequately stimulated during penetration. The vagina has fewer nerve endings compared to the clitoris, which is why many women report more pleasure from clitoral stimulation. Exploring different positions or techniques that allow for more clitoral stimulation during intercourse may enhance your experience. Additionally, discussing this with your partner can help both of you find ways to make the experience more pleasurable.

Regarding which specialist to consult, I recommend starting with a gynecologist. They can perform a comprehensive evaluation, including a pelvic exam, to assess for any physical issues that may be contributing to your symptoms. If necessary, they may refer you to a pelvic floor specialist or a sexual health therapist for further support.
In summary, your concerns are valid, and addressing them with a healthcare professional is a crucial step. Open communication with your partner about your experiences and feelings is also essential as you navigate these challenges together. Remember, sexual health is a vital aspect of overall well-being, and seeking help is a positive step towards enhancing your intimate life.

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