It has been a year since I first met Jane at the Sexology Clinic. It was on one of those cold mornings of July in Nairobi. I was early at the clinic to do my traditional morning reading before starting to attend to patients.
The medical field is quite dynamic and one has to continuously search for new knowledge to remain relevant and so I was early for a catch up but my plan was never to be. Jane was there waiting at the door of the clinic at 7 a.m.
“I had a bad night and left the house at 6am, so I have been here for about 30 minutes,” she said as she settled on the seat in the consultation room.
She was a 35-year-old designer running an art gallery in the city. She was married to an accountant and they had three children.
“I have ED and it is messing up my life,” she said, to which I frowned since ED stands for erectile dysfunction or erection failure. ED makes penetrative sex impossible and is a problem for men.
“You mean your husband is facing issues?” I asked, to which she shook her head and confirmed that she was the one having issues.
“I read somewhere that ED is failure to get sexual stimulation; that you may want to have sex but then your sex organ does not respond accordingly,” she explained. I nodded in the affirmative and added that if it is a man who is affected we call it ED but if it is a woman, we just say that she is unable to lubricate, which means that she will remain dry and sex becomes quite painful.
“Exactly. I can’t lubricate and sex with my husband is akin to my private part being sliced with a sharp razor,” she explained, her eyes welling up with tears. The previous night had especially been bad for her and she reported that she saw fresh blood dripping immediately after sex and she was quite sore.
I examined her and, true to her word, she was quite inflamed, with bruises all over her vagina.
“The annoying thing is that the more I wriggled in pain, the more he got vigorous,” she said, a tear rolling down her left cheek and falling with a thud on the collar of her white blouse.
“He later annoyingly said that he thought I was having unbearable pleasure,” she added.
Jane was facing a difficult but common problem that women face at one point or another in their sexual lives. Lack of lubrication during sex affects up to 16 per cent of women at any given time. Their spouses may also suffer pain and bruises due to the friction, making it difficult for them to enjoy sex. The condition normally causes marked distress in a couple.
“We are using condoms for contraception so that is why my husband did not feel pain and bruising as I agonised,” Jane interjected as I explained to her the basis of her problem.
A dry vagina can be a result of a physical illness of the blood or nervous system or an abnormality of hormones that affect sex. The more common cause however is psychological. It may start with a bad sex experience and escalate into anxiety and other more complex psychological problems whenever one thinks of sex.
Relationship problems
Another common cause of dryness is relationship problems. When the relationship is in a crisis, sexual excitement dies off naturally and lubrication becomes a problem. Lubrication can therefore be a physiological way of expressing dissatisfaction with the relationship.
Also common is the bombardment with negative sex messages which we all go through at family and community level. The social construction of sex can numb sexual feelings, e.g. the belief that women should not enjoy sex. Such beliefs cause withdrawal and numbness towards sex and lack of excitation and lubrication can be the result.
“So what do I do, doctor?” Jane asked. She was obviously in pain and my long explanations were not adding value to her at this point.
The first thing was to deal with the pain and soreness and to ensure that the wounds did not get infected. I put Jane on treatment and agreed that she would withhold sex and would do a follow-up visit for full assessment in three days.
The full assessment that involved examination, tests, psychological and relationship assessment revealed that Jane and her husband had serious challenges with intimacy. There was a power struggle in the relationship, with each partner wanting to have control over the other. Jane felt disempowered and withdrew emotionally. Her body, as a result, rebelled by not responding to the sexual stimulation by her husband.
The couple underwent relationship therapy. Fortunately, both were committed to making the relationship work and within three months, they were able to face their differences and make agreements. Natural lubrication flowed freely thereafter and Jane even reported squirting.
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