It has been a year since I met Jane. I was out for lunch and had just entered my popular restaurant to have a quick bite. There was a lady seated at the next table who immediately turned and looked at me. She then walked over to my table.
“I am sorry to interfere with your lunch, doctor, but I didn’t know how else to get you,” she said. “I have a quick question for you. Can I sit with you over lunch?” I did not mind the company so I welcomed her. She was a bit uneasy and shy, and introduced herself as Jane.
“I hope you are having a great afternoon, I like food in this restaurant,” I said, to break the ice. She did not seem to have heard me, and her next question was quite unrelated and confusing to me:
“Doctor, how do you manage a rocky Sahara Desert that tears car tyres apart?” she asked. I had no idea what she meant, and I said as much. “Sorry I know very little about cars. My geography of the Sahara has also faded after I left high school.”
She smiled and told me that she knew me and what I do. She said she was talking about sex. She said it was very difficult to talk about sex and she thought I could figure out her problem through the figurative language.
“So what has sex got to do with a rocky Sahara and car tyres?” I asked.
In my interaction with patients and couples on sexual issues I have learnt that people use various metaphors and similes to represent their understanding of sexual issues. It is a result of our upbringing; talking about sex can be shameful and people have learnt to camouflage it.
“Doctor, rocky Sahara is a dry vagina,” she said, looking behind her just in case someone was listening. She also avoided eye contact with me. I nodded to show that I understood. She explained that she never had lubrication when having sex and this had caused bruises her and her husband painful bruises, which made her dread sex. Her marriage was now on the rocks.
I realised the lady was dealing with a common yet difficult sex problem: lack of lubrication during sex. About 16 per cent of women suffer this problem and it can be very depressing. Their spouses also have a difficult time enjoying sex.
Dry vagina can be the result of a physical illness of the blood or nervous system, or an abnormality of the hormones that affect sex. The more common cause, though, 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.
Another common cause of dryness is relationship problems. When the relationship is in crisis, sexual excitement dies off and lubrication becomes a problem. Also common is the bombardment of 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 lack of excitation, and lubrication can be the victim.
“So what do I do, Doctor?” asked Jane as we cleared our lunch.
This was a short casual meeting and we could not solve the problem in the restaurant. To be able to identify the cause of her problem, she booked an appointment at the clinic and underwent tests and examination. Her husband also underwent examination, because sex problems are shared and are not a problem of the individual but the couple.
It turned out that the couple had serious challenges with intimacy. There was power struggle in the relationship, with each partner wanting to have control over the other. The lady felt disempowered and sat on, and physiologically rebelled by not responding to the sexual stimulation by the man.
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.