Does sex hurt?

Lucy was in a relationship with the man who would become her husband and enjoying every moment. Soon after, without warning, she began to feel discomfort and then pain in the genital area. It became so bad she could not even insert a tampon.

The pain made having sex impossible, too. At first, she thought she had a yeast infection. Eventually, her doctor diagnosed her with vestibulodynia, an inflammation of the tissues surrounding the entrance to the vagina. Putting pressure on the inflamed area can result in severe pain. In Lucy's case, the pressure occurred during intercourse.

The condition is usually accompanied by burning, stinging and irritation or rawness of the affected area. Laser surgery to remove some of the painful tissue improved the problem, but only temporarily, and Lucy went on to suffer for four more years.

Lucy says her husband has been very understanding. ''My husband and I learned to have a sexual relationship that didn't involve intercourse, but it really put a damper on things."

A newly recognised condition

Few people have heard of vestibulodynia (formerly known as vulval vestibulitis, one form of a broader category of problems called vulvodynia or vulva pain syndrome), but, although its prevalence rates are not fully known, it certainly affects tens of thousands of women in the UK. Furthermore, says Dr C. Paul Perry, the president of the International Pelvic Pain Society, ''We think the numbers are higher because it is often misdiagnosed or women are not willing to talk about it.''

The condition was not recognised by medical science until the 1980s. Before that time, doctors dismissed vulvar pain as psychosomatic and frequently sent their patients to a mental health professional.

A ray of hope

However, researchers may have found a cause for this painful condition. A study published in the American Journal of Obstetrics and Gynecology in February 2000 showed that a genetic disorder could be to blame. More than half of the 68 women in the study with diagnosed vestibulodynia were found to have this genetic abnormality.

"In vulvar vestibulitis, something triggers inflammation, but then it doesn't go away," says Dr Steve Witkin, a co-author of the study and a researcher at Cornell University in the United States. The gene the researchers looked at is involved in ending the inflammatory response in most women, but many of the women with vestibulodynia have a rare form of the gene that makes them less able to stop the inflammation, Witkin says. These women also often suffer from other inflammatory problems such as nasal congestion.

The study could be the first step towards finding a treatment that works, says Dr William Ledger, another co-author of the study and a Cornell University gynaecologist who studies infectious diseases. Since anti-inflammatory medications have not helped, the hope is to develop a medicine to do what the defective gene cannot. However, research funds are not plentiful, Ledger says, partly because the disorder takes a back seat to more life-threatening conditions.