Nine in 10 women seek help at KKH Sexual Health Clinic for pain during sex
23 Sep 2024 | Special Delivery
For about a year, Madam Y experienced pain during sexual intercourse with her husband. It was disruptive to their relationship and their plans to start a family. Madam Y decided to seek help but was initially met with difficulties, as she felt that her concerns were not properly understood.
In 2021, the couple went to the Sexual Health Clinic at KKH, where Madam Y was diagnosed with primary vaginismus. Madam Y and her husband were provided with a safe and comfortable space to share their concerns and receive customised, holistic and stepwise management. These consisted of guided physiotherapy with feedback, counselling, and medical advice on lifestyle habits, family planning and treatment goals.
The couple experienced steady improvements, and were eventually able to have intercourse without experiencing pain. They were also referred to reproductive medicine specialists to explore family planning. Madam Y and her husband were heartened by the progress and appreciative of the support from the care team.
Sexual dysfunction common amongst women of all ages
Female sexual dysfunction (FSD) is relatively common and affects about 30 to 50 per cent of women of all ages. It is defined as having persistent recurrent problems with any aspect of the sexual response such as desire and arousal, orgasm, or experiencing pain and difficulties during attempted penetration that results in significant distress to the woman and her partner. Globally, vaginismus and dyspareunia are the two most common FSD conditions.
In the past 10 years, the top issues consistently seen by the Sexual Health Clinic at KK Women’s and Children’s Hospital (KKH) are vaginismus, dyspareunia, low desire, orgasm disorder and relationship issues. Majority of the couples seen are aged between 30 and 39 years, and sought help after discovering a problem following marriage or when they wish to conceive. The clinic observed a 45 per cent increase in patient referrals from the healthcare community from 2020 to 2023.
Vaginismus the top sexual health concern in Singapore women
Nine out of 10 patients seen at the Sexual Health Clinic are diagnosed with vaginismus, a condition where muscles in the vagina tighten involuntarily and prevent any object such as the penis from entering the vagina, resulting in an experience of burning, pain or stinging.
The severity of the condition varies amongst women, and can have the following implications:
Physical: Some women can allow tampon or digital insertions but are not able to consummate their marriage; others are unable to tolerate any object entering the vagina. The male partner may also experience blockage of entry and pain during attempted penetration.
Emotional and relational: The condition is associated with intense fear of and anxiety about pain before or during vaginal penetration. The negative emotions then perpetuate a vicious cycle of pain, as these can cause the vagina muscles to tighten further, making subsequent attempts at sexual intercourse or insertion even more painful. Over time, after repeated failed attempts, this condition can sometimes lead male partners to develop their own sexual difficulties.
Medical: It can also hinder vagina medical examinations, which are necessary for certain gynaecology and fertility assessments and treatments.
Vagina discomfort and penetration difficulties from vaginismus are treatable. Couples are encouraged to seek tertiary medical help early, for timely assessment and holistic intervention targeted at addressing their concerns.
Holistic approach to tackle sexual dysfunction
The Sexual Health Clinic at KKH provides holistic and personalised support for women with FSD that are associated with (and not limited to) the following conditions:
Genito-pelvic pain (experience of pain or discomfort during sexual intercourse or medical procedures), such as vaginismus
Arousal/desire issues
Orgasm issues
Couple intimacy and relationship issues
Emotional difficulties
Gynaecological issues/treatment, such as post-cancer and post-pregnancy
Perimenopause/menopause issues
Chronic medical conditions such as thyroid disease, obesity and anaemia
Presently, the Sexual Health Clinic at KKH is the only multidisciplinary clinic centre in the Asia Pacific region, where team members are certified in the management of sexual health issues by the Multidisciplinary Joint Committee of Sexual Medicine (MJCSM) of the European Union. The team adopts an evidence-based, bio-psycho-social approach to treatment.
Jointly established by the Department of Reproductive Medicine and Family Medicine Service, with support from the physiotherapy and psychology teams, the clinic is housed under the Women’s Health and Wellness Centre.
Treatment provided by Sexual Health Clinic multidisciplinary team
O&G specialist or family medicine doctor assessment
With FSD being multi-factorial, the doctor conducts detailed medical history-taking and physical examinations as required. Investigations may be ordered as part of the screening, as certain conditions can cause sexual problems. Other factors that could affect sexual function, such as health issues and the partner’s sexual function, will also be assessed. This enables the doctor to provide comprehensive and continuous care, including sexual education, to manage contributing medical conditions.
Physiotherapy
Reduced pelvic floor function and increased tension response in the muscles are common amongst women with chronic sexual pain. The physiotherapist optimises the patient’s physical function to promote better sexual function. This includes pelvic floor assessment and exercises to increase muscular awareness, association and relaxation. Pelvic floor muscle rehabilitation, including patient education and devices such as dilators or biofeedback tools, may be introduced to improve therapy outcome.
Psychological support
A woman’s subjective sexual experience, thoughts, emotions and behaviour play a role in contributing to her difficulties. The psychologist works with patients to explore and manage psychological factors involved in sexual dysfunction. The goal is to help patients and their partners work through their distress, learn helpful coping strategies, and change unhelpful beliefs about sexual functioning and sexuality.
Relationship or marital counselling
Sexual health problems may be associated with relationship difficulties. In such cases, couples will also be referred to the Medical Social Work Department, which works closely with the team to support couples in the areas of relationship or marital counselling.
KKH provides holistic assessment, intervention and support for couples who may be experiencing sexual health issues. Community healthcare professionals can contact the KKH Central Appointments Hotline +65 6294 4050 to refer a couple for assessment by the Department of Obstetrics and Gynaecology. Intra-hospital referrals can be made directly to the Sexual Health Clinic.
Dr Lee is a family physician with more than two decades of experience in the hospital and primary care settings. Presently, she treats women with issues pertaining to menopause, osteoporosis, chronic illness and sexual dysfunction.
A Fellow of the College of Family Physicians and Fellow of the European Society of Sexual Medicine, Dr Lee runs clinics at the KK Menopause Centre and Sexual Health Clinic, which is currently Singapore’s only multidisciplinary centre for women with sexual dysfunction.
Dr Lee is also a Visiting Consultant at National Cancer Centre Singapore, treating cancer survivors with menopause and sexual health issues.
Passionate in education, Dr Lee teaches at the Duke-NUS Medical School, College of Family Physicians and Lee Kong Chian Medical School, and is active in research and innovation.
Ms Cheong Xinyi, Principal Psychologist, Psychology Service, KKH
A registered psychologist with the Singapore Register of Psychologists, Xinyi completed her training in clinical psychology, and has worked with children and adults who present with complex emotional, behavioural and mental health conditions.
Her clinical and research interests are in the area of women with sexual health difficulties. Xinyi has trained with the European Society for Sexual Medicine (ESSM), School of Sexual Medicine and is an EFS-ESSM Certified Psycho-Sexologist.
Xinyi lectures at various postgraduate clinical psychology and counselling programmes, and is involved in the training and supervision of provisional psychologists.
Ms Caroline Chua, Senior Principal Physiotherapist, Physiotherapy Department, KKH
Caroline’s main interest is in pelvic floor dysfunction and rehabilitation. With a masters in physiotherapy specialising in women’s health and having received training from the European Society for Sexual Medicine, she sees women of all ages for pelvic conditions including incontinence and pelvic floor dysfunction, and issues relating to pelvic and sexual pain.
Caroline has completed a Master of Health Profession Education in 2024. She is an adjunct lecturer with the Singapore Institute of Technology, teaching topics in pelvic health, ethics and professionalism, as well as teaching and learning in clinical supervision. Caroline also educates postgraduate students on interprofessional collaborative practice in managing female sexual dysfunction for diploma in midwifery and clinical psychology in other institutions.
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