Suzi Godson

If it hurt every time you coughed you would see your GP straight away. Pain is always a sign that something is wrong and the only way that you and your husband will be able to resume physical relations is by finding out what is causing it.

A sympathetic female GP would be a good place to start, but you might be better served by a family planing clinic. If outside London, you can find a clinic on the Family Planning Service website (www.fpa.org.uk ). If you are in London, the Margaret Pyke Clinic (www.margaretpyke.org ), in Charlotte Street, is fantastic.

You could be suffering from any number of physical conditions but once you begin to associate orgasm with cramp, sex can become a trigger for pain. If you suspect this might be the case, contact the Jane Wadsworth Clinic in London (www.imperial.nhs.uk/thejefferisswing/index.htm ). This NHS clinic offers fully integrated treatments for all aspects of sexual health and sexual dysfunction. Dr David Goldmeier, who runs the clinic, has had success treating cases such as yours using antispasmodics such as hyoscine (buscopan) before sex, but first you should get a pelvic ultrasound or MRI scan to exclude things such as fibroids.

You could do this through your GP or log on to www.privatehealthcare.co.uk or www.specialistinfo.co.uk and find yourself, deep breath, clutch wallet, a private gynaecologist. If you refer yourself through a BMI call centre (0808 1010337), a consultation costs £125. If you get referred by your GP, it can cost up to £200.

Dib Datta, a consultant obstetrician and gynaecologist, says: “GPs see themselves as gatekeepers to the NHS and have taken on a lot of the stuff that gynaecologists would have seen 20 years ago, but sometimes they are not well-placed to answer the questions that are put to them.”

Gynaecological issues such as pelvic pain, painful intercourse or cramp at orgasm may destroy a woman's quality of life and even her relationship, but they are not generally life-threatening and that plays a part in how seriously they are taken on a limited NHS budget. As a result, finding the underlying cause, or achieving a definitive diagnosis can take years. According to a survey carried out in 2005 by the Endometriosis All Party Parliamentary Group with Endometriosis UK (www.endometriosis-uk.org ), the average time between presenting at a GP's surgery with symptoms and a confirmed diagnosis of endometriosis is eight years.

That women are ostrich-like when it comes to gynaecological issues doesn't help. Figures from the NHS Cancer Screening Programme show that between 1995 and 2006 the number of women aged 25 to 29 who had taken a smear test had fallen 10 per cent. That's really disappointing when you consider that in 1988 when the screening programme was first introduced, the death rate from cervical cancer in women under 35 was among the highest in the developed world and now, more than 1,000 lives are saved each year.

At the end of the day we can hardly expect gynaecology to be a priority in the healthcare system if we don't prioritise it ourselves.

Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

Dr Thomas Stuttaford

Having a cramp after an orgasm is common but rather more common is cramp during sex. I don't quite understand why your husband is finding penetration difficult if you have already had your orgasm. Could it be that you always come as the result of masturbation during foreplay and your husband then has penetrative sex after you are satisfied?

If so, you could try what happens in many partnerships, where the woman climaxes as a result of stimulation after the man has ejaculated. The ideal would be to have an orgasm together. However, Kinsey and many other sexologists have reported that few couples manage a synchronous orgasm regularly.

Muscular cramp during sexual intercourse is a frequent occurrence. The musculo-skeletal system, the joints and muscles of the body, object to being twisted into unnatural shapes that even fit gymnasts would find difficult. The more bizarre your position the more likely you are to suffer muscle cramps in your lower limbs.

In women, and to a lesser extent in men, the heavier the woman, or perhaps the less exercised, the more likely she or he is to suffer cramps. Some authorities suggest that people who frequently have cramp during intercourse should try a variety of pre-sex stretches, however I am not certain that turning the bedroom into a gym enhances romance.

Muscle cramps are likely to wear off faster if the limb is stretched out and the ankle moved backwards and forwards and, especially if hip muscles are involved, rotated. Pushing the foot against the bedroom wall is a simple way of extending the limb. The average attack probably lasts about three minutes, but sometimes much longer. However, whether cramp persists for two minutes or ten, it is long enough to destroy the rhythm of lovemaking and to blight both partners' physical and psychological responses.

Muscle cramps are more common during sex after sweating or being dehydrated whether as the result of hot weather, during the menopause when a woman's liability to sweat increases, or if a woman is overweight. Lovers, especially men, are likely to suffer cramp more readily if they have been drinking. It may be because alcohol induces sweating and dehydration although some experts suggest it is because a few drinks have a tendency to encourage couples to be more venturesome as they work their way through the Kama Sutra.

It is possible that your letter was hinting that you are suffering from vaginal cramp, vaginismus. In this condition the spasm of the muscles around the vagina and thighs, pelvis and sometimes even the spine can make the vagina impenetrable. Vaginismus is treated with counselling to reassure and advise both partners. It is remarkable how effective advice coupled with a patient, amiable loving partner is in most cases.

If a woman is going through the menopause, she may experience shrinkage of the vagina and thinning of its lining, with the result that she has vaginal dryness, inflammation and pain on penetration. She may associate pain with penetration and hence be resistant to penetration and suffer varying degrees of vaginal spasm. Treatment must aim at removing the underlying cause of the pain. Many doctors recommend a short course of systemic HRT.

Dr Thomas Stuttaford, the Times doctor, spent many years working in a genitorurinary clinic

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