A billboard advertising safe sex in Ghana. Photo via Flickr user Erik Cleves Kristensen

I first heard about "dry sex" when one of my friends returned from Malawi, where she was doing work with women and cervical cancer screenings. Dry sex, she told me, is the practice of reducing moisture in your vagina in order to seem tighter and cause more friction during intercourse. This is believed to be more pleasurable for the person with the penis, but for the women involved, it's incredibly painful. It's an idea linked to the perception that a tight vagina is one that hasn't been stretched out by overuse, which speaks to the low level of sexual education in the region.

It gets worse. To achieve dryness, some women insert chalk, sand, pulverized rock, herbs, paper, or sponges before sex. Douching with caustic liquids such as detergents, antiseptics, alcohol, and bleach is also common. The use of these substances, in combination with un-lubricated penetrative sex, can lead to vaginal abrasions and increased condom breakage—which compounds the spread of HIV.

Looking into the trend, I found that information was thin. Most of the studies I did find were more than a decade old. The impression was that the issue was endemic, but hard figures were few and far between. For all the efforts put into HIV awareness and prevention campaigns in this part of Africa, none seemed to address dry sex or its role in the spread of the disease.

After much searching I found Dr. Marlene Wasserman, popularly know as Dr. Eve in South Africa. She's a sexual health clinician, advocate, and host of a radio program on which she attempts to dispel the country's rampant misinformation around sexual health. She believes that the silence around the issue isn't due just to ignorance but also to a massive hole in sexual education relating to pleasure equality and women's rights.

VICE: Why aren't people talking about dry sex?

Dr. Eve: There's on-again, off-again discussion around it, but you're right. There isn't enough. It hasn't got attention from the government to that level where policies are being put in place.

And it's because it's about vaginas—it's way too real to talk about. We can talk about penises and circumcision, which we do all the time, and the government puts policies into place. But dare we talk about vaginas? I've been doing radio for 20 years and the only time I've been reported to the broadcasting commission was when I referred to vaginas.

Why is there reluctance to discuss it? You'd think with South Africa on the front lines of AIDS people would get over their squeamishness.

We don't even talk about AIDS anymore; we're too fatigued. It's the same with violence: We're so immersed in a culture of it we don't want the discussion; there's a rebelliousness and a resistance. We don't have these conversations because we're so disenchanted by daily violence and the lack of justice in our country.

Look at how HIV/AIDS has been framed in Australia. Even within the paradigm of sexuality, it's been presented in the disease model. It's the ABC: abstain, be faithful, use a condom. The education is don't have sex. No one is talking about your anatomy, or vulvas, or vaginas, or clitorises, or sexual pleasure. They're talking about become pregnant or becoming infected—it's a fear-based approach.

So how do you remedy that when the discussion has become tired but isn't resolved?

It's about educating people and trying to raise awareness. The conversation began when we realized HIV was impacting more heterosexual women in South Africa than gay men. There was a drive then to say to women: "Don't put Dettol in your vagina; don't dry your vagina out. This is dangerous." But the conversation hasn't gotten going, and women are suffering.

Is there a class divide in sexual education?

It's definitely a class issue... among women who are less informed and less educated, there's an unbelievable ignorance around the idea the vagina adapts to the penis. People believe if you're with a guy with a bigger penis it means that your vagina is going to stay that big. And if you break up with him and go with a guy with a smaller penis you're going to still be really big and he's going to know you've been with other guys with larger penises. He's going to be self-conscious and not want to be with you. A woman's reputation depends on the size of her vagina.

Where is that message coming from?

It's from other women and it's intergenerational. Men aren't saying to women, "Put Dettol in your vagina," but rather they're saying, "Your vagina's loose, that means you're loose, that means you're a slut, and I'm throwing you away."

Has this thinking always been around?

It's always been around, the need to have a tight vagina. It's about youthfulness. But it's also blending with myth. You might remember in the 90s in South Africa, when the discussion of HIV began, one of the myths that was incredibly damaging was if you had intercourse with a virgin you're going to cure yourself of AIDS. Do you remember that?

Yes, and I remember all the rapes of very young girls. But it's the same as women in the West chasing youth through vaginoplasties.

They're having their own genital mutilation. It's just a little more advanced and expensive than putting creams in your vagina. But isn't the principal the same? It's incredibly unhealthy as well to go have your vagina tightened because you want to have a honeymoon experience or have your partner think you're youthful.

I can see the social pressures, but I can't get past the pain. Is the larger issue also that the pain is acceptable in sex?

Yes, and that's a big conversation. I've been part of a task force with the World Association of Sexual Health, and we've launched the declaration of sexual rights—the right to pleasure—and we've been really pushing that. Women are surprised that's one of their rights. We know 33 percent of women have and tolerate painful penetration. That becomes part of what they expect from sex.

I suppose that's what happens when sex culture is dictated from the male perspective.

I did a workshop in a school in Knysna with 200 students and was horrified when these girls were telling me they would protect their virginity by going down on men. I said, "I expect they then go on their knees and go down on you."

There was this shocked silence. They said it's just not what men do. Why wouldn't you expect it? There has to be reciprocity; there's no way you should be going down on a guy if you're not getting assurance he's going down on you.

The motivation for doing that is to get a commitment and please the guy. They haven't thought about their pleasure.

Is that key? Re-approaching sexual health by teaching women about pleasure as much as teaching them to be safe?

Oh God, I spend my life talking about that. It's not an education at all. When I spoke to these kids I asked what has sexual education been about? It was all fear-based. Here we are in 2014, and that's still what they're getting.

Sex is about pleasure, rights, health, how to make good decisions, how to negotiate, and they're not getting taught that.

But as you mentioned, the message is coming from the families, so it's not just about formal education.

The same night I did that workshop I did one for the parents. I was telling them their kids are having sex because they love to have sex. It feels nice. Let's just be aware of that and manage it from there.