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Female Sexual Pain

Susan shared about feeling burning, searing, ripping pain during sex for the last few decades. She was in a happy marriage with a caring husband. She had gone to her gynecologist many times over the years looking for answers. She had tried prescribed estrogen creams, kegel exercises, lubricants, and over-the-counter vaginal moisturizers. She and her husband had gone to a sex therapist who explored issues from her past and dynamics in her marriage that might be effecting the pain. Ultimately, nothing made a difference with the pain.

Like Susan, women may experience discomfort and pain during sex. Some I have worked with have described the same searing and ripping pain when the penis enters the vagina. Others talk about a dull or sharp pain during thrusting and others say they have stabbing pains during orgasm. Sometimes women describe their pain as minor and transitory.

The challenge is, when something is painful, you do not usually want to purposefully seek that out. If you know that placing your hand on that burner causes excruciating pain, you are not going to put your hand there. Our bodies and our brains work very hard to communicate with us about pain and work together to keep us away from it. It can then become very difficult for a woman who is experiencing pain during sex to feel much desire for sex. Many women who experience pain and discomfort during sex continue to engage in intercourse despite the warnings from their body for a variety of reasons. Sometimes they do not feel the pain, and so decide to keep trying. They love their husband and may not want to deprive them sexually. They are concerned about how their husband has reacted or may react to them not wanting to have sex due to the pain. They may feel that this is just what women have to endure. There can be so many different reasons.

However, continuing to engage sexually despite pain will send some very confusing messages to the brain. The pain is saying to the brain, "this is bad, this is bad," and the woman is trying to tell the brain, "this is good; really, this is good." But the brain will often win and for some women, the very idea of sex can become very negative or begin to have little positive value attached to it. Sex should not be painful.

The problem is, when women approach their health care providers about sexual pain, many of the health care providers genuinely do not find any reason for the pain or fail to find a treatment that relieves the sexual pain. A gynecologist may do an exam and not find any physical signs that support the woman's experience of pain. The gynecologist may then prescribe a cream containing estrogen or may recommend therapy for perceived stress that could be causing a tightening of the vaginal tissues leading to pain. There may be a recommendation to a sex therapist. The therapist may then assume that since the woman's gynecologist found no medical reason for the pain, the issue may be relational or may involve the woman's family background or past experiences.

The reality is that many of these issues may very well be involved or may have come to be involved in the sexual pain. However, it is also possible that the actual medical problem has not been identified or resolved. I have worked with numerous mentally and spiritually healthy women who are in healthy, happy marriages with thoughtful partners and they have experienced vaginal pain and not found answers in the medical community. For many of these women, seeing a sexual medicine specialist, who was able to do a much more extensive evaluation and gain a more definitive answer as to what is causing the pain, was of great benefit.

I have attended the same trainings that gynecologists and urologists take from sexual medicine specialists and have noticed that when they have been asked if they had received training on some of the techniques they are learning from these specialists, most of them have said no. It is often assumed that since someone is a medical doctor with a specialization in the gynecological or urological field, they are trained thoroughly in sexual medicine. However, that is not always the case. So, when a woman comes to me and describes her sexual pain, I have learned to ask a lot of questions about exactly how she experiences the pain, when, where, how, and to ascertain what kind of medical care she has sought. And then, if possible, I send her to a sexual medicine specialist or to a gynecologist who has sexual medicine training. This has made the world of difference for many of these women.

In my experience, good care for sexual pain may need to include sexual medicine care in collaboration with sex therapy for the couple. Medical care may include hormonal treatments such as testosterone, estrogen, or progesterone. Other medical treatments may include pelvic floor therapy or surgeries and treatments for issues involving endemetriosis, internal scarring, or nerve damage.

So what happened to Susan? She and her husband came to see me and I included a verbal medical evaluation in my assessment. As she described her pain, I suggested she see a sexual medicine specialist, as I was fairly sure she had what is called vestibulodynia (pain in the vestibule of the vulva, the tissues immediately surrounding the vaginal opening). While she and her husband sought medical care, they continued to work with me on the issues in their sexual relationship that had become problematic. She did receive the diagnoses I had suspected, as they found severe inflammation at the four glands surrounding the vestibule (Bartholin's and Skene's glands). Her process in medical care was then incorporated into the process of couples sex therapy. By the end of therapy, she was experiencing pain free sex, she and her husband had worked through conflicts in their sexual relationship, and they had achieved a renewed relational and sexual passion in their marriage.