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Pain with Sex: Not Normal

Posted Jan 15 2009 7:42pm

A couple of weeks ago, Lana, one of my oldest friends—a girl I went to high school with back in New Orleans who now lives five minutes away from me in Los Angeles—introduced me to Rachael, one of her actress friends. Both Lana and Rachael fit the model of the kind of women I can’t help but envy sometimes, not because they’re tall and fabulous (I made peace with my 5-feet, one inch stature and lack of fashion sense back in my ‘20s), but because they’re able to do all of those “normal” things women do; they wear jeans, sit on bar stools and restaurant benches without grimacing and have tons of great sex—or so I thought.

As usually happens when you mix girls and red wine, the topic of our conversation turned to relationships and sex. That’s when Rachael confided that for the past two years she’s experienced terrible pain each time she and her boyfriend of five years have sex. She said she had seen her OB/GYN, who had run tests, found nothing, and told her there was nothing wrong with her. Since then, she said, she’s just dealt with the awful pain.

I took a pause and inhaled deeply so as to contain the rage that had overtaken every cell in my body—it was a reaction that had become all too familiar to me—it was the same feeling I had every time I heard about a doctor telling a woman in pain that there was nothing wrong with her. When I exhaled, I tried to release the string of irate thoughts exploding in my brain, thoughts like: “Son-of-a-b@#$%! Can’t these doctors at the very least get on Google!” or “I don’t care what they do or don’t teach in med school! Hey doc, look it up on the Internet, and at least get a clue!”

Quick aside: I’ll never understand how a doctor can tell a patient in pain that there is nothing wrong with him or her. Why not just say “ I haven’t been able to find out what’s causing your pain, so I highly recommend you seek out a specialist for a second opinion.”

I pulled myself together and told Rachael that painful sex is never normal. I gave her the abridged version of my own chronic pain story—I typically don’t spill my pelvic floor saga on the first meet and greet, but this time I made an exception—then I asked her a few questions. Turns out Rachael has frequent yeast and bladder infections and also experiences pain every time she has her annual pelvic exam. I gave Rachael the medical term for painful intercourse, “dyspareunia.” I also gave her a rundown of the most common causes of dyspareunia. Luckily, I had recently read an article on painful intercourse that Julie Sarton, my PT, had written, and the info was fresh in my mind. But, most importantly, I gave Rachael the name and telephone number of my urogynocologist.

Since meeting Rachael, I have thought a lot about the incident. There are two things about it that I’ve just been unable to shake:

One, how random it was that I should meet a friend of a friend who was suffering from painful intercourse—a topic I am currently researching for a book on pelvic floor dysfunction. It reiterates what I know to be true, but continue to have a hard time accepting—that so many women walking around who appear in perfect health suffer from some form of pelvic health issue.

And two, how could a smart woman like Rachael, an actress who is used to being assertive and not taking “no” for an answer simply take the word of one doctor that there was nothing wrong with her. Is it common for a woman to just accept painful sex as her lot in life? Is there a deeper issue here? Do women in general feel less entitled than men to enjoy sex? If they experience pain or discomfort during sex, do many women just assume it’s because of something they are doing wrong or not right? Am I over thinking things? I’m not afraid to say that I don’t have answers. But, I’ll tell you this, I’m going to ask every single sex therapist and every single doctor specializing in sex, and every single woman I interview about sexual pain for their insights into these questions. And you know I'll keep you posted on what I uncover!

In the meantime, here’s what I DO know, thanks to Julie's article: Click here to read the entire article.

Some of the most common causes of dyspareunia, or painful intercourse, are:

• Insufficient lubrication
• Hormonal changes (common during menstruation and menopause)
• Decreased arousal
• Thinning of vaginal tissues
• Surgical scar tissue
• Childbirth/improperly healed episiotomies
• Infections
• Allergic reactions to lubricants or condoms
• Vaginismus - Involuntary spasms of the vaginal muscles known as the pelvic floor.
In severe cases, penetration is not possible.
• Physical trauma – Falls onto the hip, back or tailbone.
• Emotional trauma – A history of abuse or religious/cultural restrictions.
• Chronic constipation
• Fibroids and endometriosis
• Retroverted (tilted) uterus
• Bartholin’s gland cysts – Growths on ducts from glands in the genital area.
• Vulvodynia/vulvar vestibulitis – Inflammation of tissues surrounding the entrance to the vagina.
• Dermatologic conditions such as lichens sclerosis

If you have any insights into any of the questions I’ve raised in this blog post, please share them with me!

Y’all come on back tomorrow when I'll post about a few items in my “pelvic pain be gone” tool kit that I can’t live without! And be thinking of yours, ‘cause you know I’ll be asking about them!

Until then,
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