The world of women’s sexual pain disorders is a murky one, full of different labels for overlapping conditions, uncertain prevalence rates and frequent misdiagnoses. But the problem is real. A significant proportion of women – between 6.5% and 15% – experience varying levels of pain in their genital areas particularly during sexual intercourse at some point in their life. As it is not difficult to imagine, painful sex can lead to a fear of and aversion to any type of sexual activity, anxiety, depression and a lower quality of life for women.
Sexual pain for women can also place a large burden on the partner. For instance, partners may perceive the woman’s lack of interest or aversion as being a personal reflection of their sexual abilities, and also experience anxiety and depression. The relationship can, correspondingly, suffer too. Couples may feel less connected and affectionate and communicate less. Couples can also feel a sense of loss and injustice for being robbed of what is considered an important aspect of a “normal relationship”.
All of this makes it important to demystify sexual pain disorders. So what do couples in this situation need to know?
Types of sexual pain
Pain during sexual intercourse is not an imaginary condition dreamt up by women trying to get out of sex. It can involve various types of serious pain. There four common typed os sexual pain: dyspareunia, vaginismus, vulvodynia and provoked vestibulodynia.
Dyspareunia refers to painful sexual intercourse for unexplained reasons and vaginismus refers to pain due to spasming of pelvic floor muscle or muscles around the vagina, making penetration difficult or impossible.Women can develop a great fear of pain which makes vaginal insertion with a finger, penis or a medical instrument difficult. Vulvodynias refer to chronic pain in the vulvar region, which is the region around and including the vagina.
Provoked vestibulodynia, the most common form of vulvodynia, refers to repeated pain specifically in the vulvar vestibule when pressure is applied during sex and otherwise. Vaginal entry is possible, but there is recurrent pain. And if the pain has persisted for over six months, during sex or otherwise, such as when inserting a tampon, women should consult a medical doctor.
These conditions can overlap in their symptoms and are often difficult to diagnose.
Physical and psychological causes
Pain during sex is caused by a range of both physical and psychological factors such as genetic predispositions, infections, injury to the area, external irritants, neurological conditions, and physical and emotional trauma. Thoughts like “this feels terrible”, “the pain will keep getting worse”, and “my partner will leave me” can add to the fear and pain associated with sex. Being hyper aware of the slightest twinge or fearful thoughts like, “last time inserting a finger really hurt” can maintain sexual pain. How the partner responds to pain, for instance, being dismissive or insisting on sex despite it, can also add to the disorder. So, in addition to exploring physical causes, women should consider exploring psychological and relationship causes with a mental health professional.
Various medical treatments can help reduce the pain. Since these pain conditions are caused by multiple factors, women might need to visit one or more kinds of medical specialists like gynecologists, urologists, dermatologists, neurologists and pain management experts, to identify treatment options. Medical treatments might include pain blocking medication and physical therapy for strengthening pelvic muscles.
Psychological treatments can help women significantly reduce and manage their pain and help couples experience a fulfilling sex life. Counselors specializing in cognitive behavioural therapy can help with both vulvodynia and vaginismus by providing women the skills to gain control over their pain by understanding the thoughts, behaviours and feelings that contribute to the pain. Counselors can also help women deal with their fear-based avoidance of sex and pain, by teaching relaxation skills and desensitizing them to painful stimuli.
Couples counselors can help improve intimacy and communication in the relationship by encouraging women to exercise greater control over their sexual interactions and their partners to be more supportive. Couples that can use their experience of sexual pain to come together as a team and build a deeper bond, often fare better.
Couples counselors can also help couples diversify their sexual interactions. Engaging in pleasurable non-penetrative sex can be a satisfying alternative and a step towards penetrative sex. In the case of chronic sexual pain, couples are encouraged to accept the role of pain in their life and relationship and create a “new normal” for their sex life.
The writer has a PhD in Couples and Family Therapy and practices as a couples therapist in Mumbai.