Expanding Knowledge and Discourse: Female Sexual Pain

Female sexual pain is something that spans across ages, races, orientations, and sexual activity.  Although “sexual pain” seems very related to intercourse, it can also include pain during or after gynecological exams, tampon insertion, or the use of fingers or sex toys.  Frustratingly, for patients and doctors alike, there isn’t one specific cause of sexual pain.  This complicates matters and makes most cases patient-specific.

New research and information has been getting a lot of attention lately that indicates treatment should include mental health support as well as medical treatment.  Chances are, by the time women talk to their doctor about their pain, they have experienced emotional distress, self-esteem issues, and relationship struggles.

Female sexual pain? Is that a real thing?

I get asked this a lot.  Mostly from men, but surprisingly women have asked me too, even though a study cites that between 8-16% of women experience sexual pain at some point in their lives.  That’s roughly 13-25 million women in the United States.  The majority of the pain can be due to something as simple as insufficient lubrication, and only occurs once and then never happens again.

For other women, however, it becomes a chronic struggle and something that affects them more than just physically.  For these women, the causes of sexual pain could be vast or even unknown.  Some possible causes could be allergic reactions, dry skin conditions, side effects of medication, chronic yeast infections, postpartum injuries, anxiety, and the list goes on.  Typically, by the time women seek treatment they have experienced the pain for quite some time and are understandably frustrated and concerned.

What is it exactly?

Dyspareunia is an umbrella term defined as general sexual pain, and the term that most women are diagnosed with when they see their physician.  As mentioned, the cause is typically hard to pinpoint and might be complicated due to overlapping causes.  This is especially the case if there is a physical or medical condition in addition to a psychological cause for the pain.

Another term used often is vulvodynia.  It is a type of dyspareunia and referred to any pain in the vulvar area.  This type of pain can occur with or without sexual penetration and may or may not occur during, or as a result of, penetration.  This also means that it could occur with gynecological exams or tampon insertion, for example.  Vulvodynia can be specific to a particular area of the vulva,  such as the vestibule (which is sometimes referred to as vulvar vestibulitis syndrome) or general vulvar pain.

Similar to dyspareunia, the causes for vulvodynia can be known, unknown, simple, complicated, medical, psychological or any of the above.

Is your head spinning yet?  There’s more…

Pain isn’t just on the surface – it typically involves the muscles, too

A potential cause for painful intercourse is vaginismus.  This is an involuntary spasm of the pubococcygeus (PC) muscles, which are the hammock-like arrangement of muscles that run from the pubic bone to the tail bone.

In general, when the body anticipates pain, it responds by moving away from the stimulus that might cause pain.  With sexual pain, it is similar, except that the PC muscles contract in an effort  to keep anything from entering the vagina.  As mentioned, this can occur with gynecological exams, tampon insertion, sex toys, fingers or intercourse.

There are two types of vaginismus – primary and secondary.  A diagnosis of primary vaginismus is given when there are muscle spasms at the first attempt of vaginal penetration.  Secondary vaginismus is when there had been prior, pain-free penetration.

The causes of vaginismus also vary – it could be a result of physical (i.e., medical conditions, injury, age-related changes, etc.) or non-physical issues (i.e., anxiety, fears, traumatic experiences, etc.).  Additionally, vaginismus might be a result of a combination of issues.

A multi-faceted problem

Hopefully, the reader is not too overwhelmed at this point, but if you are, it is completely understandable – this can be a frustrating and convoluted issue, especially if you are directly affected by female sexual pain.

Oftentimes women seek treatment only from a gynecologist and the psychological concerns (such as relationship stress) are not addressed.  Or, women will seek sex therapy, expecting that if they can improve their desire, arousal, or relationship then the physical pain will be resolved.

What makes it so troublesome is that the pain tends to overlap between physical and psychological issues.  Therefore simply seeing either a gynecologist or a sex therapist does not address all of the potential issues that female sexual pain might create.

Furthermore, since there are not very many resources or enough research conducted on this issue, not many physicians or clinicians know how to work with it best.  This is not because they are incompetent providers, it is simply because there is a limited amount of information.  However, it would be very important to get a physician on board that is up to date on the most recent information about painful sex.

Since the physical pain or anxiety around sex creates a response within the body to tense up, it is likely that a woman with physical discomfort during or after sex will also have a degree of vaginismus.  As a result, there can be psychological ramifications and relationship stress that arise as well.  Sometimes women choose to avoid sexual encounters, which might create distance in the relationship and intimacy issues that can put a strain on them.

A lot of women who have been struggling with sexual pain have also been told that their pain is “all in their head,” which can greatly affect how they are able to deal with their pain and the effects of it.  Women might question their self worth, feel anxious, depressed, hopeless, or even out of control of their situation, which is why it is important to also treat the mental health aspects of female sexual pain in addition to the physical pain.

Multi-dimensional treatment

Similar to other chronic pain, having an involved treatment team that is up to date on the most current research and aware of the multi-faceted issue of female sexual pain is essential to recovery.  Bergeron (1997) found that a multi-modal form of treatment is one of the most effective ways of working with female sexual pain.  The treatment team should include a medical physician, a pelvic floor therapist, and a mental health clinician, all of whom should be specialized in female sexual pain.

The gynecologist will be able to determine if there is currently a physical component that needs treatment.  For instance, if there are chronic yeast infections the gynecologist would work on getting that under control through medication or dietary changes.  Or, if the pain is a result of hormonal changes, the physician would create a treatment regimen to address the effects of the imbalance in hormones.

A pelvic floor therapist will work on assisting the woman in gaining control over her PC muscles.  This is often times done with the use of a vaginal dilator.  The therapist will educate the patient on exercises to do at home and how to use a vaginal dilator.  Dilators can be purchased online at http://www.vaginismus.com/products/dilator_set.  Stretches are also introduced and can include working on the PC muscles, as well as hip, back, and core muscle groups.  The pelvic floor therapist will teach relaxation techniques to use while stretching and working with the PC muscles.

Finally, incorporating a  into the treatment is essential in healing the emotional and relationship struggles.  As mentioned before there is a lot of psychological stress that can arise from female sexual pain.  Typical sex therapy is helpful in addressing some of these issues; However, a combination of sex therapy and cognitive-behavioral therapy (CBT) that addresses the struggle of pain management is important too.  Bergeron (2001) found that 40% of participants in a CBT/sex therapy group setting had significant improvement or a complete elimination of pain.  Unfortunately, there are very few mental health clinicians that offer services in a group setting that directly addresses female sexual pain.

Fortunately, for those living in or around the Los Angeles area there is such a group.  I have created a 10-session therapy and support group that is set to begin in March, however it will be recurring throughout the year.  Women in this group will find that they are not alone in their struggles.  The Female Sexual Pain Therapy and Support Group will teach participants how to cope with their pain; address and modify current thinking patterns that perpetuate their pain and anxiety; help women understand how to incorporate meditation and relaxation into their daily lives; teach more effective communication skills; assist participants in becoming more in touch with their levels of desire, arousal, and sexuality and teach them how to increase these levels; and more importantly, help women find comfort in their mind and body again by taking control back over their sexuality!  For more information and to find out how to register visit KaynaCassard.com/VVS

If you are not in the Los Angeles area but are interested, feel free to contact me about a world-wide version of this group in the works.

Create discourse!
Talking about issues such as these with your physicians and friends or family is the best way to bring about awareness that female sexual pain is a real issue, and not something that is “just in women’s heads.”  Women are worthy of having happy and healthy sexual lives, and I am just another sex-positive professional attempting to get women on that path!

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