Some years ago, I had a friend confide in me that sex hurt. And we're not talking postcoital rug burns here but intense pain. From what I could gather, it sounded like vaginismus, which is an involuntary spasming of the vagina at penetration. At the time, I didn't know what to tell her.
Naturally, this was having a profoundly negative impact on her sex life with her husband. But she didn't seem particularly comfortable discussing the issue, and we later grew apart. So, I have no clue what happened to her. She was not alone in her suffering. According to stats, between 8 and 21% of women suffer from sexual pain disorder - a poorly understood, largely ignored variant of female sexual dysfunction.
There are times when painful sex is probably normal. If you haven't had intercourse in a long time and go on a lengthy shag-a-thon, you will most likely be sore. The mittlelschmerz (German for "middle pain") syndrome occurs when intercourse is painful during ovulation and is due to the release of an irritating fluid along with the egg. This fluid creates local inflammation that can make deep penetration, in particular, uncomfortable. Also, intercourse with little preliminary clitoral stimulation, no lubrication, and a lover who mistakes your vagina for a trampoline is probably going to be uncomfortable as hell.
However, consistently painful sex is not normal. My friend's vaginisumus may have had a number of causes: including medical, psychological, or relationship based. Sometimes painful sex begets painful sex. If a woman has had a bad experience with penetration in the past, or has had any medical condition that created painful penetration, vaginismus could result simply from the fear that intercourse will be painful again--even if the condition, or the circumstances that created the pain have changed. A woman, with this condition, finds her vagina spasming shut in anticipation of pain.
The most common treatment for this condition is Kegel exercises and the use of vaginal dilators -- the latter is basically a collection of dildos that come in graduated sizes. A woman starts with the smallest she can handle and works her way up from there.
As I mentioned before in my post Dysfunction Junction: What Flavor of Dysfunction Do You Have? Sexual pain disorders consist of two varieties: vaginismus and dyspareunia. Dyspareunia is genital pain that can occur during intercourse, oral sex, manual sex, and sometime from just sitting. For some women, any kind of genital touch is excruciating.
Dypareunia can occur for a number of reasons. If it's primary (i.e., lifelong), it could be the result of some form of congenital abnormality of the vagina or vulva, or possibly, a stiff hymen that resists stretching enough for intercourse to be comfortable. Secondary dyspareunia (condition has only exited for a certain period of time) could occur from vaginal atrophy (which often occurs when estrogen levels drop during menopause), endometriosis, pelvic inflammatory disease, or ovarian cysts.
One of the worst forms of dyspareunia is vulvadynia - a baffling disorder that often has no discernible cause. About 16% of women suffer from this condition. According to the National Vulvadynia Association, women, who have this problem, report burning, stinging, or cutting sensations that may be limited to one area of the vulva or spread throughout the genitals. They may find it uncomfortable to wear pants, or to sit for extended periods of time. Women have described the sensations as feeling "knife-like" or like "acid being poured on my skin".
Vulvadynia is a neurosensory disorder where the nerves begin to transmit pain signals from the vulva. It can be caused by repeated infections, inflammation, trauma, low dose birth control pills, and genetic factors. Gynecologist Hilda Hutcherson claims that some women find that tricyclic antidepressants calm their overly excited nerves. Of course, antidepressants also tend to have negative sexual side effects. Acupuncture can also be effective for some women.
Vulvar vestibulitus is a subtype of vulvadynia that is associated with pain of the vestibule, which surrounds the vagina and includes everything from the clitoris to the perineum (the taint). Many women with this condition find certain areas around the opening of the vagina painful to touch. Naturally, penetration can be a miserable experience. Some women find a small application of lidocaine (a local anesthetic) helpful. In rare cases where severe pain is present, surgery may be necessary to remove tender tissue.
In order to deal with this issue, Dr. Hucherson recommends steroid creams, calcium citrate supplements, reducing your intake of high oxalate foods like soy, tomato, nuts, wheat, and chocolate, and the use of biofeedback. It is also wise for women (even those without sexual pain) to avoid irritating perfumes, or hygiene sprays.
This is a skin disease that can cause itching, burning and tearing of genital tissue. Some times, the labia minora (the small lips) develop adhesions and stick to the labia majora (the large lips). The clitoral hood may also start adhering to the clitoris. This condition can be treated with a steroid cream.
With all the focus on desire and orgasm issues in the media, it seems that women's sexual pain is often regulated to a small blurb on the back page, which is unfortunate. Theses issues often make sex impossible for many women. Furthermore, they are often poorly understood. Here are some references and resources to help you if you suffer from sexual pain disorder.
Hilda Hucherson: What Your Mother Never Told You About Sex
Shirley R. Baron, PhD, Judith Florendo, PT, Stacey Sandbo, MS, RN, C-ANP,
Andreea Mihai, BA, Stacy Tessler Lindau, MD, MAPP: Sexual Pain Disorders in Women Evaluation and Treatment
National Vulvodynia Association: http://www.nva.org/
The International Foundation for Functional Gastric Disorders Brochures and Fact Sheet Library
Bladder Function and Incontinence
American Urogynecologic Society Foundation
Vaginismus, Including OTC Vaginal Dilators
Qualified Sex Therapists
American Association of Sex Educators, Counselors and Therapists
Society for Sex Therapy and Research
Physical Therapists Specializing in Women’s Health
American Physical Therapy Association Section on Women’s Health
International Organization of Physical Therapists in Women’s Health
Feminists with Female Sexual Dysfunction