I was at a sexology symposium recently, listening to a presentation on painful sex. And I found myself moved to tears.
There were stories of women who had endured pain for years.
There were stories of women who thought they were broken or abnormal for not enjoying sex.
What upset me is that sex is not meant to be painful. If there's pain, it's your body telling you there is something not working properly.
What struck me was that a lot of pain or unpleasant sex resulted from beliefs that sex is something that should be endured. That it is owed or something you need to do in order to get or to keep a relationship.
How common is experiencing painful sex?
I understand the distress experienced by those with the pain.
A colleague of mine wrote her PhD on women experiencing painful sex. She found often they had seen upwards of 18 different practitioners and spent vast sums of money trying to find a solution.
Australian data shows 20.3 per cent of women and 2.4 per cent of men have experienced physical pain during sex.
That's one in five women experiencing painful sex. I think that figure may actually be as high as 25-30 per cent based on my clinical experience.
An American study revealed about 30 per cent of women and 7 per cent of men reported pain during vaginal intercourse events, and about 72 per cent of women and 15 per cent of men reported pain during anal intercourse events.
Those figures are high.
More than half of the painful sex presentations that I see are the body responding to:
- Lack of adequate arousal
- Lack of understanding of female arousal system
- An assumption that pain is something that should be pushed through
- Rushing to get to intercourse.
In the course of my work, I meet many women who find themselves caught in a narrative of what they think they 'should' do in the bedroom.
Or they are driven by their partner's sexual needs.
Without realising, they are pushing their bodies to do things that are not pleasant without adequate warm up.
Nowhere in their sex education or experiences has there been a focus on pleasure or understanding arousal systems for people with vulvas.
This lack of understanding can also apply to their sexual partners — who seem to be treating the vulva/vagina arousal systems as similar to a penis arousal systems. They are far from that!
A recent article on the female price of sexual pleasure attempted to explain this by pointing out the difference in definitions of 'bad' sex, in that bad sex for women involved pain or coercion. For men it involved missing out on specific sexual activities or having an orgasm.
When it came to good sex: again, for women it was free of pain or coercion, and for men it was related to a pleasurable experience and having their needs met.
These are completely different measurement systems.
I wonder what it would be like if women could focus on pleasure?
What is happening when sex hurts and what helps?
It may be tissues tearing (stinging pain), not enough lubrication, or muscles tensed (dull pain), or the body not warm and ready to 'receive'.
Some instruction on female anatomy and arousal can usually address these kinds of issues.
Take time to warm up and get your sexual engines purring — it's important and you will experience far more pleasure.
If a person has been enduring unpleasant or painful sex for a long time, their body may have some issues, like muscles in spasm or nerve endings firing. These will need to be dealt with as well.
Vaginismus
Sometimes intercourse can be painful or impossible.
This may be due to a condition called vaginismus, which is an involuntary tightening of the pelvic floor muscles that can prevent anything (genitals, fingers, toys, doctor's examination instruments) entering the vagina.
This condition is listed in the DSM-V (the bible for psychiatric diagnoses) because it starts as a psychological issue, but has very real physical ramifications.
If this is you, you are NOT imagining the pain.
There are a variety of ways people can seek help for vaginismus.
My recommendation is using a team of a somatic-focused sexologist and a physiotherapist who specialises in the pelvis. The team approach sees effective and lasting results.
By the time people come and see me, they have been experiencing this for years and their bodies will have issues that need help, as well as the head.
Dyspareunia
Dyspareunia is the name given to many other types of sexual pain.
It can be superficial, deep or in between. It can be localised or general, and it can happen in certain situations or all the time.
It covers things like vulva vestibulitis, thickened hymen, nerve spasms, endometriosis, pelvic inflammatory disease, ovarian cysts, episiotomy, hysterectomy and more.
It can take a long time to get to the bottom of what exactly is going on. Seek out pelvic pain specialists if you need help.
Menopause
Menopause can lead to painful sex because the walls of the vagina atrophy and the skin becomes thinner and less elastic.
Menopause is not a guarantee of painful sex, far from it — many people continue to have hassle-free sex lives after their menopause.
Working around the changes in the body can help ensure that sex is not painful or unpleasant.
A thought about pleasure and what makes sex 'good'
At the symposium, we were presented with a case study about a young university student aged 20.
She believed she had to have sex, or at least provide oral sex to her partner, if she was in a relationship.
She also believed she had to "go through with it (sex)" if she started it.
She thought she was abnormal because:
- She doesn't enjoy casual sex with strangers
- She doesn't enjoy giving oral sex
- She doesn't have orgasms
- She doesn't feel like sex very often
- She thinks she takes too long to get turned on
- She thinks she is "no good" at sex.
This is not an unusual presentation; I see it often in my work.
It seems to be all about other people's ideas and expectations, and not about what may be OK for her and her body.
Pleasure is about what feels nice for you. It is not about pain or pushing through something.
It doesn't have to match what you see in the movies, or in porn, or even your partner's expectations.
It can be gentle and quiet. It can be exciting and lustful. It can be many things — you are the architect of that.
If you don't know what you like, take some time to work out what may feel nice, enjoyable and pleasant.
There are no wrong answers for an exploration of that type. It may feel strange but it's a great investment in your sex life.
Listen to your body. It will tell you what it likes and what it doesn't. It knows more than your head does!
Tanya Koens is a clinical and somatic sexologist and relationship counsellor working in Sydney's Surry Hills.