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23 Sep 2018 1:15
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  •   Home > News > International

    Painful sex: Why women put up with it, and what can be done

    One in five women experiences painful sex. So what can do be done about it? And why is it so common?

    For the first seven years of her marriage, Ing couldn't have sex. It was too painful.

    "It felt as if there was a tear in my vagina … I would feel a sharp pain for two or three days afterwards," she says.

    "Every time my husband touched me, my whole body would break into a sweat."

    Ing says she couldn't tell anyone. She felt too embarrassed.

    "I felt like I was a failure or something … because everyone was having sex, everyone was having a baby, and it seemed like I was the only one having this issue, so it must just be me."

    Ing was unknowingly suffering from a condition called vaginismus.

    Vaginismus is when the muscles in the vagina — which typically relax with sexual stimulation — spasm involuntarily, creating a feeling of tightness that can make sexual penetration, a gynaecological examination, and even inserting a tampon painful, if not impossible.

    "It can feel as if there is a brick wall or something blocking the vagina, so that nothing can go in," explains Anita Elias, head of the Sexual Medicine and Therapy Clinic at Monash Health in Melbourne.

    Ing says it took seven years for she and her husband to get help.

    "It [the pain] was very intense, and I never told anyone," she says.

    Painful sex 'more prevalent than people realise'

    Experiencing pain before, during or after vaginal intercourse is known as dyspareunia, and it's not uncommon.

    According to the American College of Obstetricians and Gynaecologists, 75 per cent of women have experienced painful sex at some point during their lives.

    For many women, this pain is transient. It may the result of inadequate foreplay, a skin infection, a urinary tract infection or thrush.

    For other women, pain with sex is more persistent. An Australian study of 20,000 people found 20 per cent of women had experienced pain during sex for at least one month during the past year, compared to just two per cent of men.

    "It's far more prevalent than most people realise," Dr Elias says.

    Physical and psychological factors at play

    For many women, the hormonal changes that accompany events such as childbirth, breastfeeding and menopause can lead to increased vaginal dryness, causing a stinging, burning or tearing sensation during intercourse.

    Then there are chronic conditions like vaginismus and vulvodynia, which is when a woman feels pain, discomfort or a burning sensation in her vulva that cannot be linked to a specific cause.

    "It can be excruciatingly painful even just to be touched … it's a very great sensitivity at the entrance to the vagina," Dr Elias says.

    While the exact cause of vulvodynia is unknown, there are several physical and psychological factors thought to contribute to the development of vaginismus.

    For some women, the condition may be a result of past injury or pain associated with their vagina, such as endometriosis, recurring urinary tract infections, sexual abuse, or trauma during childbirth or surgery.

    Dr Elias says vaginismus can also be triggered by feelings of fear, anxiety or stress, which may be a result of inadequate sex education or partner problems.

    "The pelvic floor can automatically contract or tighten up. It's sort of a protective mechanism," she says.

    Dr Elias says when it comes to sex, what may begin as a physical problem can go on to manifest as a psychological problem — and vice versa.

    "You can't separate the mind and the body, because how you feel affects what's happening physically in your body, and the other way around," she says.

    She adds if sex hurts, a woman may begin to anticipate pain — creating a cycle of anxiety, reduced libido and, ultimately, more painful sex.

    Women 'conditioned to be uncomfortable'

    Medical reasons aside, Dr Elias says the most common cause of painful sex among the women she sees is a lack of arousal.

    "I've been seeing women with painful sex for more than 20 years, and what I'm finding is that these days there's more pressure — particularly on young women and girls — to have sex … and to have sex in ways that they may not particularly like."

    Sex education researcher Anne-Frances Watson says in addition to problems around sexual consent and communication, young women are sent messages from an early age that sex involves pain.

    "From the beginning, you're told that your first sexual experience is going to hurt … and you've just got to push through that and hope that things get better," Dr Watson says.

    She says women are "conditioned to be uncomfortable for a lot of [their] lives", and that sex is no exception.

    It's an idea that Lili Loofbourow, a writer for the online magazine Slate, is no stranger to.

    In January, Ms Loofbourow wrote a hugely popular article, The female price of male pleasure, following global debate about the nature of sexual consent, amid the #MeToo movement.

    "The way women are encouraged to present in order to be sexually attractive actually involves a fair amount of suffering," Ms Loofbourow says.

    "There's sort of a routine discomfort that women are encouraged to ignore as they pursue romantic lives … and it's hard to figure out where to draw that line."

    Ms Loofbourow says women are often praised for their ability to withstand or disregard pain, particularly when it comes to childbirth and premenstrual syndrome.

    She adds that it is "very hard to undo the idea that men are owed sex".

    "I think even the most staunch feminist has found herself in a situation where she's put up with pain just to be polite."

    Ms Loofbourow says many women put up with sex that isn't pleasurable — or indeed is painful — for "other payoffs" such as feeling intimate with their partner, or "making someone else feel good".

    "I think a lot of women are socialised to locate their pleasure in someone else's. And this is a problem," she says.

    "I think that realising that you deserve more pleasure and, more importantly, you deserve not to feel pain is a radical step to take."

    Help is available, but not always easy to get

    There is help available for women who are experiencing painful sex, although it's not always easy to get, Dr Elias says.

    "All causes of pain from sex can be treated … but unfortunately, some doctors don't know about vaginismus or vulvodynia" she says.

    "If your doctor isn't familiar … ask them to refer you to someone who is.

    "Painful sex is a legitimate medical problem, like every other kind of pain, and it needs to be treated in the same way."

    In instances where painful sex has a physical cause, treatment of the underlying medical condition may help to alleviate pain.

    When painful sex is caused by psychological factors, treatment will often involve individual, couples or sexual counselling.

    "So much of it is about feeling safe and learning how to feel safe with your body … and with a partner as well," Dr Elias says.

    Ing, who has been successfully treated and now has a two-year-old daughter, hopes that by sharing her experience, other women will be encouraged to speak up and seek treatment.

    "I'm happy to talk about what I went through because I don't want that to happen to anyone," she says.

    "It's really common … and I think there's nothing to be ashamed of."

    © 2018 ABC Australian Broadcasting Corporation. All rights reserved

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