In an ideal intercourse situation, the result is an equal payoff for both parties. But for many women, having sex can mean more pain than pleasure.
Earlier this month, some of the finest minds in sexual academia descended upon Charlottetown for the annual Canadian Sex Research Forum conference. One of the industry’s more prestigious events, it provides an opportunity for PhDs to discuss matters like orgasm rates and the frequency of masturbation among asexuals.
Sadly, The Grid’s expense account doesn’t cover a return ticket to P.E.I. for research Q&As over beers, so I had to make do with flipping through the conference’s many abstracts. Lurking among them was a startling statistic: For more than 12 per cent of women, sex is a really painful experience—and we’re not talking about S&M.
The culprit is a condition called vestibulodynia (a.k.a. vulvar vestibulitis), which causes intense pain whenever the person attempts to insert anything into her vagina. Whether the object is a sex toy, a penis, a finger, even a tampon, the result is the same: a feeling that is variously described as someone cutting or rubbing sandpaper over the highly sensitive tissue.
One sufferer, Michelle (who asked that I not use her last name), described her first time having sex in excruciating terms. “It felt like I was being ripped in half,” she says.
Now in her early 30s, Michelle has lived with that pain for more than a decade. Like many women in her situation, she continued having sex for the sake of her relationship with her husband, but “there were massive repercussions [because of] the pain afterwards,” she says.
You might think that a condition affecting upwards of one in 10 women would be well understood in medical circles, but when Michelle started frequenting the offices of family doctors and dermatologists, she received little more than blank stares.
According to gynecologist Andrew Goldstein, director of New Jersey’s Center for Vulvovaginal Disorders and author of the book When Sex Hurts, the vast majority of doctors aren’t adequately trained to diagnose the causes of female genital pain. “Ninety-five per cent of the time a woman goes to her doctor, she won’t receive a diagnosis,” he says.
According to Goldstein, most vestibulodynia cases are caused by one of two things. The first is changes in testosterone levels often brought on by the birth-control pill, which affect the glands of the vulva and decrease lubrication. The second is spasms of the pelvic-floor muscles—believe it or not, Goldstein lists overdoing it at Pilates class and not peeing often enough as potential spasm-starters.
Treatment options for vestibulodynia are varied, to say the least. At the more appealing end of the spectrum, the patient can look forward to warm baths, relaxation exercises, and physical therapy. Vaginal dilation may also be called for, using either a medically approved dilator or an off-the-shelf dildo, to train the muscles not to react. But some unfortunate women—to whom my sympathy goes out—will elect to have paralyzing Botox injections.
Often, doctors also recommend a hefty dose of therapy, as the condition often affects sufferers’ relationships and self-image.
“There is a lot of shame around it,” says Rae Dolman, a sex therapist at Mount Sinai Hospital’s Wasser Pain Management Centre in Toronto. “People don’t talk about it as openly as, say, tennis elbow, and so it certainly has an impact on the way they see themselves as women. Often they do show up in my office having given up a lot of sexual pleasure because they get into a cycle of avoidance.”
That sentiment is echoed by Michelle, who eventually contacted the National Vulvodynia Association; they put her in touch with a physical therapist. After seeing an improvement, Michelle says that, ironically, she became more reluctant to have sex for fear of experiencing pain again.
Therapists like Dolman try to get couples to experiment with more non-penetrative sex acts, ones that won’t hurt. “I get people to expand their sexual menu, put a ban on intercourse or anything painful, and try to make sex more fun again,” she says.
Despite two decades of research, though, surefire cures remain elusive, with some women simply learning to manage their symptoms with painkillers. Some also turn to anecdotal remedies like wearing cotton underwear, eating special diets, and taking baking-soda baths. And while few of the aforementioned remedies have medical evidence to back them up, when the alternative is having a doctor inject Botox down there, who would blame them for trying?