Unspoken: The Sexual Pain Gap
Almost 75% of people with vaginas experience pain during intercourse.
Getting diagnosed with painful sex can get wordy. Ascribed many names, sometimes it ironically seems harder to remember your diagnosis than it is to get one. Dyspareunia, vaginismus and vulvodynia, all of which have been combined under one common term in the DSM-V called Genito Pelvic Pain Penetration Disorder, or GPPPD. That’s a lot of P’s. These medically-recognized conditions have both physical and psychological roots and lead to the same outcome: painful penetration.
In addition to the physical distress, experiencing painful sex can take an emotional and relational toll as well. What happens in the bedroom (or the shower, on top of the laundry machine, the counter, whatever) doesn’t exactly stay there. It can create feelings of inadequacy and fear, as well as distance and tension in relationships with sexual partners. Painful sex doesn’t just mean painful sex, it has repercussions that affect the whole individual.
Sometimes pain during sex means urogynecological concerns like ovarian cysts, interstitial cystitis, or endometriosis. Other times, it’s related to lack of desire or lubrication, often categorized as sexual dysfunction, or rather, sexual displeasure. Emotional and sexual trauma, cancer, childbirth, and menopause can be key players in painful sex too.
But despite its prevalence, painful sex doesn’t receive nearly the attention it deserves.
Part of this is due to public discomfort with and general cluelessness about female anatomy. According to a poll from The Eve Appeal, a gynecological cancer charity, 50 percent of men and 44 percent of women were unable to identify a vagina on a diagram of the female reproductive system. And while the tides are slowly changing, comprehensive sexual education faces strong opposition across the globe. This speaks to a general reluctance to talk about sex candidly. If our mainstream is ill-informed and in the dark, how do we even begin to address painful sex?
Not only do we, the public, avoid talking about sex, many doctors do too. In an international study including thousands of patients, only 9 percent were asked about their sexual health within the last three years. Another study performed by Bespoke Surgical reported that only 25 percent of respondents were asked whether sex is pleasurable or painful by a doctor. This is the case even amongst medical professionals dealing directly with sexual and reproductive health. A 2012 survey found that less than two-thirds of OB/GYNs asked about their patients’ sexual activity, only 40 percent asked about sexual problems routinely, and fewer still inquired about sexual satisfaction.
Often times the focus is on fertility rather than overall sexual wellbeing. A stark example of this is the delay in endometriosis diagnosis based on reported problems; patients who reported infertility experienced a shorter delay than those who reported pelvic pain.
Another factor contributing to the silence around painful sex can be placed in historical context. There is a long scientific history of inadequate female representation in clinical trials, and this can be seen in the current academic literature regarding health conditions affecting the ability of female-bodied people to experience sexual pleasure vs. those affecting male-bodied people. According to an article published by The Week, a PubMed search revealed 393 clinical trials on dyspareunia, 10 on vaginismus, and 43 on vulvodynia. Meanwhile, erectile dysfunction had a whopping 1,954.
Thankfully, painful sex is not an inevitability or a pleasure death sentence.
There are existing treatment options for pelvic health that include pelvic floor physical therapy, dilator therapy, or surgery. While these can all be very beneficial, we need to continue to investigate painful sex and expand treatment options to meet the needs and the budgets of all.
Insurance companies prevent physical and psychotherapy from being so wallet-friendly, and may not be available to certain communities, such as those in rural areas. Similarly, though very beneficial for some, pelvic surgery is not always necessary, can be cost-prohibitive, or even downright daunting. Vaginal dilation is a valid and less expensive option for treating painful penetration, and has yielded great results in regards to successful penetration, however it has been indicated that further therapy is necessary to increase sexual satisfaction.
Independently, each of these options do not exist as cure-alls or magic bullets, but together, holistically, and combined with new technologies, they can help folks continue to develop physically and mentally healthy sex lives.
One of the new kids on the healthtech block is Ohnut, a donut-shaped intimate health wearable designed to address deep dyspareunia. With a series of interlocking polymer blend rings that slip down the penis or dildo, Ohnut allows users to customize the depth of penetration.
Initial qualitative interviews from users showed enormous promise in terms of successful penetration, increased intimacy, and initiating open minded conversations between partners about painful sex; you can see a few users’ stories here. A clinical study is also on the horizon to determine Ohnut’s efficacy. Thus far, recruitment centers include Pelvic Health and Rehab Center, Dana Farber Cancer Institute, IntimMedical Specialists DC, and Northwest Specialty Hospital. For inquiries and to request professional materials, visit the Clinicians page.
While also not an antidote for painful sex by itself, Ohnut is a promising addition to a pool of interdisciplinary treatment options.
Both women’s pain and pleasure have been neglected, and while what has been done in the field already is incredibly important, we should view this body of work as a foundation to build upon. Painful sex is hugely underrepresented in medical literature for how common an experience it is, and further studies are needed to assess why it happens and what we can do about it. More education is also needed to alleviate the burden of painful sex.
If 44% of women and 50% of men don’t know where the vagina is, how can they recognize, talk about, and seek treatment when sex is painful?
One thing that I would add to this is the overwhelming research that shows how male circumcision can create pain for the woman during intercourse. When the foreskin is missing so is the natural male lubrication, male sensitivity, and the gliding motion and cushioning that the foreskin provides. The foreskin is also not able to buffer against the corneal ridge which then drags lubrication from the woman’s vagina. This can make sex dry, while the less sensitive penis with skin stretched tight can cause friction. In addition to this the circumcised man must thrust harder and deeper to gain feeling/pleasure with the missing sensation and keratinized glands.
This is an issue my husband and I have struggle with for awhile. We are excited to try ohnut as a temporary relief while he works on foreskin restoration.
More information can be found in these academic resources.