Imagine not being able to have sex. Seriously. Imagine. Every time you attempt intercourse—searing, burning, ripping pain shoots through your pelvis. Sometimes you bleed. Sometimes it hurts to pee for a week after sex. Your partner’s erect penis is perceived as the enemy. As the ‘enemy’ approaches, you brace yourself and ‘white-knuckle’ it.
You avoid dates with your boyfriend because he might expect sex afterwards. You don’t snuggle your husband because he might (God forbid) think you are initiating sexual contact. You wear flannel pj’s to bed in the hopes your husband won’t get turned on. Anything you can do to reduce the risk of having to accommodate that ‘enemy.’
If this sounds familiar, you are one of the millions of women who suffer from chronic pelvic pain (CPP) called Dyspareunia. Dyspareunia is defined as persistent or recurrent genital pain that occurs before, during, or after intercourse. In the newest Diagnostic and Statistical Manual (DSM-V), the diagnosis of Dyspareunia was replaced with ‘Genito-Pelvic Pain/Penetration Disorder.’
Sadly, by the time I meet most of my clients with pelvic pain, they have seen 3 (or 7 or 11) doctors who have all told them the pain is ‘in their head.’ “You just need to relax, honey,” or “Have a glass of wine, it will help loosen you up,” they are told. This chronic ‘gaslighting’ by physicians (and often partners) that the pain is not real sets women up to question their reality and sometimes even their sanity. The truth? Pelvic pain is a real, diagnosable, treatable medical condition. And the emotional impact is also treatable!
Don’t panic. There is hope.
Individual sex therapy, couples therapy and support groups (or any combination thereof) can help women reclaim their femininity and celebrate their sexuality.
Don’t let CPP rob you of optimal sexual health. With proper medical and psychological care, you can have the satisfying sex life you deserve. You can stop CPP from overtaking your sexual self esteem (and your life!).
This blog is not about the organic causes or medical treatment options for pelvic pain (of which there are many). It’s about the psychological and emotional impact of pelvic pain on women and their partners. After treating hundreds of women with this issue, I’ve come to understand the incredible emotional toll it takes on so many aspects of daily life.
CPP can affect work, school, hobbies, social life, family life, sexual health, relationships, and (in extreme cases) even the will to live. Acute pain is immediate, severe, and short-lived. You break your leg, it hurts (a lot), and then you get better. Chronic pain, on the other hand, is always there. It never goes away. Like an albatross on your sexual back, it mocks you day and night. This seemingly never-ending burden can cause anxiety, depression, sleep disorders, chronic fatigue, and even suicidal thoughts.
My clients with CPP describe their bodies as “broken,” “unfeminine,” and “damaged.” They are keenly aware of the fact that they have to choose between pleasing their partner (and dealing with physical discomfort, which can last for days) or avoiding sexual contact (and worrying that their partner may leave them or be unfaithful). Neither option is appealing. They feel like no matter what they choose, someone loses. Either they ‘take one for the team’ and suffer physically; or they avoid sex and hope their partner will stick around.
Although CPP complicates physical and emotional intimacy, it can provide couples with an opportunity to be honest, creative, flexible and playful. These four traits; honesty, creativity, flexibility and playfulness, allow couples to overcome even the most shameful and embarrassing situations in the bedroom.
A condition like CPP may force a couple to work a little harder to get in the sexual groove, but it is definitely worth it!
Don’t Ask; Don’t Tell
I treated a woman with CPP pelvic pain who chose to keep it secret for two years. She did not want her husband to know that she was in pain because she wanted him to think she was ‘normal.’ She was afraid he would stop initiating sex if he knew it hurt her. So she mastered the art of faking orgasm and camouflaged her sounds of pain into sounds of pleasure. When she screamed out in pain, she hoped he would think she was enjoying herself.
When she sought treatment, I encouraged her to be honest with her husband about her medical condition so he could support her physically and emotionally. Initially she was resistant, but after a few weeks, she mustered her courage and made a formal disclosure to her husband about her pain.
When she told him she had a pain disorder, he said, “No shit.” She was completely stunned. “You knew??” she said. “It’s obvious,” he said. It took her a second to process, then she simply ended the conversation with “you bastard.” She could not believe that he knew she was in pain, never mentioned it and had sex with her anyway. She was devastated. Here she was, enduring pain so he could have a good time and he knew all along that it hurt her. It took a lot of healing, but they eventually got back on track and enjoyed an active satisfying sex life.
Will my partner leave me? Can I have kids?
Women with pelvic pain understand that ongoing sexual contact is a healthy, appropriate, reasonable expectation in a committed relationship. When women are sexually ‘out of commission’, they often feel guilty. “My husband deserves to have sex and I can’t give him that. How can I expect him to live this way? It’s not fair to him.”
Single women have their own unique worries. They wonder if they will ever find a partner willing to commit to them, given their sexual baggage. “It will become evident quickly that I can’t have normal sex. Maybe I’ll just stay single and adopt.”
Young women with CPP worry if they will be able to get pregnant through ‘traditional’ means and deliver a baby vaginally. “If I can’t even get a tampon in (let alone an erect penis), how can I get a baby out?”
Some women resent needing vaginal dilators, valium suppositories or pelvic floor physical therapy. They are afraid they will need to do these things forever to maintain any progress. “I just want to have sex like a normal person. I don’t want to prepare 24 hours in advance with dilators and suppositories or botox injections in my vagina. I just want carefree, pain-free sex.”
Readers, don’t be discouraged. There are many effective treatment options for pelvic pain and many women get better.
I must warn you, however, that CPP, even after successful treatment, leaves a complicated legacy in many relationships. The good news? I’ve seen transformation occur time and time again in my office and it can happen for you. Stay tuned for part 2 of this blog to learn about the common relationship traps associated with CPP; and how to get back on track.
Kimberly Resnick Anderson
*Researchers estimate that 12-20% of women have chronic pelvic pain (but unfortunately getting proper diagnosis and treatment takes far too long due to doctors’ dismissiveness and/or lack of advanced diagnostic skills).
*Many women with organic sexual pain appear normal upon visual exam. The average OB/GYN is not trained to identify these conditions. Find a vulvar specialist with the proper diagnostic equipment (i.e. vulvoscopy) who specializes in these conditions.
*Up to 33% of women will have pelvic pain during their lifetime
*Ten percent of visits to gynecologists are for diagnosis and treatment of chronic pelvic pain (but far too many are told there is nothing wrong)
*Twenty-five percent of women affected by chronic pelvic pain are bed-ridden for nearly 3 days per month. I’ve treated women who had to go on disability because their chronic pelvic pain became disabling.
*Pelvic floor physical therapy is shown to be effective for reducing chronic pelvic pain. Many of my clients report that this treatment is more effective than vaginal dilators, valium suppositories, and even topical hormone replacement. Click this link to find a certified pelvic floor physical therapist in your city.