Painful Sex: Empowered Help Seeking

Painful sex is incredibly distressing & confusing for those who experience it, and their partner/s.

Sexual pain can be caused by a variety of medical factors, and it manifests in a variety of ways – such as chronic discomfort during sex, pain upon genital touching and/or penetration, or an inability to have penetration due to intense pain. Some people who experience sexual pain may also experience pain using tampons, and/or discomfort sitting or wearing tight pants.

Sexual pain is hard to describe by its sufferers, but some of the words they may use to describe pain in the genitals or surrounding pelvic regions are: burning, itching, sharp pain, dull pain, aching, soreness, jabbing, cutting, cramping, tightness, irritation, and radiating pain.

Not all of the causes of sexual pain are known, but the main categories include vulva and vaginal skin conditions, endometriosis and chronic pelvic pain, vulvodynia and provoked vestibulodynia, pelvic floor dysfunction and vaginismus, gastrointestinal conditions, infection (such as genital herpes and thrush), interstitial cystitis (painful bladder syndrome) and pudendal neuralgia (nerve damage/entrappment).

Diagnosis and Treatment

Despite sexual pain being a significant issue for those effected and their lovers, there is often a long and frustrating journey to find accurate diagnosis and proper care.

Often people are told after a physical examination that there is nothing wrong with them because the condition may not be visible to the clinician. For some, this can perpetuate the idea that the pain is “all in your head” and that they just need to relax. This is not accurate.

Shockingly, most of the clients I have seen for chronic sexual pain had already seen multiple medical clinicians and therapists before me. And this is reiterated in the research around sexual pain – with many sufferers reporting to have seen at least 4 doctors before receiving the correct diagnosis (although there are also some wonderful doctors working in and progressing this field!).

It is very important, where possible, that people find a specialist to diagnose and treat their sexual pain. But pain sufferers may be in several different circumstances as they seek help.

They may:

1. Know a specialist and be going to them directly.
2. Know a specialist but need a GP/primary care physician referral to access them.
3. Not know a specialist or where to go, and start with their GP/primary care physician or gynaecologist for further information and referral.
4. Be living remotely and have no local specialist, and need to be managed by their GP/primary care physician (plus given information about referral options in their nearest city).

I have recently been reading the book When Sex Hurts by Andrew Goldstein, Caroline Pukall and Irwin Goldstein. As well as having helpful information about management of sexual pain, the authors also have a section on how to best prepare for your initial doctor’s appointment to ensure best care.

I think this information is relevant no matter who your first point of contact is – your GP/primary care physician, a gynaecologist or a sexual pain specialist.

Here is a summary of their suggestions.

A Guide to Preparing for & Attending your Initial Medical Appointment.

1) Tell the receptionist about the purpose of your visit – sexual pain. This may feel embarrassing, but it gives them the opportunity to tell you about their extended appointment times, which may well be necessary, as well as their costs & rebates.

It also allows the doctor to prepare for the appointment themselves, by knowing a bit about you before you arrive.

2) Ask if any blood tests are needed prior to the appointment. If the receptionist does not know, ask them to inquire with the doctor and get back to you.

3) Track your symptoms using a pain/symptom diary (or just a notepad) for at least a week prior to the appointment. Note when your pain occurs, the kind of pain experienced, what you were doing, what helped (if anything), and how long it lasted. Other tips for tracking your symptoms:

• Find words to describe your pain. For example, burning, itching, sharp, dull, aching, soreness, jabbing, cutting, cramping, tightness, irritation, radiating.
• Note where you are in your menstrual cycle.
• Try to describe where the pain is – the labia, entrance to the vagina, inside the vagina, bladder, pelvis, lower back. A medical examination can then help to specify this further.
• Note what makes the pain better or worse.
• Note whether the pain is all/most of the time or only when you are touched/provoked.
• Describe which sexual activities do and do not hurt you.
• Use a pain scale from 0-10 (0 = no pain, 10 = excruciating pain) to rate your pain on different days.

4) List all medications (prescription & non-prescription), vitamins and supplements you’re taking, as well as dosage. Or just bring them all to the appointment.

5) Bring a partner or support person if possible. They can help to fill in any gaps or just to give you moral support.

6) Bring a pen & notebook. Bring a list of questions you want answers to, and also write down important information from the appointment, or unresolved questions.

7) Reflect on the narrative of your pain so that you can explain this in detail to your doctor. Here are some things to think about and explain to your doctor:

• When the pain started and any specific injuries or events around that time;
• Has the pain changed overtime;
• Have there been times the pain was better or worse;
• How the pain has previously, and is currently, impacting your sex life, relationships & life in general;
• How many health care professionals you have already seen for the pain;
• What treatments you’ve tried already.

It’s really important that you get to tell your doctor about the full picture of your pain & its impact on your life.

These ideas are not fool-proof – it’s still possible that your doctor may not be experienced enough in this area, or understanding enough, to provide you with appropriate pain management. If this is the case, it might be worthwhile trialling a new doctor because there are some really great doctors out there to help, it’s just a matter of finding the right person for you. And unfortunately, this can take time.

And remember, while doctors are there to diagnose, refer and offer advice, you are an expert on your own body.

Resources

When Sex Hurts by Andrew Goldstein, Caroline Pukall and Irwin Goldstein

Explain Pain by David S. Butler and G. Lorimer Moseley.

Painful Yarns: Metaphors & Stories to Help Understand the Biology of Pain by G. Lorimer Moseley.

National Vulvodynia Association: www.nva.org/learnpatient/

Online vaginismus resources: https://www.vaginismus.com/

Go here for a list of other resources.

By Dr. Alice Hucker, Clinical Psychologist