I remember being surprised by the complete absence of pain the first time I had sex. After all, there is an assumption among women that the first time will always be painful. Awkward. Ugly.
Though my first time was, indeed, ugly—in that it was coercive and I wasn't ready and I cried afterward and he didn't care—that first instant of penetration was so unremarkable as to seem like an accident. Like oh, your penis has accidentally slipped into my vagina. Why don't we do something about that?
Sex remained painless for the next several years, well into the beginning of my relationship with the man I would eventually marry. Until suddenly, inexplicably, it wasn't painless anymore. What followed were years in which I would come to wince my way through sex, clenching my teeth, tensing my muscles, squeezing my thighs together. Then, once he slipped in, I would experience a sharp, jagged pain that ripped me apart.
I did this—continued to have painful sex—because I felt obligated. After all, if I didn't let the man I most cared about into my pants, how could he ever love me? Why would he ever want to stay?
Still, when this pain persisted, I finally told my gynecologist, hoping she could give me a definitive answer, hoping she would say to me: This is what is wrong with you. This is how you can fix it. But she told me she couldn't see or feel anything wrong. And though she gave me a prescription for a transabdominal ultrasound, she also suggested it was more likely a psychological issue. When the ultrasound tech also failed to find anything amiss, I finally had to accept that my brain was the problem. I went to see a psychologist. And this was much the way of things back in the day. According to Talli Rosenbaum—a certified sex therapist, couples' therapist, and well-known expert in the treatment of what are now known as sexual, or genital, pain disorders—the ideology around sexual pain, until fairly recently, was that it was either physical or psychological.
Recent research has blown all of this to hell, and it is now becoming understood that genital, vulvar, and pelvic floor pain are biopsychosocial issues. What this means is that this pain can be attributed to biological factors, psychological factors, social factors, or some combination thereof. There might be an STI at play. There might be skin cancer. There might be a neurological disorder. And at the same time, there could a troubled relationship. Or post-traumatic stress. Or anxiety and depression.
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But merely understanding doesn't make it any easier to live with. Before I learned about the complexity of sexual pain, all I knew was that painful sex was wreaking havoc on my marriage. Not wanting to get busy because the sex is bad is one thing. But painful sex with no discernible cause is a bit more slippery. When a recent study showed that sexual pain adversely affects sexual response, my reaction was basically: No shit, Sherlock. Still, the study was a confirmation of what I had been through. It was a validation of my own experience, and of my reaction to it.
When I had been grappling with sexual pain, my avoidance of sex made my husband feel rejected. Undesirable. I, meanwhile, felt an immense pressure to provide my husband with the sexual release I felt he deserved from me. But that pressure only seemed to make the pain worse, and so I pushed him away. And then I felt guilty for pushing him away. And then I felt resentful that I was being made to feel guilty.
It was a nauseating mix of emotions. And Rosenbaum says that the ways in which a woman's partner reacts to her pain can be just as important as the way in which a woman reacts to her own pain. "It is important to explore how a couple communicates with one another about their feelings," she says, "and if they are able to contain and provide empathy, rather than attribute blame.
Often, there's a dynamic where the partner pulls away, withdrawing all affection to avoid rejection, or a woman with pain avoids hugs or other physical intimacy, for fear it will "lead to" sex. Deborah Coady, gynecologist and co-author of Healing Painful Sex (a book I pored through carefully when I was focused on "fixing" myself) echoes Rosenbaum's comments on this relational dynamic. "Even in a long-term relationship," Coady says, "there can be a sense of isolation and withdrawal that is not just about the sex, but is about intimacy in general—like when you touch something hot."
And when the one who is experiencing the pain pushes through it out of a sense of obligation? "Women often are extremely motivated to allow intercourse to occur and to engage in intercourse despite pain, due to societal messages that sexual activity is expected to culminate in intercourse," Rosenbaum says. "Feelings of obligation, guilt, and a pressure to please their partner turn sex into a chore that must be fulfilled. A lot of anxiety is created around that need to succeed."
In cases such as this, "muscles contract as part of a defensive, fight-or-flight response to what feels threatening," Rosenbaum explains. "Telling women to just relax," she says, "is like telling a person to stand in the middle of the street when a car is coming."
Seven years ago, my husband and I decided we were ready to start a family. As eager as I was to be a mother, the knowledge that I'd have to have more frequent sex during times of ovulation—despite my enduring pain—terrified me. When we struggled to conceive—weeks spinning out into months spinning out into years—our troubled sexual dynamic was only magnified. Because of all of this, our marriage faltered.
I started taking yoga classes at a nearby studio, partially to get a nice ass, but also partially to get the hell out of a home where I felt I was walking on eggshells. I became hooked when I saw how the practice helped my stress, anxiety, and depression, and was soon taking four to six classes a week. Over time, I began to cultivate a body awareness I hadn't previously had. This enabled me to more easily relax my muscles during sexual activity, bypassing their normal, fight-or-flight response.
Psychologist Lori Brotto has been studying the usefulness of mindfulness exercises in the treatment of various sexual dysfunctions for years, and Rosenbaum herself also contributed to a paper on using a mindfulness-based approach in the treatment of sexual pain and anxiety. Practicing mindfulness—an essential aspect of yoga—forces one to focus on their breath, their body sensations, and their thoughts without judgment. In the context of sex, it can help the practitioner become more attuned to their body's sexual response, and more accepting of their body's physical limitations.
Perhaps because of this—and because of our increased, babymaking-related sexual frequency—one day, I realized sex wasn't painful anymore. The pain that had been a source of mental and physical anguish for years stopped without my even noticing.
My experience isn't typical. But with so many possible contributors to sexual pain, I don't know that anyone's is. The one thing I can say without hesitation is that, while sex can hurt, it shouldn't. And while the route to managing or eliminating sexual pain can be a circuitous one, it's well worth following.
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