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Key points
- Women sometimes experience painful intercourse which causes them to lose interest in sex.
- Sexual pain, also known as dyspareunia, may result from any form of touch, not just intercourse.
- Help is available for sexual pain; it does not have to be tolerated.
It happened fairly regularly in my sex therapy practice. A young couple calls me for help. They love each other but are struggling because the wife has lost all interest in sex. They are confused, embarrassed. They don’t know who to turn to. They keep trying, but over time, she loses interest in sex, starts avoiding her husband’s touch, gets to where she actively dislikes sex and wishes they would never have sex again.
They arrive in my office ambivalent: hopeful and fearful, in despair and yet willing to try this as their last resort. He loves her, but he can’t go on like this. We talk about their relationship, how they met, how they fell in love, how sad they are that they have gotten to this point in their marriage. Often, the final push to seek help comes because they want to have children. No intercourse, no children, unless they take extraordinary measures. At the end of the first session, I give them some papers to fill out and ask them each to make an appointment to talk with me individually about things. They agree. They are hopeful that I can help.
The wife comes to her appointment wary. She feels bad because she can’t meet her husband’s need for sex. She knows that sex is supposed to be pleasurable, but she would rather just never do it again. Except that she feels guilty because he wants it. What can I do to help? Then, we review the forms she’s completed. We get to those questions: Does it hurt. Yes. Where? How much? What kind of pain? Turns out, it has always hurt. She has avoided gynecological exams because they hurt. She can’t use tampons because they hurt. I wonder how she thought sex would be different. I tell her, something is physically wrong. Sex is not supposed to hurt. Let’s get you to a doctor who understands this and can help you.
She goes to the doctor I recommend. She is diagnosed with vulvodynia, vulvar vestibulitis, or vaginismus. The doctor starts a course of treatment. I work with the couple to help support the medical interventions and treat the psychological and relationship damage that has been done.
Then, one day they come in, shyly smiling. They had pain-free intercourse! It’s a miracle! We celebrate. We work to repair the damage that the painful intercourse has done over the months, years, or longer. She becomes interested in finding pleasure in sex. Then, my work turns to sexual enhancement and I help them find each other. It is very satisfying work.
Let me summarize: Sex should not hurt. If intercourse is painful. If that’s a new problem or an old problem, if it’s just intercourse, or also tampons and pelvic exams, it should not hurt. Not every gynecologist is prepared to deal with this. Sexual medicine is not in the curriculum of every medical school. If you or someone you love is struggling with painful intercourse, get help. It does not have to be this way. Don’t wait and don’t ignore it. When sex is good, it is a small part of satisfaction with one’s marriage, but when sex is bad, it is a huge part of dissatisfaction with one’s marriage. It should not hurt.
