Opinion Anal sex is not the only option for women suffering painful vaginal intercourse Nina Booysen Endometriosis, vulvodynia and pelvic mesh implants can all make vaginal sex painful. But it doesn’t have to be the end of a fulfilling and pleasurable sexual life

Mon 4 Sep 2017 00.07 EDT Share on Facebook

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Women around the world reacted with disgust to doctors who suggested women experiencing painful sex as a side-effect of vaginal mesh implants try anal intercourse instead. Sadly, this kind of dismissive attitude from the medical profession is not surprising. However, as a sexologist who mainly works with women who have trouble enjoying sexual intercourse, I can tell you there are other options.



Research shows that doctors respond differently to patients who complain of pain based on gender. Typically, people do not question the experience of pain of a cancer patient, or indeed a man. A woman tends to be met with scepticism, especially when it comes to her reproductive organs or nether regions. Often, woman will be met with: “I’m sure it’s not that bad” or “that really shouldn’t hurt” or even, “you’re being a little hysterical”.

It’s not just women suffering pain from vaginal mesh implants who are dismissed. It is also the reason conditions such as endometriosis, vulvodynia (unspecified pain or burning in vulva region) and vaginusmus (involuntary contraction of the pelvic floor muscles) have not been adequately researched and treated. Endometriosis typically goes undiagnosed for seven to 10 years. The statistics show one in 10 women of reproductive age suffer from endometriosis – that’s 176 million women worldwide. Yet, so many women suffer silently and are afraid to be a “nuisance”.

Painful sexual intercourse is a common side effect of all these conditions. When we are young and learning, if you put your hand on a hot stove, your brain screams at you to never, ever do that again! Well, painful sex can have the same effect. The difference being we don’t need to have our hands on hot stoves to lead fulfilling lives. We do however seek relationships, which survive because of intimacy, connection and sex. This is where the work of a relationship therapist or sex therapist can help. We essentially help woman reconnect with their bodies and rewire their brains to have a renewed relationship with themselves. It’s about finding what’s “good enough” and what works for each individual woman based on her history, medical diagnoses, sexual experiences and values.

Even when woman are managing their condition well, they may be left with psychological and emotional issues in relation to body image, intimacy and self-esteem. It is important to note that the onset of endometriosis occurs during the crucial years of sexual development. Women struggle between the often debilitating symptoms of endo, making sex difficult, and the pressure of knowing it is a social expectation, especially if you want to be in a relationship, not to mention if you want children. This inhibits the development of an identity as a sexual being. Sex is something you have to endure.

It is important for women experiencing any sexual dysfunction to grieve and surrender. Grieve the loss of what they feel being “normal” is, the loss of relationships, the loss of fertility, the loss of their own hopes for their sex lives. In doing so, women are able to surrender. We can then look at what parts of yourself you want to keep, what parts you want to give away and, in doing so, what you are making space for. What can be different? Because all we really want is quality of life.

Can we make space in our brains for the possibility that our bodies can bring us pleasure? Can we make space for the possibility that not all affectionate touch has to lead to sex and not all satisfying sex has to involve penetration? Do we understand what it feels like to be a sexual being, not a sexual object? Is it possible that the thought of a partner’s touch won’t trigger a fear response? I believe it is, and many women have benefitted from seeking assistance in these matters.

As a couples therapist and sexologist I know that any sexual issue is a couple’s issue and needs to be addressed as a couple, therefore making the experiences of partners quite valid. In understanding our partner’s experience, we can gain understanding, not just guilt. Suggestions made by the medical fraternity can be simplistic and insensitive. There seems to be a repeated narrow focus on what can make it work for the partner, not necessarily what can help the woman. Suggesting anal sex is extremely narrow-minded and offensive to some, even though it might be an option for others.

So what can we do? I would suggest to clients that they seek help where they can be given ownership of their disease or issue and empowered to manage it. I would encourage them to go back to basics in being self aware and understanding how they identify as sexual beings, not sexual objects. Experiment and think outside the box at the accessories and sexual aids available to help make sex more comfortable. Furniture wedges or fake vaginas have proven very successful for some couples.

These options allow the woman to be more comfortable and less tense. Partner penetration of a fake vagina, strategically placed, can also be stimulating for a woman at the same time. I emphasise the need for open communication and for the woman to reconnect with her body in a pleasurable way, not necessarily sexual in nature, but to reconnect in ways that are pleasant – such as the great taste of a square of chocolate.

At the same time, we must continue to talk about and study women’s experiences of endometriosis and other chronic diseases and conditions of the female reproductive system. As sufferers, we can grieve the life we thought we would have and surrender to the necessary steps for managing the disease. This doesn’t mean it owns us. We experiment psychologically and physically, challenging our pre-conceived ideas about sex, pleasure and intimacy.

We can continue to encourage women to “never give up”. We can ask them to push professionals to look for new options and be mindful of their approach. We can celebrate the ability to adapt. We can feel validated as human beings, women and lovers.

Nina Booysen will be speaking at the EndoActive endometriosis conference on Saturday 9 September in Sydney. Get your tickets here.