Dyspa-Who?

A study has just been published, featured in the news headlines last week, stating that nearly one in ten British women finds sex painful. A breakthrough moment for anyone working in sex and relationship therapy!

Sadly, painful sex – or dyspareunia, as it is known in the medical world – is an all too common experience for women of all ages. It affects women in their late 50s and early 60s the most, followed by younger women aged 16-24. I see it in my consulting room often and I would suspect that ‘one in ten’ is a conservative figure and that a large proportion of cases go unreported for one reason or another. Indeed another (global) prevalence study reports that dyspareunia occurs from 14% to 34% of the time in younger women and 6.5% to 45% in older women.

Dyspareunia is a tricky problem to treat; there are often complex emotional, psychological and relational factors at play, and this requires time and effort to tease apart and fully understand. A woman with dyspareunia may lack sexual confidence or have had a string of mediocre sexual experiences early in her adult life. She may have experienced unwanted sex or childhood abuse. She may be all too eager to please her lover, at the expense of her own enjoyment and sexual pleasure. Or she may be in a relationship that feels unstable, volatile, or unpredictable. All of these factors can contribute to a general feeling of anxiety and tension in the bedroom which will inevitably interfere with, or stop, the process of arousal. As the purpose of arousal and lubrication is to prepare the body for enjoyable, smooth and pain-free intercourse, sex is going to hurt if a woman isn’t emotionally and physically ready for it!

Sometimes, painful sex is caused by a physical condition such as endometriosis, fibroids, urinary tract infections or sexually transmitted infections (STIs). It is also often triggered by the menopause and dryness resulting from a decrease in sex hormones. In these instances, there are targeted medical treatments that can help if women seek advice.

And that’s the problem. Many women (and men) still find it intensely difficult to talk about sexual matters. There is a taboo surrounding sex which prevents people from seeking help and advice or from talking to their partners and friends. How often do women discuss and openly share their experiences of menstruation, miscarriage, the menopause and masturbation? How often do you express your sexual likes and dislikes with your partner? Unfortunately, we are rarely taught, be it in our families, or in schools, about the softer aspects of sex and relationships, such as sexual pleasure, sensuality and communicating desire. Sex education covers the basics but it is largely considered to be ‘too little, too late and too biological’. And we often learn to associate sex with feelings of deep shame and guilt.

Whatever the cause of dyspareunia, it is clear that the impact is significant. The 2017 study states that painful sex has been linked with poorer sexual, physical, relational and mental health. I have heard reports of excruciating, debilitating pain among my own clients – like a “knife stabbing”, “flesh tearing” kind of pain. This, and the resulting lack of intimacy, can cause a significant amount of distress both in the individual and within the couple.

So it’s encouraging to see the issue of painful sex appear in the news headlines. Hopefully it will help raise awareness about a condition which is more common than we think.

Don’t suffer in silence. Talk to your GP or request an examination from your local sexual health clinic. Educate yourself. The Vulval Pain Society is a good source of information and support on the subject. And if there’s an emotional reason or anxiety behind your pain, arrange to see a sex therapist.