I'm lying on my back in a quiet room. There's calming music drifting out of a speaker in the corner, and the air carries a slight scent of essential oils. The lights are low; the atmosphere is tranquil. I could be in a yoga class, stretching and meditating. But if I were in a yoga class, no one would be pointing a laser beam at my nether regions.
In October, the Center for Sexual Health Promotion at Indiana University released a study in which one-third of the women surveyed reported feeling pain the last time they had sex. For some of these women, that pain was most likely a one-off occurrence. For others (though, sadly, the study didn't indicate how many) it is a chronic problem.
I fall, most unfortunately, into that latter group. The first time I had sex, it hurt like hell. This, I figured, was pretty normal, since most women report feeling some pain when they lose their virginity. When the pain didn't go away, when sex continued to feel like pouring acid on an open wound, I learned to grin and bear it. But as anyone who's ever grinned and borne something will tell you, it's a coping mechanism, not a solution.
We don't know how many women experience chronic pain during sex, and we don't know exactly why. There simply hasn't been enough research into the problem for us to know what causes pelvic pain conditions like vulvodynia and vestibulitis, or to determine the best way to treat it (which isn't the kind of thing you want to hear about a condition with which you've just been diagnosed, especially when that condition is ruining your sex life). If you've never heard of these conditions, or if you were surprised by the 1-in-3 number, it's no wonder. Despite the fact that we live in a sex-saturated culture, chronic pelvic pain remains widely unknown and poorly understood.
Part of that stems from a lack of research. "The state of the research on vulvar and vaginal pain issues is pretty bleak," says Dr. Debby Herbenick, associate director of the Center for Sexual Health Promotion and co-author of this year's study. The National Vulvodynia Association has lobbied Congress and the National Institutes of Health for years, Herbenick said, to get support research on chronic pain. "Funding has been released but sometimes more slowly than they've asked. So it's encouraging that funding over the last decade or so has been available, but it's still not enough."
If studies aren't funded, there are no findings to report to gynecologists. The result is that doctors don't know what to tell women who come to them complaining of chronic pain. There are also no findings to report to the press, and as a result, women who experience pain during sex can't read about possible medical explanations of their problem. They also can't read about the fact that, while they might feel terribly alone, they most certainly aren't the only women in America who don't find sex to be enjoyable, let alone orgasmic. Additionally, without funding, without research, without a medical explanation for the problem, it's awfully difficult to determine how to treat chronic vulvar pain.
Then there's a fear of speaking up about the problem. Our society is obsessed with sex; images of ecstasy are everywhere, and young people enter the sexual arena certain in the knowledge that sex is going to be, to use a demographically appropriate term, awesome. Sure, there's a risk of pregnancy and of sexually transmitted infections, but aside from those dangers, and a little initial discomfort for women, sex is going to be incredible. Why else would we all be so totally fixated on it? Sex feels fantastic … right?
Not always, according to one-third of American women. The reality that sex isn't the soul-shattering, earth-shaking bliss-fest they've been taught to expect can leave women feeling like there's something wrong with them. After all, everyone is talking about how great sex feels. The pressure to stay silent about pain for fear of being different, or even abnormal, is intense. Our cultural consensus, constantly repeated but clearly inaccurate, is that sex is always pleasurable, and that makes it difficult to talk -- with friends, partners or doctors -- about any experience that doesn't fit that mold. Even those who pride themselves on being open and unabashed about taboo subjects might find it difficult to admit to themselves, and to their partners and friends, that sex isn't living up to the hype. With sex education in this country being as poor as it is, there's a good chance most teenage girls will never be taught that occasional discomfort during sex is normal, but severe or chronic pain is not.
After almost seven years of gritting my teeth during sex, and after consulting multiple mystified gynecologists, I was at my wit's end. Finally, one doctor diagnosed me with vulvodynia and suggested that physical therapy might help. Having been an elite gymnast and then a dancer, I've seen more than my fair share of physical therapists, and I was skeptical. The pain I felt was superficial, not muscular, and I couldn't imagine what physical therapy could do to relieve it. The physical therapists to whom I was referred, however, seemed confident they could help. Though I'd read little about it in the press, though my doctors had been confounded, and though pain during sex was something that my friends and I never talked about, it turns out that what I was going through was fairly common.
And so I started treatment, or, as my friends and I have come to refer to it, vagina therapy. It wasn't an easy step to take. The idea that I needed physical therapy to learn how to do something that's meant to be instinctive, even primal, was depressing. Sex, after all, is among the most basic of human urges. But the folks at the physical therapy clinic (which was recently featured on an episode of MTV's "True Life") assured me that I wasn't an evolutionary failure. I just needed a little help.
The treatment plan for chronic pelvic pain is holistic, as is often the case with conditions whose causes aren't well-understood. There are stretches, massages and warm baths to loosen the muscles around the pelvis because it turns out that while vulvar pain is often superficial, its origin is mostly muscular. There are lifestyle changes, like switching to a gentle laundry detergent, and cutting back on caffeine and other diuretics that can cause vulvar irritation (a phrase that's about as fun to write as it is to experience). There are dilators, designed to stretch the vaginal muscles and teach them to relax when something enters the vagina. Then, there's the laser. It's a small hand-held device that emits no heat at all. It could easily be mistaken for a flashlight, except that it glows blue and makes a highly annoying beeping noise. The laser, as science fiction-y as it sounds, is fully approved by the FDA for treating everything from carpal tunnel syndrome to migraines. Low-level laser therapy is designed to reduce pain and inflammation and stimulate cell repair and healing. So far, it seems to be doing just that. But I'm sure I'm not the only woman who recoiled slightly at the suggestion that it might help to point a light saber at her ladybits.
There are other barriers to treatment. As soothing as the music and ambience of a clinic might be, treatment sessions aren't always comfortable. There are internal exams and, like other forms of physical therapy, this isn't a quick fix. There's no pill, no surgery, no instantaneous cure for this problem; it takes repeat visits and you're expected to do exercises on your own, too. This is a treatment that takes time and involves homework.
But it's worth it. Sex isn't something you should cope with -- it's something you should enjoy, and it certainly isn't supposed to hurt. It might not always be a thigh-quivering, chandelier-shaking adventure that wakes the neighbors, but sex should never cause you pain. If it does, there are treatments available, and they work. And while there's no medical evidence for this claim, I suspect they might work better if, during the light saber therapy, you switch off the meditation music and put on the "Star Wars" soundtrack instead.
Chloe Angyal is a freelance writer from Sydney, Australia, who lives in New York City. She is a contributor at Feministing.com and her writing has appeared in the Guardian UK, Slate and Foreign Policy magazine.
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