By Rebecca Mariana Bengtsson

Before the pain started, I had never heard of most of the conditions that affect female sexual health, and before it gradually got more and more painful and started affecting my daily life, I thought it was normal. Although I had received sex education, knew the importance of consent, and did research to find out the different ways of enjoying sex, I experienced a lot of shame and unnecessary pressure around my sexual experiences and what I enjoyed. I communicated with my partner, but often felt like a burden or like I was being difficult when it came around to ‘my turn’, regardless of if that was the case from my partners point of view or not. Being diagnosed with vulvodynia forced me to go on a journey to learn about my own body and to change what I believed about sex. Here is what I have learned, so far.

I have learned that pain during sex is common, but not normal. Swedish scientist Eva Elmerstig states that in her research, about 50% of women report pain during sex. Many women keep having intercourse despite the pain, prioritizing their partner’s pleasure. This is especially common in heterosexual relationships where penetration is the norm. Common causes of pain are conditions like vaginismus and endometriosis, yeast infections, STI’s and simply not being ready for penetration due to dryness or not being turned on enough. As previously mentioned, in my case, the cause was vulvodynia.

Vulvodynia, or vestibulodynia, is a chronic pain condition with general or localized pain around the vulva and/or at certain points around the vaginal opening. The cause is unclear, with high stress levels, heightened sensitivity in nerve-endings, hormonal changes and infections mentioned among many possible ones. Symptoms include a burning, stinging or scraping sensation. Sometimes vulvodynia can co-exist with other conditions like vaginismus, which makes penetration difficult or impossible. The pain can be provoked by touch, tight clothing, biking etc. It may also be unprovoked and continuously present, with some occasional relief and flare-ups during periods of stress.

I have learned that sexuality permeates all areas of life. Many women affected by pain associated with sex cope by avoiding their genitals entirely, also avoiding non-painful sexual activity such as clitoral stimulation or even kissing and intimate touch, out of fear that one thing will lead to another and pain will be inevitable. It can also extend to avoiding everyday activities that might trigger the pain. Vicious circles of negative thoughts and damaging behaviour can lead to depression and negative self-image that makes the condition worse. It can also lead to difficulties forming romantic relationships and can be detrimental to existing ones. Once diagnosed, the relief of putting words to the problem can be coupled with helplessness – will I ever be able to have sex or ride a bike again?

Although there is no one-size-fits-all cure, taking a holistic approach has in many cases led to considerable improvement. A team consisting of physiotherapists, sex therapists, psychologists and gynaecologists treat the physical and psychological symptoms, treating the mind and the body as connected and dependent on one another. A healthy diet, regular exercise and enough sleep coupled with good mental health, open communication with partners and positive mechanisms for coping with pain can lead to virtuous circles – leading to less pain and greater possibility of enjoying a satisfying sex life and improved everyday life functions, despite the chronic nature of vulvodynia. For me, this means to take time out of my schedule to slow down, to learn my boundaries in life and in bed. It means to not let the pain stop me, but also not hurt myself to please others.

I have learned that well-informed health care professionals who listen make all the difference. I consider myself lucky to have been listened to and believed from the beginning of seeking help, and to have received the help I needed. For many women it’s a different story. Being diagnosed can take a long time and be extremely frustrating, as it is typically diagnosed by ruling out other conditions. Proper treatment can also be delayed by misdiagnosis and ignorance due to lack of visible symptoms. Many women are not taken seriously by their doctor, told they have a yeast infection or to just ‘relax’. A horrifying example was given by Tara Langdale-Schmidt, who is an entrepreneur in the field, talking about vulvodynia in an interview for BBC Future. She explained that she was told to go home, take an ibuprofen and have a glass of wine before intercourse.

This issue is part of a larger problem surrounding pain bias in healthcare, where women reporting pain are often referred to a psychologist or simply disregarded. A BBC Future article on the topic cites a study that found that individuals with more ‘feminine’ traits were less likely to be taken seriously by healthcare providers. Couple this with a poor medical understanding of female sexual health concerns, lack of funding and interest in researching the issue, as well as stigma around female sexuality, and you can perhaps start to imagine how it feels to be a woman with a moody vagina, stuck in the middle.

Lastly, I have learned that my pleasure matters. If I’m not present or not feeling good during sexual activity, it will hurt. That fact has forced me to prioritize my own pleasure, and to start dealing with shame around talking about it. Having a safe space in the office of a therapist, partners that are emphatic and understanding, and other people close to you to talk to when needed, is a good start. Talking about it openly outside a closed circle of people is the great challenge – but an important one to overcome, if we want the stigma around everything that has to do with pain and pleasure regarding the female body and sex to subside. We cannot just talk about the good, we also need to talk about the bad and the ugly. Is our sex education really any good if 50 percent of women report being in pain regularly during sex? Is it OK for healthcare professionals to tell women to shut up and take it? 

Acknowledging the fact that it took being diagnosed with a chronic pain condition to learn these lessons is disturbing. My body had to scream for attention for me to learn what I should have already internalized, and what should have been as natural a part of my sex knowledge as how to use contraception. Unwanted pain during sex is not normal. Deriving pleasure from seeing a partner satisfied is good, but shouldn’t come at the expense of your own well-being and your own pleasure. Safe sex, beyond using protection, should be about feeling safe enough to enjoy yourself fully and to talk about it when you don’t.

Illustration: Julia Holmström

Rebecca Mariana Bengtsson is aiming for a bachelor’s degree in development studies and hopes to work in and around Asia in the future. Few things make her as happy as the ocean, great writing and people who are passionate about their interests. Time well spent is time spent cooking, in conversation or learning something new, and even though she loves exploring, Norway will always be her bias.

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