How To Talk About Sexual Pain With Your Doctor So You Get The Care You Need
Let's just put this out there: Sex isn't supposed to hurt, whether you're having sex for the first time or you've gone through menopause.
Yet up to 20% of women deal with dyspareunia, which is the clinical term for experiencing persistent pain during sex, and three in four women have dealt with pain during intercourse at least once in their lives. March is Endometriosis Awareness Month, so it's a good time to talk about sexual pain, a common side effect of the condition.
If you're experiencing pain some or all of the time when you're having sex, usually there's an underlying cause that can be remedied or at least alleviated—whether it's vaginal dryness, an STI, or a condition like endometriosis or vaginismus (a painful spasm of the pelvic muscles). The first step is to talk to your doctor about what's going on so you can get to the bottom of what's going on and start seeking out solutions or treatment.
Now, if only talking to your doctor about this stuff was so easy.
The barriers to getting care for sexual pain.
"There are many barriers to accessing care for both pelvic and sexual pain, the first one being the stigma," Sonia Bahlani, M.D., a New York–based OB/GYN specializing in pelvic pain, tells mbg. "Sexual and pelvic pain is often underreported and misdiagnosed because many delay or refuse to seek care because of the shame and stigma associated with these disorders."
In general, talking about sex in a health care setting can feel really intimidating, embarrassing, or even traumatizing for some people, especially if you have to take the initiative and bring it up because your doctor didn't ask. A 2012 study found only about 40% of OB/GYNs ask about sexual problems, and a quarter of OB/GYNs also express disapproval of their patients' sexual habits when these conversations come up. And many people who deal with pelvic pain say they've found their concerns being dismissed or not taken seriously.
"I see many women in my office who have tried to have this conversation with their general OB/GYN or family doctor and have been told 'it's all in their head' or 'all women have pain' or 'just have a glass of wine before,'" Bahlani explains. "They often come into the conversation previously being dismissed, and this can make it so hard to try to approach the conversation again or realize that there is so much we can do to help."
Emily Sauer, the founder and CEO of OhNut, a simple wearable tool designed to help people who experience pain during intercourse, herself experienced this type of dismissal by gynecologists for over a decade. "My questions about painful sex would be a nuisance to a doctor who has 15 minutes for an appointment, and who is equipped with a tool kit that pushes surgery and medication—over quality of life," she tells mbg.
Our medical institutions, in general, have historically revolved around the male biological template, Sauer adds, and there's a severe lack of both research and education around female sexual concerns and pelvic health. That means not only do many doctors know little about how to address women's sexual pain, but many women themselves don't even know how to explain the pain they're experiencing.
"With our current lack of sexual and pelvic education, it's nearly impossible for us to know what's 'normal' or 'not normal,' how much pain is too much, even to have a basic anatomic understanding in order to explain where things feel a certain way," Sauer explains. "Without language, particularly language that we're not embarrassed by, how can we begin to advocate for our health?"
How to get the care you need.
Despite the barriers, the good news is that more and more people are beginning to speak up about their experiences with pelvic and sexual pain, and receiving treatment and support is becoming more and more accessible. If you're someone who deals with pain during sex, here's where to start:
1. Find the right doctor.
"There are a limited number of practitioners who specialize in the field of sexual health. Ultimately this can lead to misdiagnosis of patients and gaps in accessing accurate and effective treatment plans," Bahlani explains.
You can definitely start by talking to your current primary care physician or OB/GYN. That said, it's extremely important to make sure you're working with a practitioner who will take your pain seriously. It may help to specifically seek out a doctor who not only specializes in sexual health but also specifically has experience treating patients who deal with sexual and pelvic pain. Where to start? Google around for doctors in your area with terms like painful sex, pelvic pain, dyspareunia, vaginismus, and vulvodynia in your search query. It can also be helpful to join Facebook groups or other online communities for people who deal with sexual pain to get some doctor recommendations.
"If your doctor isn't helping you, then there are many out there who will, who understand, who care," Bahlani explains. "You know your body best. I firmly and truly believe this. Listen to it. If something seems off, with your symptoms or your doctor, seek further care."
2. Come prepared.
It can help to know exactly what you want to talk about before you walk into your doctor's office, including precise details about the kind of sexual pain you're dealing with. Of course, oftentimes in the moment of the appointment, it can feel hard to get the words off your tongue to describe what you're going through—and it doesn't help if your doctor isn't asking the right questions.
To help you navigate the conversation, consider taking the pelvic pain assessment over at the Pain Perception Project, which is a helpful, HIPAA-compliant resource created by the Ohnut team in partnership with Duvet Days. It's a very friendly, approachable, but thorough questionnaire that helps you fully articulate your pain symptoms. You'll get a printable PDF report you can take to your appointment, hand to your doctor, or use as a reference point for the conversation.
"There's a huge gap in communication and education from both sides of the patient/provider dynamic, a gap that we're actively working to bridge," Sauer explains. Their hope is that the assessment makes that initial conversation with your doctor a lot easier—and helps make it easier to get the appropriate referrals to a specialist if needed.
When you get there, also bring or have access to all your prior imaging studies, tests, doctor's notes, and history of procedures to your appointment, Bahlani adds.
3. Trust the process.
Sometimes people will heavily research their symptoms prior to a doctor's appointment and walk in expecting a diagnosis, Bahlani explains, and sometimes people tune out or shut down if they don't receive the diagnosis or treatment plan they were expecting. Especially if you've found a specialist, Bahlani encourages people to keep an open mind and lean into the strategies their doctor recommends.
"Treating pain can be a slow process," Bahlani explains. "Pain is multifaceted, requiring a multidisciplinary approach. I often compare treating pelvic pain to peeling an onion because treating one component of pain can reveal other bothersome symptoms. Understand there's no magic pill. It's a process but worth it."
She adds, "Teamwork makes the dream work. It's important to approach treating pelvic pain as a collaborative partnership. We are working together for a goal."
The bottom line.
"When it comes to sexual health, it's up to the patient to advocate for oneself," Sauer explains. Opening these conversations with your doctor can feel daunting, but it's the first step toward getting the care you need and deserve.
Remember: You don't need to just live with sexual pain. "There is hope," Bahlani says. "There is hope."
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