not tonight: women for whom love is a pain
by John Illman
When Viagra hit the market in 1998, it caused a revolutionary shift in sexual attitudes and expectations. As the first pill to treat impotence, it has helped millions of men – it is thanks to Viagra that impotence or ED (erectile dysfunction) is no longer a taboo. Scientists are now trying to formulate Viagra-like drugs to treat another common problem – female sexual dysfunction.
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A survey reported in the Journal of the American Medical Association in 1999 suggested that more than 40% of women suffer from female sexual dysfunction. More than a fifth (22%) of those in the survey complained of low sexual desire, 14% experienced problems with sexual arousal (lack of vaginal lubrication) and 7% had pain during intercourse.
This begs the question, why does female sexual dysfunction attract so little attention when it is so widespread? Why is male impotence taken so seriously, while lack of sexual desire and arousal in women is dismissed as 'psychological'? Many sufferers are simply too afraid or embarrassed to seek help. Others believe that they are beyond help. Another problem is that many GPs are not trained to help – and it is to GPs that many women first turn to for advice.
painful sex
Angela recalled, 'It took all my courage to go to my GP and tell him that my husband and I had found love difficult for the past three years. He told me to stop dwelling on it, that lots of women find this, and that it's not unusual. His solution was, "If it hurts, don't do it." I was shattered.'
Michele Goldsmith describes Angela's case in her courageous book, Painful Sex. Turning to her own story, Michele describes herself as a liberated, fun loving woman, fully in tune with her sexuality – but for years she associated sex with pain. She was 19 when she first sought help and a gynaecologist advised that changing positions during lovemaking might help – which it did for a while.
She was then prescribed antibiotics for tonsillitis, which triggered thrush and cystitis.
'The causes of these conditions were never investigated,' she recalled. 'I quickly learnt that painful sex, like painful periods, is something many women are expected to grin and bear.'
After a brief respite in her mid-20s, she had another bout of symptoms similar to thrush. None of the usual treatments seemed to work. The pain was so severe that it sometimes kept her up all night. She underwent extensive tests, all negative, and was given a cream to soothe her dreaded 'phantom itch'.
vulval vestibulitis
Her problem seemed to be 'all in the mind' and she became convinced she had developed a psychological aversion to sex. Six months later she was referred to another gynaecologist who almost straightaway diagnosed her real problem – 'vulval vestibulitis' – an inflammatory condition. The name meant nothing to her, but she burst into tears of relief and anger. Why hadn't she been diagnosed before? How many other women had suffered similarly?
The cause of vulval vestibulitis is not very well understood by doctors. Usually it produces a tender area with some redness just inside the opening of the vagina. Sometimes it disappears without any treatment. Sometimes it helps to use analgesic gel (to numb the pain) and steroid creams (to reduce the inflammation).
Vulval vestibulitis is reported to be the most frequent cause of sexual pain in women and has been linked to sexual arousal disorder. Having sex without being aroused or properly lubricated is painful for women and may lead to fear or avoidance of sex.
key to sexual fulfillment
What is the relationship between desire and arousal? How does the one trigger the other? The answer to this intriguing question may hold the key to sexual fulfillment for millions of women. Men always know when they are sexually aroused. They have an erection. They know when they have an orgasm. They ejaculate or 'come'. But research at Amsterdam University has shown that in women, 'the desire-arousal' relationship is far more complex. Women volunteers were shown a series of erotic images that measured their response.
Assume for a moment these images excited the women and generated sexual desire. In the normal course of events this would trigger arousal. As a woman becomes aroused, the tissues of the vagina become moist from fluids secreted by the genital walls. The vagina gets longer and expands. But – and this is what surprised the Amsterdam researchers – many of the women they studied did not react as expected.
One of the researchers, Dr Ellen Laan explained: 'They were unaware if they're lubricating properly or not.' In other words, they did not know whether or not their bodies were ready for sex.
why a woman can't be more like a man
How could drugs like Viagra help? In men it works by increasing blood flow to the penis which is enough to produce the desired effect – an erection. The hope is that in women it will increase vaginal blood flow and stimulate arousal. But in a preliminary study, it achieved only the first of these goals, without producing any significant increase in sexual arousal. It may be that in women, Viagra-like drugs need to be given in combination with another drug or with psychological therapy.
Professor Virginia Sadock, of the New York University Medical Center, points out that the 'feminisation' of the brain may put women at a disadvantage. The male hormone testosterone is the hormonal basis for our libido or sex drive – and men have more of it than women do.
A woman's sexual desire, arousal and ability to reach orgasm may also be critically influenced by her feelings about her partner or upbringing. A woman brought up to think that sex is 'dirty' may be consumed by guilt about the idea of making love. Sexual disinterest may also be embedded deep in our evolutionary history, and developed, as a protective mechanism, to prevent unwanted pregnancy. Depression, medication, poor body or sexual self-image and negative emotions can also have a major impact on a woman's ability to enjoy intercourse.
poor sexual technique
Initial blame for a woman's sexual problems often lie with her partner. Insensitive love-making and poor sexual technique can create a vicious circle in which she reacts by avoiding sex and he loses confidence in his love-making ability. He may even become impotent as a result. About a third of men suffering from 'psychogenic' or psychological impotence have partners with significant sexual problems of their own.
don't be afraid to seek help
Experts predict that new drugs to treat female sexual dysfunction will emerge, but what should sufferers do in the interim? Dr David Delvin, who specialises in the treatment of sexual problems, says: 'The first thing to say is don't be afraid to seek help.' Try seeking an appointment at a family planning clinic with a doctor trained at the Institute of Psychosexual Medicine or with a specially trained Relate counsellor.
help and info
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organisations
British Association for Sexual and Relationship Therapy
PO Box 13686
London SW20 9ZH
Tel: 020 8543 2707
E-mail: info@basrt.org.uk
Website: www.basrt.org.uk
National specialist charity for sexual and relationship therapy. The website lists accredited therapists.
Couple Counselling Scotland
18 York Place
Edinburgh EH1 3EP
Tel: 0845 119 6088
Helpline: 01382 640340 (Thurs 2pm-4pm)
E-mail: enquiries@couplecounselling.org
Website: www.couplecounselling.org
Exists to promote, develop and co-ordinate a confidential counselling service for people in marriage and other intimate personal relationships. There are 14 Couple Counselling services across Scotland – visit the website to find details of the service in your area. The counsellors are fully trained volunteers who work part time and provide counselling for a wide range of people, regardless of race, religion, marital status or sexual orientation. Some services have additional counselling centres in their region and some also offer a Sexual and Relationship Therapy Service and/or a telephone helpline.
Institute of Psychosexual Medicine
12 Chandos Street
Cavendish Square
London W1G 9DR
Tel: 020 7580 0631
E-mail: ipm@ipm.org.uk
Website: www.ipm.org.uk
Psychosexual medicine is concerned with understanding how emotional factors can interfere with sexual performance and enjoyment. Types of problems successfully managed include: chronic pelvic pain, genital pain, lack of orgasm and loss of libido. Members of the public requiring help with sexual problems can send a SAE to the Institute, or e-mail, to receive details of local members.
Interstitial Cystitis Support Group (ICSG)
76 High Street
Stony Stratford MK11 1AH
Tel: 01908 569169 (Mon-Fri 9am-5pm)
E-mail: info@cobfoundation.org
Website: www.interstitialcystitis.co.uk
Brings IC sufferers together, through local meeting groups, to share information and experiences via newsletters and resources. ICSG aims to bring recognition of the condition to the medical profession and to the public. Website contains information about IC and IC treatments, frequently asked questions, a publications list, and details of local support group co-ordinators.
Relate
Herbert Gray College
Little Church Street
Rugby CV21 3AP
Tel: 0845 456 1310 (to find your nearest Relate)
Relateline: 0845 130 4010 (Mon-Fri 9.30am-4pm)
Relate Direct appointments line: 0845 130 4016 (Mon-Fri 9am-5pm)
E-mail: enquiries@relate.org.uk
Website: www.relate.org.uk
The largest relationship counselling organisation in the UK. Offers counselling,
psychosexual therapy, and other services to help those experiencing difficulties in any
adult couple relationship. Some branches of Relate offer individual counselling to
young people. Relateline is for couples experiencing emotional crisis who wish to talk
things through with an experienced Relate counsellor. Relate Direct is a telephone
counselling service (see website for more details, including costs).
Sexual Dysfunction Association
Windmill Place Business Centre
2-4 Windmill Lane
Southall UB2 4NJ
Helpline: 0870 7743571 (Mon-Fri 9am-5pm)
E-mail: info@sda.uk.net
Website: www.sda.uk.net
A charitable organisation set up to help men and women who suffer from some sort of sexual dysfunction. The main focus is on impotence but they also have information and factsheets on a range of other sexual problems. Callers to the helpline can request general or specific information and a list of specialists in their area.
The Vulval Pain Society
PO Box 514
Nottingham NG3 5ZQ
Website: www.vul-pain.dircon.co.uk
Provides women with information about their condition, possible treatments and ways of coping with vulval pain. Website features information about vulval pain, frequently asked questions, details of local support groups and an extensive range of links.
Women's Health Helpline
52 Featherstone Street
London EC1Y 8RT
Helpline: 0845 125 5254 (Mon-Fri 9.30am-1.30pm)
Minicom: 020 7490 5489
E-mail: info@womenshealthlondon.org.uk
Website: www.womenshealthlondon.org.uk
Offers confidential and non-judgemental health information, advice and support on gynaecological health issues such as abnormal smears, HRT, fertility awareness, fibroids, lesbian health, hysterectomy, painful periods, menopause, vaginal infections, thrush, pelvic inflammatory disease, PMS, unplanned pregnancy and abortion care.
websites
National Endometriosis Society
www.endo.org.uk
The largest UK charity devoted exclusively to endometriosis – symptoms of which include pain during or after sexual intercourse. Website discusses what endometriosis is, describes treatments, features a message board and lists a range of publications available.
National Lichen Sclerosus Support Group (NLSSG)
www.lichensclerosus.org
This site offers some information about lichen sclerosus (LS), a poorly recognised, chronic inflammatory skin disease which mainly affects the vulval and perianal area. NLSSG offers support and self help information and aims to relieve the sense of isolation.
Painful Intercourse (dyspareunia)
www.netdoctor.co.uk/sex_relationships/ ..
This article discusses painful sex, what causes it, and what you should do about it.
Painful Sex
www.thesite.org/sexandrelationships/ ..
Aimed at young women, this website outlines the common causes of painful sex, including lack of lubrication, and vaginal infection.
When Sex is Painful
www.surgerydoor.co.uk/ ..
This article considers the reasons (both physical and non-physical) that many women and men experience painful sex, and features helpful advice.
Journal of the American Medical Association
http://jama.ama-assn.org/ ..
Contains the abstract for the article 'Sexual Dysfunction in the United States: Prevalence and predictors' by E Laumann, A Paik and R Rosen (JAMA, vol 281 (1999), pages 537-544).
reading
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The Nutritional Health Handbook for Women by Marilyn Glenville (Piatkus Books, 2001) |
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Relate: Sex in loving relationships by Sarah Litvinoff (Vermilion, 2001) |
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A Woman's Guide to Overcoming Sexual Fear and Pain by Aurelie Jones Goodwin (New Harbinger Publications, 1998) |
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Women Without Sex: The truth about female impotence and other sexual problems by Catherine Kalamis (Self-Help Direct Publishing, 2003) |
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(November 2001, resources updated February 2005)
