Pain During Intercourse: It’s Not Histrionics

Michelle MillerPerspectives32 Comments

I’ve debated writing this post for some time now. I don’t feel embarrassed – not with you, Persephone readers – but I do feel reluctant to expose myself to certain sorts of criticism, of which I have had my fill in the last three-odd years. However, what convinced me to talk about this issue and my personal experiences with it was something my doctor told me at our last visit: “Most women go their whole lives feeling ashamed just because they and their doctors have never heard of this disorder, and everyone finds it easier to blame it on their minds, anyway.” So I’m going to open up and share here. Some of you may think, “Wow, that’s more than I ever wanted to know about you.” But others, maybe just a few of you, will read and find an answer for which you have been searching for years.

I was a virgin, a super-duper-never-so-much-as-done-more-than-kiss-on-the-lips virgin, when I got married. And my story is this: on my wedding night, I discovered I couldn’t have sex. Note: not wouldn’t have sex, but couldn’t have sex. You hear people describe losing their virginity in a number of ways, but feeling as if someone is stabbing you with a rusty blade in the worst possible way is rarely the common descriptor. We ended up having a great honeymoon, but a honeymoon completely without sex.

8 months and a therapist later, Mr. Michelle Miller and I had not had intercourse even once. I had seen several gynecologists, one of whom referred me to a therapist. They all told me that there was no cause for my pain and that it probably wasn’t real. One told me I might believe I was feeling pain, but really, I was just creating the sensation in my mind. But I was feeling pain, I told them. “Sure,” they said, and patted me on the head. After 8 months of trying this and that, of being told I had daddy issues, of being told “You’re not doing it right” or “You’re not doing it enough,” of being told God was punishing me for being a feminist,  I had had enough. So I told Mr. Miller that I wanted to try again. I gritted my teeth. I shut my eyes. When we came to the part where we always stopped because the pain was too much, he didn’t want to keep going, but I made him. And it was horrible. And it was wonderful. Horrible because I bit into my tongue so I wouldn’t scream from pain. Wonderful, because I realized that the experience had not killed me. I was still alive. I could learn to endure this. And for me, to this day, that is sex. Once every month or two, when my hormones just can’t take it anymore or I’m feeling hopeful, I try.

A few months ago, after yet another disappointing gynecology appointment that had left me grief-stricken and hopeless, I got an email from my mother about a condition of which she’d heard a fleeting mention in a recent documentary. The condition was vulval vestibulitis, now known as vestibulodynia. I had never heard of this condition and not ONE of my doctors had mentioned it. I booked an appointment with one more gynecologist (now the fifth I had seen). She, unlike all the others, did not roll her eyes and sigh at me when I explained all my difficulties (“What a silly little virgin!” is usually the expression on their faces). She had heard of this condition, and when she had finished testing for it, she sat back and apologized to me for every gynecologist I’d ever seen who had ignored my complaints, who had stuck a speculum inside me and chastised me when my body tensed and quaked and I couldn’t breathe. She said, “You have textbook vulvar vestibulitis, but we can do something about it.”

Confession? I cried. Right there on the exam table. Three years of shame fell away. Three years of self-doubt and self-loathing. I had never hugged a doctor at the end of an appointment, but I did that day. Even if my case were incurable, at least I had a name. At least I could say, “This is a thing, and this thing is not in my head.”

Now that I have some perspective, I see that I came face to face with the same old thinking about women and illness. The common line is, “You’re imagining. It’s not as bad as you’re saying it is. You must be getting some of the details wrong.” Only now are researchers realizing that women have been coming to doctors with this problem for decades. Only now are they acknowledging that this is a “thing” women get and not merely the manifestation of some mental hangup. An article by Dr. Julius Metts suggests that as much as 15% of women have this condition in varying degrees of severity, which means that doctors are constantly misdiagnosing it. He goes on to say the following:

Most patients consult several physicians before being diagnosed. Many are treated with multiple topical or systemic medications, with minimal relief. In some cases, inappropriate therapy may even make the symptoms worse. Since physical findings are few and cultures and biopsies are frequently negative, patients may be told that the problem is primarily psychologic, thus invalidating their pain and adding to the distress.

I’m not great at math, but according to Dr. Metts, more than 1 in 10 women have the same problem I do. And yet many doctors still know nothing about it. Not a thing. How many other women out there suffer in silence like I did because doctors tell them their pain isn’t real.

Ladies, we cannot be cavalier about our health. We cannot. While medicine has made many strides in understanding the female body, ultimately, women still face many of the same pathetic attitudes toward our suffering that defined centuries past. This experience has taught me that no one will fight for my health but me. I’ve learned that looking up information on my own and demanding that doctors (male or female) hear me, has to be par for the course. We have to be willing to stamp our feet and shout, ladies, until they hear us. We may be women, but we are not hysterical.

 

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Michelle Miller

Michelle Miller is a twenty-something blogger, cook, freelance writer and editor living in Seattle, Washington. She’s a feminist trying ever-so-hard to embrace her spaces, conventional or not. She looks forward to numerous bad hair days, burnt cremes, a soapbox or two, and maybe (just maybe) a yellow polka-dot bikini in the years ahead.
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Michelle MillerPain During Intercourse: It’s Not Histrionics

32 Comments on “Pain During Intercourse: It’s Not Histrionics”

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  1. Profile photo of triskele1d
    triskele1d

    I’m so sorry, Michelle, that you encountered such idiots. As a CNM, we were taught about these issues (and my degree is now 16+ years old). It’s a shame that MDs are as educated. I hope you have now found a health-care provider who understands your pain, and is helping you to overcome it. Enjoyable sex is part of life. Pain is always a warning and a problem, not something in a woman’s head FFS.

    Best wishes to you, and hugs to Mr. who is so patient.

    1. Profile photo of Michelle Miller
      Michelle Miller

      Sorry I’m only just now seeing this comment!

      Thank you so much for your support. I think that information like this just hasn’t made it into all the textbooks yet. I was quite pleased to discover on my last visit to my doctor that she is teaching several other doctors (interns, maybe?) and makes a point to inform them fully about this condition.

  2. Profile photo of considerthewaffle
    considerthewaffle

    Thank you for this! I’ve only ever had sex with one person, and I can think of only one specific time where it didn’t hurt. Since we only have sex about once a month (a long story), I didn’t know if it was him being too big, me being too small, me never getting the chance to adjust to it, or what. I always feel so horrifically guilty about it, because while he’s a trooper and understands that it’s genuine pain and I’m not trying to avoid sex with him, I never, ever ask for intercourse. Now I have an idea of what to talk to the doctor about. If I may ask, how do you test for it?

    1. Profile photo of Michelle Miller
      Michelle Miller

      Sorry I’m only just now seeing this comment!

      The test is very simple. The doctor takes a Q-tip or swab and tests several areas to gauge the level and location of pain. He or she will also administer a pelvic exam, if possible. The doctor may also elect to test for some infections, just to cover all the bases.

      For me, I didn’t even feel the Q-tip in some areas, but in others, it feel like she was scraping me with a fingernail. When she showed me the type of pressure she was using on my hand, I was astonished. She was only doing the lightest of touches.

  3. Profile photo of dellbot
    dellbot

    Wonderful, powerful post.

    Something said further down thread got me thinking about possible treatments. I’m actually really hesitant to say this because I don’t want to sound like an asshole who thinks something as serious as this can be easily treated, but have you tried/considered yoga? (I’m really not trying to be a jerk, so if this suggestion is way out there I apologize!)

    The reason I ask is that I practice a lot of yoga and have seen some pretty significant changes with regards to how my vagina/orgasm function. There was a period of time while I practiced (I’ve been doing it for about five years) when I would almost orgasm in class while doing back bends. It was actually very uncomfortable (almost to the point of pain) and I know a lot of women have experienced this same thing as well. What got me thinking was the discussion about the pelvic floor and I’m sure that’s related to what I’ve experienced in class.

    Anyway, I’m sorry if this is an out-there ridiculous suggestion, I’m not trying to diminish your experience at all, but because I’ve seen so many people change their bodies through yoga (ie. get rid of chronic migraines, go off insulin for Type II diabetes) it *might* be something to consider, if you haven’t. (And if you have, did it help?)

    Thanks again for your great post and opening up this terribly important conversation.

    1. Profile photo of Michelle Miller
      Michelle Miller

      Not offended in the least! I have tried a little yoga (nothing in earnest). I suspect that it would indeed be helpful for women who have developed the tendency to tighten those muscles. As a result of the pain, I also have that tendency. From what my doctor tells me and from my own experience, however, the cause of the pain itself is not muscular in nature, but related to nerve function.

      So actually, your comment intrigues me because once I sort out the nerve issue, I will definitely need to sort out the muscle issue. I really cannot think of a better way, short of pelvic floor therapy itself, to do so. Think I better start looking for a yoga studio!

  4. Profile photo of wannabemusicologist
    wannabemusicologist

    Thank you for sharing this. I am so sorry you had to go through this. I think that there are huge societal problems around doctor/patient relationships, especially for women. About a year ago, I was doing a group camping/performance art thingy for my masters thesis research and I contracted what I later discovered was giardia from incorrectly purified water. I already have a chronic, non-life threatening intestinal problem (IBS), so I started getting super sick, and naturally headed off to my family doctor right around christmastime.

    He sent me for a variety of tests, but before even doing that he told me, rather glibly, “oh you probably have Crohn’s” (which is a serious disease) without any basis for that information. Still, because I was feeling really awful and sort of on edge anyways, it devastated me entirely. It sort of ruined the holiday time with my family, my parents worried and mourned how much shorter and how different my life was about to become.

    Fast forward a week and a bit, and I have my followup appointment for the variety of tests. He had a resident in the room, a guy about my age, and the tests had revealed that it was just giardia (which is highly treatable) and my IBS. They basically scoffed at me for my concern, and I was made to feel like a hypochondriac, even though a week prior my Dr. told me I had a life altering and threatening disease with no basis for that assertion.My intestinal woes have always been a source of embarrassment for me (because hey, they deal with poop!) and essentially being laughed at in an appointment compounded that. Because of his behavior I promptly switched family doctors. There are too many stories like this (both yours and in the comments) there needs to be better doctor-patient dialogue, it seems to be sadly lacking when the patient is female. I find it horrible that you had to go to five doctors, before you could be diagnosed with something that affects 15% of women. If that’s not indicative of women’s health not being taken seriously, then I don’t know what is.

    1. Profile photo of Michelle Miller
      Michelle Miller

      That honestly makes me a little sick for you. I’m familiar with Crohn’s disease, and telling someone in a flippant manner that he or she probably has it, and then mocking expressions of stress and worry after the fact is beyond heinous.

  5. Profile photo of Alice Nevada
    Alice Nevada

    Thank you for sharing this, it must have been tough to put yourself out there! While I don’t have the medical issues you face, I have had a couple experiences where doctors blew me off, thinking me ‘hysterical’. About 4 years ago I had a sinus infection and a horrible pain in my head, behind my left ear. The pain was unbearable. My regular Dr. was on vacation outside the country, so I had to see another (male) Dr. in the group. He told me the pain couldn’t be THAT bad, it was just part of the sinus infection, nothing else was going on. I started to experience vertigo and amazing pressure in my ear, so I went back to the Dr.. I was so miserable and in so much pain I started to tear up, and he asked me if I had a history of depression! When I finally got to see my regular Dr. she immediately sent me to an ENT who discovered I had a horrible inner ear infection that had spread through my middle ear, eustachian tube and sinuses. The ENT said if I had waited to see him I might have had permanent damage due to the swelling. To this day I still have trouble with my left ear. So YES! We must be our own health advocates and fight back against those who would label us ‘hysterical women’!

    1. Profile photo of Michelle Miller
      Michelle Miller

      Wow. History of depression. THAT IS RICH.

      I find that when it comes to pain in particular, we have to fight to be heard. I wonder if that’s because we deal with so many different forms of pain in our lives, biologically, than males? It seems foreign to males, so they naturally think we’re all just exaggerating all the time. I honestly don’t know, but inexcusable in your case.

      What really burns me here is that it would have been SO EASY for those doctors just to order the test and find out for sure.

      Seriously. What is UP with the world?

  6. Profile photo of
    Kortney Thoma

    Thanks for posting this, Michelle. I can’t believe no one listened to you for so long and that they treated you in such a condescending way. For me, that would be the most horrible part, to never have anyone believe you and call you names instead. You are a brave woman to have kept trying. And Mr. Michelle Miller is a sweet man for never giving up on you either.

    I really appreciate this article because even though I don’t have this problem, I can relate to the shame. As women, we are too often dismissed as unwilling, too emotional, or just anti-men if we can’t perform the way our bodies are meant to, and doctors are no exception when it comes to perpetuating the stereotype. Good for you for standing up for what you believe in and for forcing someone to listen. I hope that as a future doctor, I never make that mistake of dismissing someone’s pain and blaming them for it. And I hope I always give my patients an ear to at least hear their ideas and concerns, whether they came from the internet or not.

    1. Profile photo of Michelle Miller
      Michelle Miller

      Thank you, Kortney.

      I know you’ll be a bang-up doctor because you’ve always had the ability to hear and understand.

      “As women, we are too often dismissed as unwilling, too emotional, or just anti-men if we can’t perform the way our bodies are meant to…”

      You really said it there. One of the fascinating accusations I frequently heard from doctors and even those around me was that I must just hate sex. After all, I had been a virgin when I got married, so I couldn’t have wanted it much to begin with, right?

      I think I would have preferred being called a slut to being told that, any day of the week.

  7. Profile photo of Meghan Young Krogh
    Meghan Young Krogh

    This experience has taught me that no one will fight for my health but me. I’ve learned that looking up information on my own and demanding that doctors (male or female) hear me, has to be par for the course. We have to be willing to stamp our feet and shout, ladies, until they hear us.

    Yes, exactly. I’ve often heard medical professionals roll their eyes and bemoan the patients who come in armed with data from a documentary or study they found on the internet, but, um, I think we’ve all had too many of these same medical professionals tell us that our Something was Nothing, all in our heads, only to later have a diagnosis and a cure that could have saved us years of pain, self-doubt, discomfort, or illness. So, I’ll self-educate and keep asking questions, absolutely. I don’t really care if I’m annoying the doctors at this point. It’s my fucking health, not just another appointment, to me.

  8. Profile photo of Teri Drake-Floyd
    Teri Drake-Floyd

    I suffer from this. I had no idea it existed until this post (I thought I suffered from vaginismus), but it sounds just like what I experience.

    I wasn’t able to wear tampons for years. I think I was probably 21 or so before I could use them. And intercourse has always been very, very painful. I’ve had partners ask me why I’m such a ‘prude’ and accuse me of deliberately trying not to enjoy myself because I’m in such pain. It’s humiliating, and shaming, and horrible.

    The one time I mentioned the problem was when I was having a pap smear and the doctor told me to, ‘relax, it isn’t like I’m going to hurt you.’ I explained that it wasn’t ME, it’s just that I felt pain, and he kind of rolled his eyes like I was just some prude who was being shy and silly.

    I’m glad to read this post because now I can put a name to what I experience, and also have something to refer to now when talking to doctors/friends/my partner.

    1. Profile photo of Michelle Miller
      Michelle Miller

      That sounds about right, Teri. You may even have a form of the condition that is temporary and comes and goes. If that’s the case, treatment is a little more successful.

      Next time you setup an appointment, have them put a note on your appointment notes that specifically mentions this disorder. That way, the doctor will need to go look it up before your appointment if he or she hasn’t heard of it before.

      I totally hear you about the lack of understanding with partners, too. Before we had a name for this, Mr. Miller and I went through a period where he thought maybe I just didn’t *want* sex and was making up the pain to get out of it. How can you prove something like pain?

      There are some great treatment options out there, Teri. Don’t put up with people telling you it’s all in your head. Science is on your side!

  9. Profile photo of fun back in sin
    fun back in sin

    Thank you so much for sharing this with us. I have not had this problem, but I had an awful time losing my virginity–I say I had “five ‘first’ times”–but I had an even worse time trying to talk to the gynecologist at my college about it, who made me feel like it was all in my head. She asked if I was from a very religious background, or thought sex was dirty. It made me feel so ashamed and abnormal for having all that pain.

    1. Profile photo of Michelle Miller
      Michelle Miller

      Yes, I can relate! These were all accusations leveled at me, too. Didn’t help that I *am* from a very religious background.

      Course, my family never shied away from frank and approving discussions of sex. :)

      I think that sense of shame and abnormality is the worst thing. It also deprives you of power: how can you change something like that about your body? How can you change something your mind is doing to make you feel pain when you shouldn’t?

  10. Profile photo of paperispatient
    paperispatient

    Thank you for being willing to share this with us – I think it can be really difficult to talk about vulva/vagina-related problems for a number of reasons, and so I appreciate you being so candid. While I’ve never been affected by this problem, I’ve been to tons of GPs and gynecologists about some recurring vaginal issues and I can relate to how frustrating it is when your doctor is dismissive or won’t listen or can’t offer you any information or hope. I hadn’t heard of this condition until I started commenting on VaginaPagina in college – something so common and so painful ought to be better known, at the very least by doctors if not by all women in general. (Sidenote: am I correct in thinking that this is similar to but not the same as vaginismus? I just want to have all the terminology straight in my head.)

    1. Profile photo of Michelle Miller
      Michelle Miller

      Vaginismus is the blanket term for pain during sex. It used to be the only term, but in the past twenty years or so, doctors have found several different types of pain with several different causes, so it became a general term instead.

      I found the whole experience with doctors not believing me very jading. I suppose I had taken for granted that things I say I’m experiencing would be taken at face value. The naivety that comes of growing up in my generation, I suppose.

      1. Profile photo of paperispatient
        paperispatient

        Thank you, that’s helpful! I occasionally see “vaginismus,” “vulvodynia,” and “vestibulodynia” used interchangeably and other times see them used in ways that made me think they referred to different things, so that’s good to know.

        It’s completely reasonable to think that a doctor is going to take you seriously, and it’s so sad that we can’t actually expect it will happen. (I mean, to be fair, I’ve had a few really awesome doctors – but man, I’ve had some shitty ones too.)

      2. Profile photo of ultra violet
        ultra violet

        Hi Michelle,

        Thank you for being courageous and sharing your story. I just wanted to clarify one thing– vaginismus is actually not the blanket term for pain during sex– this term is dyspareunia, and you can read about the difference and other terminology here: http://www.vaginismus.com/faqs/vaginismus-questions/dyspareunia-diagnosis-treatment

        Basically vaginismus is pain during intercourse resulting from involuntary contraction of the pelvic floor muscles. Pain is only present when any insertion is attempted. With vulvodynia, something is irritating the skin in that region (e.g. a yeast infection), so there is often pain when simply touching the skin, without attempting penetration. A gyno who knows what she’s doing can often also see discoloration or redness just looking at the skin. These skin inflammations (vulvodynia) can sometimes *cause* vaginismus because your mind associates touching that region with pain and those muscles start contracting, so sometimes after the skin has healed, you can be left with vaginismus. Vestibulitis is a subset of vulvodynia in which the external pain is specifically confined to the vulva.

        There is a fantastic book called “The V Book” by a pioneering OB/GYN in the field of intercourse-related pain named Elizabeth Stewart that I recommend, although these days you can get really good info from sites like the one I link to above.

        One thing all your readers affected with any of these conditions should know, in addition to the fact that many doctors are uninformed about these conditions, is that many INCORRECTLY recommend surgery as treatment to “break the hymen” or “widen entry to the cervix”. Surgery is RARELY needed to treat any of these and in many cases can make things worse. So please please go to the nearest major city and find the best expert you can and get a consultation, even if you have to pay out of pocket, before undergoing surgery or if whatever treatment options you’ve been given aren’t working.

        1. Profile photo of Michelle Miller
          Michelle Miller

          Thanks for the information! In my experience, clarification on this topic is so difficult to find, so I always, always, always welcome more info!

          Question: One expert with whom I’ve spoken has recommended surgery not to widen the entrance or remove the hymen, but simply to remove the top layer of skin in the affected areas. The goal, as I understand it from the expert, is to allow the skin to heal without the inflammation, or to potentially correct the number of nerves in the region.

          There’s some new research that suggests that an over-abundance of nerves not inflammation may be to blame for some instances of vestibulitis. However, my doctor mentioned that it can be difficult to diagnose whether it’s one or the other.

          Do you have any thoughts on that specific line of treatment?

          I can’t imagine how surgery to widen something would help, you’re right.

          1. Profile photo of ultra violet
            ultra violet

            It sounds like you (finally) have a good doctor, so yay for that– I can’t tell from what you wrote if he cautioned you against the surgery or simply acknowledged in general that diagnosis and treatment is tricky, but because of the latter I’d save the former as a last resort after at least two doctors who have seen many cases of pain during intercourse advise it. (And if you don’t live in a major city it’s unlikely you have an ob/gyn who has seen more than a handful of women with pain from intercourse.)

            With any medical issue I tend to look for the “National XXX Association” website to see what medical experts specializing in that condition recommend. http://www.nva.org does list surgery on their treatment page for your condition, but to read about when it’s recommended you have to do their online teaching program, which I haven’t done but is probably worth the $45 if you can’t find the answer to your question in the V Book (the book is like an encyclopedia for vaginas). The problem with surgery is the formation of scar tissue can make things worse, but I am thinking of cases where surgery was performed on the hymen not on the vulva. That said, I know a physical therapist in Boston (where the world sends their most difficult medical conditions) whose only patients are women with pain during intercourse or trouble holding their pee (the opposite of vaginismus– the pelvic floor is too loose instead of too tight), and she’s got a bunch of patients on her hands who would have been way better off if a doctor had sent them to her before surgery instead of after. Out of curiousity, I’ll ask her when I see her next week if she’s ever recommended surgery to a patient with your condition.

              1. Profile photo of ultra violet
                ultra violet

                Hi Michelle,
                I spoke to Raquel,and in 20+ years of practice she has seen ONE patient benefit from surgery, and she’s met one other who wasn’t her patient. She’s seen 5 who were worse off after surgery (not as many as I thought, but still…). She said you should try biofeedback, physical therapy, and medication before thinking about surgery. Are you in an urban area? If finding professionals who are familiar with various causes of painful intercourse is hard where you are, get thee to a city ASAP. Also if you go the surgery route, be sure to get a doctor who has done this type of surgery before (also hard if you’re not in a city), or at LEAST is not right out of med school. Good luck!!

                1. Profile photo of Michelle Miller
                  Michelle Miller

                  Thanks for asking her about it!

                  I’ve done several types of medication, numbing agents, physical therapy (including biofeedback), and even counseling. I’m lucky to have found a doctor who has made this area her specialty and she’s really been scouring research, case studies, and journals to find something that might work. She only just recently suggested surgery.

                  I’ll give this some more thought. Might be worth a trip out of state if I can find another opinion!

                  Thank you!

  11. Profile photo of Luci Furious
    Luci Furious

    I had been having pain during intercourse for a couple weeks when I went to the gyno. It wasn’t the worst pain ever, but I said it felt like either vagina had gotten smaller or my bf’s penis had gotten bigger. The gyno just laughed it off. So I felt like it was just mental. It went on for months, to the point where sex just wasn’t happening and was super awful. Turned out, it was just a yeast infection from hell. And I wished I had pushed it or gone to a different dr. instead of waiting to find out on my own. Gynecologists – take pain during sex more seriously!

    1. Profile photo of Michelle Miller
      Michelle Miller

      What so sad, Luci, is that the treatment plans available for most forms of vaginismus (the general term for pain during intercourse) are so easy. The pain usually has simple causes, like yeast infections, or a small overhang of skin, or even just a lack of lubrication!

      Here you had to suffer for MONTHS from something as treatable as a yeast infection (albeit, a really nasty one, from the sounds of it).

      I suspect that it will take an update to the medical literature of pre-med students and interns before we’ll see a more welcoming attitude about these issues.

      1. Profile photo of Maggie
        Maggie

        I suffered for about 8 months with pain that was absolutely excruciating at the worst. Fortunately it went away; but I still don’t know why it even happened, because I couldn’t get any help for it either.

        (And now I’m dealing with non-genital chronic problems, which I can assure you I’m already tired of fighting to find out what’s wrong)

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