Expanding knowledge and discourse of female sexual pain

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Expanding knowledge and discourse of female sexual pain

  1. 1. www.KaynaCassard.com www.DecodingHim.comExpanding Knowledge and Discourse of Female Sexual PainFemale sexual pain is something that spans across ages, races, orientations, andsexual activity. Although “sexual pain” seems very related to intercourse, it can alsoinclude pain during or after gynecological exams, tampon insertion, or the use of fingersor sex toys. Frustratingly, for patients and doctors alike, there isn’t one specific causeof sexual pain. This complicates matters and makes most cases patient-specific.New research and information has been getting a lot of attention lately that indicatestreatment should include mental health support as well as medical treatment. Chancesare, by the time women talk to their doctor about their pain, they have experiencedemotional distress, self-esteem issues, and relationship struggles.Female sexual pain? Is that a real thing?I get asked this a lot. Mostly from men, but surprisingly women have asked me too,even though a study cites that between 8-16% of women experience sexual pain atsome point in their lives. That’s roughly 13-25 million women in the United States. Themajority of the pain can be due to something as simple as insufficient lubrication, andonly occurs once and then never happens again.For other women, however, it becomes a chronic struggle and something that affectsthem more than just physically. For these women, the causes of sexual pain could bevast or even unknown. Some possible causes could be allergic reactions, dry skinconditions, side effects of medication, chronic yeast infections, postpartum injuries,anxiety, and the list goes on. Typically, by the time women seek treatment they haveexperienced the pain for quite some time and are understandably frustrated andconcerned.What is it exactly?Dyspareunia is an umbrella term defined as general sexual pain, and the term that mostwomen are diagnosed with when they see their physician. As mentioned, the cause istypically hard to pinpoint and might be complicated due to overlapping causes. This is
  2. 2. www.KaynaCassard.com www.DecodingHim.comespecially the case if there is a physical or medical condition in addition to apsychological cause for the pain.Another term used often is vulvodynia. It is a type of dyspareunia and referred to anypain in the vulvar area. This type of pain can occur with or without sexual penetrationand may or may not occur during, or as a result of, penetration. This also means that itcould occur with gynecological exams or tampon insertion, for example. Vulvodynia canbe specific to a particular area of the vulva, such as the vestibule (which is sometimesreferred to as vulvar vestibulitis syndrome) or general vulvar pain.Similar to dyspareunia, the causes for vulvodynia can be known, unknown, simple,complicated, medical, psychological or any of the above.Is your head spinning yet? There’s more…Pain isn’t just on the surface – it typically involves the muscles, tooA potential cause for painful intercourse is vaginismus. This is an involuntary spasm ofthe pubococcygeus (PC) muscles, which are the hammock-like arrangement of musclesthat run from the pubic bone to the tail bone.In general, when the body anticipates pain, it responds by moving away from thestimulus that might cause pain. With sexual pain, it is similar, except that the PCmuscles contract in an effort to keep anything from entering the vagina. As mentioned,this can occur with gynecological exams, tampon insertion, sex toys, fingers orintercourse.There are two types of vaginismus – primary and secondary. A diagnosis of primaryvaginismus is given when there are muscle spasms at the first attempt of vaginalpenetration. Secondary vaginismus is when there had been prior, pain-free penetration.The causes of vaginismus also vary – it could be a result of physical (i.e., medicalconditions, injury, age-related changes, etc.) or non-physical issues (i.e., anxiety, fears,
  3. 3. www.KaynaCassard.com www.DecodingHim.comtraumatic experiences, etc.). Additionally, vaginismus might be a result of acombination of issues.A multi-faceted problemHopefully, the reader is not too overwhelmed at this point, but if you are, it is completelyunderstandable – this can be a frustrating and convoluted issue, especially if you aredirectly affected by female sexual pain.Oftentimes women seek treatment only from a gynecologist and the psychologicalconcerns (such as relationship stress) are not addressed. Or, women will seek sextherapy, expecting that if they can improve their desire, arousal, or relationship then thephysical pain will be resolved.What makes it so troublesome is that the pain tends to overlap between physical andpsychological issues. Therefore simply seeing either a gynecologist or a sex therapistdoes not address all of the potential issues that female sexual pain might create.Furthermore, since there are not very many resources or enough research conductedon this issue, not many physicians or clinicians know how to work with it best. This isnot because they are incompetent providers, it is simply because there is a limitedamount of information. However, it would be very important to get a physician on boardthat is up to date on the most recent information about painful sex.Since the physical pain or anxiety around sex creates a response within the body totense up, it is likely that a woman with physical discomfort during or after sex will alsohave a degree of vaginismus. As a result, there can be psychological ramifications andrelationship stress that arise as well. Sometimes women choose to avoid sexualencounters, which might create distance in the relationship and intimacy issues that canput a strain on them.A lot of women who have been struggling with sexual pain have also been told that theirpain is “all in their head,” which can greatly affect how they are able to deal with theirpain and the effects of it. Women might question their self worth, feel anxious,
  4. 4. www.KaynaCassard.com www.DecodingHim.comdepressed, hopeless, or even out of control of their situation, which is why it is importantto also treat the mental health aspects of female sexual pain in addition to the physicalpain.Multi-dimensional treatmentSimilar to other chronic pain, having an involved treatment team that is up to date on themost current research and aware of the multi-faceted issue of female sexual pain isessential to recovery. Bergeron (1997) found that a multi-modal form of treatment isone of the most effective ways of working with female sexual pain. The treatment teamshould include a medical physician, a pelvic floor therapist, and a mental healthclinician, all of whom should be specialized in female sexual pain.The gynecologist will be able to determine if there is currently a physical component thatneeds treatment. For instance, if there are chronic yeast infections the gynecologistwould work on getting that under control through medication or dietary changes. Or, ifthe pain is a result of hormonal changes, the physician would create a treatmentregimen to address the effects of the imbalance in hormones.A pelvic floor therapist will work on assisting the woman in gaining control over her PCmuscles. This is often times done with the use of a vaginal dilator. The therapist willeducate the patient on exercises to do at home and how to use a vaginaldilator. Dilators can be purchased online atwww.vaginismus.com/products/dilator_set. Stretches are also introduced and caninclude working on the PC muscles, as well as hip, back, and core muscle groups. Thepelvic floor therapist will teach relaxation techniques to use while stretching and workingwith the PC muscles.Finally, incorporating a mental health specialist into the treatment is essential in healingthe emotional and relationship struggles. As mentioned before there is a lot ofpsychological stress that can arise from female sexual pain. Typical sex therapy ishelpful in addressing some of these issues; However, a combination of sex therapy andcognitive-behavioral therapy (CBT) that addresses the struggle of pain management isimportant too. Bergeron (2001) found that 40% of participants in a CBT/sex therapy
  5. 5. www.KaynaCassard.com www.DecodingHim.comgroup setting had significant improvement or a complete elimination of pain.Unfortunately, there are very few mental health clinicians that offer services in a groupsetting that directly addresses female sexual pain.Fortunately, for those living in or around the Los Angeles area there is such a group. Ihave created a 10-session therapy and support group that is set to begin in March,however it will be recurring throughout the year. Women in this group will find that theyare not alone in their struggles. The Female Sexual Pain Therapy and Support Groupwill teach participants how to cope with their pain; address and modify current thinkingpatterns that perpetuate their pain and anxiety; help women understand how toincorporate meditation and relaxation into their daily lives; teach more effectivecommunication skills; assist participants in becoming more in touch with their levels ofdesire, arousal, and sexuality and teach them how to increase these levels; and moreimportantly, help women find comfort in their mind and body again by taking controlback over their sexuality! For more information and to find out how to register visitKaynaCassard.com/VVSIf you are not in the Los Angeles area but are interested, feel free to contact me about aworld-wide version of this group in the works.Create discourse!Talking about issues such as these with your physicians and friends or family is the bestway to bring about awareness that female sexual pain is a real issue, and notsomething that is “just in women’s heads.” Women are worthy of having happy andhealthy sexual lives, and I am just another sex-positive professional attempting to getwomen on that path!About the authorKayna Cassard, M.A. (IMF#67179, supervised by Mary Kay Cocharo, LMFTMFC#MFC25394) has her Masters in Clinical Psychology with an emphasis in Marriageand Family Therapy. She has a private practice in West Los Angeles specializing insexuality issues, sexually compulsive behaviors, and gender or sexual identity
  6. 6. www.KaynaCassard.com www.DecodingHim.comexploration. Kayna’s clinical focus has been working with individuals, couples, andgroups with a variety of psychological concerns in a sex positive and empathicmanner. Recently, she has been focusing on disseminating information on andproviding therapy for female sexual pain.Check out her website to learn more www.KaynaCassard.com.For more free tips and insights on what really attracts a man, how tomake yourself irresistible to him and how to capture his heart, click thelink below.www.decodinghim.com

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