50 Shades of Comfort…Finding Sexy Through the Pain
Written by Dr. Megan Fleming on Oct 30th, 2022
Hate to disappoint you, but I’m not talking about S&M. I’m talking about vaginal (vulva to be technically accurate) and pelvic pain, the pain you don’t see. According to Prevention Magazine chronic pelvic pain affects 1 in 7 women.
Yet most women don’t know where to go or how to get the right diagnosis and treatment. So it’s important that you understand the most common causes and diagnoses where chronic pain is the primary symptom:
- Vulvar Vestibulitis
- Interstitial Cystitis
Women need to educate themselves and become their own advocates
I’ve heard countless stories of the challenges women have in getting their pain accurately diagnosed and experiencing treatment options that can make a significant difference. One of the greatest tragedies perhaps, is when a woman hears that her pain must be all in her head because our current ways to make a diagnosis (history, MRI, CT scan, blood results, etc.) don’t offer anything conclusive.
Women often feel there’s no place to go to discuss their concerns and the impact of this pain on their personal lives, relationships and sense of their own sexual and feminine identity. Women who suffer from these issues need to become experts in their own care and negotiate on behalf of their own experience and needs with a health system that often shuffles them from one specialist to another, or one treatment to another.
For most, there’s no one size fits all treatment
One of the most frustrating challenges of getting treatment for vulvar or pelvic pain is getting the right diagnosis and then figuring out which treatment options are effective. These kinds of chronic pain don’t have standard ways to assess and identify treatment options like other common medical illnesses. Diabetes for instance, uses scores from standardized blood sugar tests that point to clear treatment options, like diet, oral medication or insulin. Chronic vulvar/pelvic pain is not that well understood, yet.
Common treatments for pelvic and vulvar pain are:
- Pelvic floor physical therapy
- Lidocaine and other topical creams to numb (that when initially applied often sting and burn-as if a woman needs that additional challenge!)
For some, countless medications that benefit neuropathic pain are prescribed; even anti-depressants known to have analgesic properties.
Remember the Sex in the City Episode when Charlotte comes back from her gynecologist and after being prescribed an antidepressant for her vulvar pain, says, “my vagina is depressed!”
I lamented that we all missed a collective opportunity for psycho-education; but hey, sometimes we all really just want to be entertained.
I want women everywhere, who have ever suffered from consistent, vaginal pain to know that they are not alone. There absolutely are treatments and specialists who can help change the lives of these women for the better.
Women need to take charge of their own health in order to get treatment. Most university medical settings offer specialists and that’s a good place to start looking in your area. There are also practices that specialize in vulvovaginal and pelvic pain disorders. Thankfully, now, these places are only a Google search away.
The role Sexy Therapy plays in integrated treatment
This is where I come in; I’m one of those providers.
I’m a sex therapist and I help women with vulvar pain understand their own experience, and what factors they do have control over which impact the intensity or frequency of their pain.
I help them make sense of why their libido is typically non-existent (it’s real hard to desire what you know will hurt.) And they typically have become avoidant of almost all sexual touching and experiencing pleasure in their bodies. As you can imagine, this can take a significant toll on intimate relationships.
This is what I love about my work. It’s why I became a sex therapist. I worked as a Psychologist in Pain Medicine & Palliative Care and I saw sex as a means to give back pleasure to the body for those who experience chronic pain.
Sex therapists help clients understand that when they can stop resisting their pain and just accept it in that moment, because it just is, when they can learn mindfulness practices – such as breathing, meditation, and compassion for themselves – the experience itself starts to shift their energy and soften the pain.
I help women redirect their attention to places in their body that feel good and to really focus attention, love and gratitude for what feels good. There’s a freedom in re-connecting with the parts of the body that reliably and consistently feel good to be touched. I teach women to explore their bodies and to notice pleasurable sensations, arousing sensations. Sometimes that means taking penetration off the table and enjoying external clitoral stimulation and even orgasm. This kind of self -care, to take responsibility for one’s body and one’s pleasure plays a huge role in the ability to live a rich beautiful life. And little is more beautiful than a woman who nurtures her health.
The greatest thing I help women do is to discover, for themselves, their own personal and often unique ways to move out of suffering and back into living. It’s a tough and rewarding job. I honor the courage and strength of all of the women I’ve spoken to in groups, seen one on one and with their partners.
So while there are no S&M references in this blog, there are ways for women who suffer with chronic pain to experience sexual activity that feels good to them. I help women find their own, 50 shades of comfort, to help them gain control of what does and doesn’t feel good, to feel pleasure and connection in their bodies and with their partners. It’s time pelvic and vulvar pain gets talked about with the same public interest in 50 Shades of Grey and BDSM. Don’t you think…because self-awareness, comfort and care are beautiful things!