When sex hurts…and we don't mean heartbreak

We’ve been writing about sex for more than ten years, and when we started out, the topic that our female readers wanted to hear about most was orgasms — how to have them (either solo or with a partner), how to have them more often, how to have different kinds, how to have them simultaneously with a partner, how to stop faking them, and so on. Well, the Big O is still a favorite topic, but these days it practically ties with another topic: painful sex. (And we’re not talking about the attending heartbreak, though consistent physical pain during intercourse can itself be heartbreaking, of course.) We don’t necessarily think that sex is suddenly more painful for women, but rather that it’s becoming more acceptable to talk about the fact that, for women especially, sometimes sex can hurt like a motherfucker…not to put too fine a point on it. But too many women still fail to speak up. So we were thrilled to hear about a new book that focuses on this topic: When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain, by Andrew Goldstein, MD, Caroline Pukall, PhD, and Irwin Goldstein, MD. We definitely don’t have nearly enough letters after our names to adequately address the issues involved here! The authors were kind enough to allow us to publish an excerpt from the first chapter of their book, which you can read below. Check back in next week for their summary of the various causes of painful sex, and the week after that for a Q&A with the authors, in which they address some of the most common question they hear about painful sex.


“Sex has such an intense impact on how you see yourself and how you relate to other people. It penetrates every relationship….In fact, it is the central issue in any relationship whether the couple is aware of it or not. The nine years of sexual pain I lived through were an emotional hell.”—ANNIE, THIRTY

It’s been ten years, but Annie, now thirty, remembers the doctor’s words as if it were yesterday. She’d gone to her mother’s gynecologist for what she thought was a highly unusual and, truth be told, embarrassing problem: She couldn’t have sex. It simply hurt too much. After examining her, the doctor said, “You have a perfectly normal anatomy, but, sweetheart, if you’re as tense with your boyfriend as you are with me, it’s no wonder it doesn’t work.”

While those words, and the complete lack of empathy they exhibited, did nothing to help with her problem, they made Annie decide to become a doctor so other women could find someone with more compassion. Many other women like Annie, like you—more than 20 million American women alone—will experience painful sex in their lifetime. You’ve been bouncing from doctor to doctor and spending thousands of dollars seeking help to no avail. Even if you have found a doctor to correctly diagnose your condition, chances are you haven’t found much relief from the recommended treatments. Instead, you’ve spent years in agony, with pain so severe it feels as if acid is being poured on your skin or a knife inserted into your vagina.

Annie knows the drill well. From the first time she tried to have intercourse, she had lived in a world of pain, doubt, and frustration. The first time her boyfriend tried to enter her, she told us, she screamed in pain. “It felt like he was stabbing me, like I was being torn apart. It was horrifically painful.”

The two thought maybe Annie just needed to relax. And she tried. But nothing—not alcohol, not Valium, not even her pleas that he just “rape me”—worked. “I wanted to be normal so bad that I kept asking him to do pretty much anything he wanted,” she recalled. “‘Just close your eyes and go in there; it doesn’t matter if I’m in pain,’ I told him. But he was too good a guy to hurt me, and he couldn’t do it.”

It took another nine years—years filled with dozens of doctor visits, ruined relationships, and the certainty that she was crazy—before Annie found me (Andrew), and I diagnosed her with provoked vestibulodynia (PVD), a condition in which the slightest touch to the vulvar area results in excruciating pain. As many as 6 million American women suffer from this syndrome, which may have a dozen or more causes. Nearly 60 percent report visiting three or more health-care providers to obtain a diagnosis, and an astounding 40 percent remain undiagnosed.

In fact, as many as 40 percent of women with sexual pain don’t even seek medical care! They think that some level of pain or discomfort during sex is normal. Others are simply too embarrassed to talk to their doctor or don’t know how to bring the topic up. If this sounds familiar, take heart—our book gives you the tools to get you the help you need and deserve.

The problem is that painful sex doesn’t just occur in the bedroom. It infiltrates every aspect of your life. Many women feel it destroys their very sense of who they are. “I was very shut off physically for three years and am still recovering from that,” says Sheila. “I have a hard time being sexual because I don’t want to lead my fiancé on into thinking we are going to try to have sex when I am just not ready yet. For me, the pain really affected me more emotionally than it did physically.”

The National Vulvodynia Association reports that women like you find the pain of dyspareunia affects far more than your ability to have sex. It affects your ability to function in the everyday world, forcing you to leave careers and to limit physical activities. Some women we’ve met can’t even handle the pain of sitting long enough to drive a car, so they become virtual prisoners in their homes.

“I haven’t had sex since I was forty-two,” says Patty, now forty-nine. “I cannot wear underwear or pants or anything around my vulva. I wear long skirts with no underwear all year. I bought a special bike seat with a hole in the middle so when I ride nothing rubs against my vulva.” Patty used to express her sexuality through salsa dancing. Now that the pain has spread to her entire pelvic floor and hips, it hurts too much to merengue, so the dancing, her last vestige of sensuality after years of sexual pain, is out.

As you can see—and as you may well know—such pain soon becomes the focus of a woman’s life. No wonder a study published in 2007 found that 42 percent of women with dyspareunia felt they had no control over their lives and 60 percent felt they had no control over their bodies.


“After the first month, I began to experience slight pain upon sexual intercourse. After three months, sexual intercourse was completely impossible and still is today (two years later). I went to numerous physicians only to hear it was a yeast infection, a bruised pelvic bone, or “just in my head” because I was nervous. I went through much emotional distress, anxiety, and hopelessness. My family and I have spent over $2,500 on doctor bills and laboratory tests. I had everything done on me, including numerous pap smears, pelvic exams, two ultrasounds, an upper GI panel, kidney tests, and a barium enema. Until three months ago, when my doctor finally diagnosed me with vulvodynia, I was hopeless and felt I would never have sexual intercourse again (much less have children).”—SUSAN, THIRTY-TWO

Susan’s story is so familiar. The women we see have typically spent years searching for a diagnosis and treatment for their pain. Unfortunately, not only do few doctors know much about human sexuality, but even fewer know anything about sexual pain. For until about fifteen years ago, not only was painful sex not discussed, it wasn’t even researched. If a woman couldn’t have sex, didn’t enjoy sex, or had pain during sex, she was classified as “crazy,” sent to a therapist, or handed a bottle of pain pills.

We think this relates, in part, to the way women’s sexuality has traditionally been viewed in society—as something to be feared, denied, and destroyed. For instance, in the nineteenth century a woman who masturbated might have her clitoris irradiated, cauterized, or surgically removed. To quell female “hysteria” (i.e., desire for or enjoyment of sex), doctors applied leeches to a woman’s vulva and anus. A woman who complained of pain during intercourse (with her husband, of course) was labeled as “frigid.” If she could only learn to relax and stop tensing her vaginal muscles, she was told, she could satisfy her husband. Her own satisfaction was not a concern. And why should it be? Women were raised to view sex in terms of submission and degradation3; many probably believed that pain was just a natural by-product.

It wasn’t until the 1950s and the groundbreaking research conducted by Alfred Kinsey that we began to understand and explore the true nature of a woman’s sexuality and to view women as sexual beings in their own right. Kinsey published Sexual Behavior in the Human Female in 1953 to a firestorm of protest, controversy, admiration, disgust, and just plain prurient interest (if you’re interested, pick up a copy). The interviews he and his colleagues conducted with more than 5,500 women of all ages, races, and socioeconomic levels forever changed the way the world viewed women’s sexuality.

Unfortunately, it did very little to change the way doctors viewed it. And even though issues of sexual desire in women get more attention in the medical field these days, sexual pain remains misunderstood, underdiagnosed, and mistreated by all but a handful of doctors around the country.

And that’s unfortunate, for in the past decade—indeed, within just the past few years—we have made incredible inroads into understanding the medical as well as psychological origins of sexual pain. That, in turn, means we are so much better at diagnosing and treating the underlying causes of the terrible agony so many women experience with sex.

Excerpted from When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain by Andrew Goldstein MD, Caroline Pukall PhD, and Irwin Goldstein MD.


photo by mistress_f