I just read a moving and sad article in Self Magazine about lichen planus and vulvodynia. A young women talks about her vaginal pain and how it has shamed her and ruined her sex life. Vaginal intercourse became excruciatingly painful and none of her gynecologists could see any problem and so everyone thought it was in her head. Over the years she became more and more avoidant and the lack of sexual contact with her partners ruined a number of relationships.

I have so many thoughts.

1. I think it was very brave of this woman to describe her situation which has caused her so much shame, self doubt and pain. I think it’s an article worth reading if you are in her situation. (Even though I’d argue that perhaps more could have been done to help the pain.)

2. I can’t help but wonder how many more women have been told that their pain is “in their heads” because a physician wasn’t able to identify the problem.  I wish more mds would be comfortable saying, “I’m sorry. I just don’t know.” As a practitioner it just makes me so mad. If I had a nickel for every women we have seen who we have been able to help through  physical/medical/behavioral interventions who had spent years in therapy with little to show if it, I’d be rich! I think most women have a gut feeling whether the problem is physical or psychological. We should trust them. And more often than not, pain is PHYSICAL.

3. Our view of sex as having to revolve around penile/vaginal intercourse is perhaps the single most limiting and misleading element  of our current sex education. There are many kinds of sex. There’s oral sex, manual sex, anal sex. There is sex using every potential part of your body. If you can’t have sex one way…. there are so many other ways!! Why does someone who can’t have vaginal intercourse feel as though she should be embarrassed to discuss this? And why does she feel like her sex life is over??? I had a patient who had vaginismus (a condition in which you can’t get a penis into the vagina.) She was married for 3 years when I saw her. (And yes, we helped her!)  She had one of the best sex lives I’ve seen. She was having sex with her husband about 3 times a week, in various way. She had an orgasm (or more) most every time they had sex.  She was having fun. Now— do I think she’s probably having more fun now that they are having vaginal intercourse? Yes. Probably. (Although she’s quite clear that intercourse is not her favorite sexual activity.) More options is usually better. BUT do I think someone’s sex life should be over because they can’t have vaginal intercourse?! No way. And I think we’d do ourselves, our daughters and our partners  a big service if we put vaginal intercourse into perspective.  Would her husband be having a grand old time if he was having sex 2 times a week with a happy, excited, willing partner who was the queen of blow jobs (kind of how she describes herself) , who brought him to orgasm with her tongue, her lips, her breasts, her feet, her butt, her anus? Would her husband be having a grand old time if hew was having sex 2 times a week with a happy, excited, willing partner who was having orgasms using his hand, a vibrator, his mouth. My guess is yes. Would he miss vaginal intercourse? Probably. Is that a price he would pay to be with a woman he loves? Would it be that be so very different from a guy who is heartbroken because his wife won’t go down on him and he loves oral sex? Perhaps not so very different.

So here’s advice if you (or your friend or your partner) has pain with intercourse. 1- Get help. 2- It’s probably not in your head 3- Try to build a fun, happy sex life anyhow. You can do it.