Guest Post: On sexual pain, consent & treatment

08/09/2011 at 10:51 pm | Posted in Uncategorized | 10 Comments
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[Dear internet, we have a guest poster today! The following was written by someone who prefers to remain anonymous. A trigger warning applies, for questions of sexual consent and rape.]

I offered about two years ago to make a guest post on this blog, then tried to actually write it, and vanished into thin air because I was so uncomfortable with the issues it was dragging up. I was trying to write something hilarious, and political, and historically enlightened. But it turns out that the only important thing I need to share right now is what happened to me.

This is a post about feminism, sexual pain, and consent.

Here’s what’s wrong with me: I have a pelvic floor dysfunction. It’s originally a muscular problem: it means that somewhere along the line, I got the habit of carrying tension in my pelvic floor the way other people carry it in their shoulders. I get vaginal muscle spasms the way other people get neck cramps. They could get set off by any kind of anxiety, such as direct stimulation of an already-painful spasm, leading to a godawful feedback loop called “secondary vaginismus”—a conditioned psychological response of increased painful spasms, and aversion to sex, due to the association of vaginal penetration with intolerable pain. The happy ending is that my primary dysfunction was treated by physical therapy, which gave me strategies for combating the muscular issues; and the secondary aversion went away because the association was broken. The physical therapy process took about 3 months. I wasn’t able to find it for 9 years.

The horrible thing about getting to the correct therapy for vaginismus was that even reasonably well-educated doctors seem to routinely believe that the only way a woman gets a conditioned aversion to sex is rape, or a fundamentalist upbringing that teaches that sex is dirty. I have had fruitless arguments with puzzled GPs who, I believe, left the encounter convinced that I had somehow buried sexual abuse trauma somewhere in my brain—when in actuality, the genuine traumatic moments of my life had been occurring on their own gynecological exam tables. And all in the name of getting my poor, long-suffering boyfriend laid.

To say that this sort of thing breeds resentment is just a little bit of an understatement.

Here’s the thing of it. Since I had my first orgasm (clitoral, manual), I never really saw the big deal with getting my twat all stretched out into fighting shape. I liked sex, I was fully capable of climax, I could make my partner climax, and as the pain mounted, I was increasingly convinced that there was no logical need for vaginal intercourse specifically. The boyfriend didn’t share this analysis. At his urging, and my initial gameness to experiment, we tried, and failed, and tried, and failed.

Maybe it’s really bad for all girls, but they put up with it better than me. I’m a spoiled, privileged elite wimp. I need to grit and bear it before I can get the good stuff. “Our Bodies, Ourselves” taught me sex was supposed to be fun for me. Was that just rose-tinted glasses?

The more we tried, the less it worked, and the less I wanted to have sex at all. I went to the gynecologist. I grit my teeth around the speculum, was told I was “small” and needed to stretch, was handed a plastic dilator and sent home. I couldn’t look at it. I put it under the bed.

I am lazy. I am a coward. I am frigid. Did feminism make me frigid?

(Years later, on vaginismus support groups, I would encounter all these women who described their boyfriends as saints. Soooo patient, soooo understanding. Here’s the thing, ladies: he’s not the one suffering dysfunction and pain. That’s you. Him? He’s horny. It’s not a martyrdom. Last resort solution: he whacks off.)

I am denying sex to my boyfriend. Every day we are together is an archetypical punishment for him. If other people knew, they would think he was crazy to stay with me. I can’t tell anyone this is going on.

He stopped requesting that we try, but everything had already turned into guilt. Without really knowing why, I no longer wanted to have sex with him. He would ask, and because I felt like it was ungenerous not to, I would whack him off. I let him touch me only when I wanted it, because that’s what a good feminist does, and that was less and less often. I was frigid when he was home, and I masturbated when he went away. This went on gradually for about six years. It was some kind of screwed up, semi-coerced, semi-consentual sex; nobody made me do what I didn’t want to, but I didn’t want to. The logic goes something like this:

1) Who would ever date someone who can’t have intercourse? Such a person isn’t a functional woman. Such a person isn’t a whole woman at all.
2) Therefore, this is my only option for a life partner. I have to make it work.
3) He wants consentual sex with me. So we will have (unwanted) consentual sex.

(All the while I’m angry as hell, on some level, and undermining the situation like mad.) I sought treatment again, and was referred twice to a psychiatrist for vaginismus, which was described as a mental condition caused by the aforementioned rape or ignorance. I threw the pamphlet away in disgust. St. Boyfriend became depressed, I was pretty sick of it too, and he broke up with me. In the desperation of feeling like I was defective—which I felt very deeply and very abstractly and clinically—I finally went to a psychologist, who confirmed that the problem was physical and not psychological, and referred me to a specialist in pelvic pain, who referred me to a physical therapy specialist in pelvic floor dysfunction. Three months later I was having intercourse.

Here’s the kicker, though. I went through the therapy process because I felt defective without the capacity for PIV intercourse—even though I thought, all the while (and I still think) that this is a nauseatingly offensive and wrongheaded idea, and that all those quiet thoughts I had between the lines of what happened were horrible and wrong and poisonous, untrue things. And I got desperate enough to fight my fear and pride and begin the therapy process because I believed that no matter how poisonous I knew they were, precious few men would be enlightened enough to date someone incapable of intercourse. I might even be right about that. But I don’t think I’m ever going to be quite reconciled to the fact that even though a streak of self-destructive pride kept me from seeking treatment in time to quench the lust of my own St. Boyfriend, I did finally seek it for the sake of the hypothetical St. Boyfriend of my future—not for my own sexual needs. Now every time I give consent, no matter how willing, it’s always going to be tainted by that history. And that strikes me as very unfortunate.

Guest post: The Sexual Subject

03/09/2011 at 4:46 pm | Posted in Uncategorized | 3 Comments
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[Dear internet, we have a guest poster today! The following was written by Elaine F. Bayless:

Elaine F. Bayless is an author and pastor who lives in Raleigh, NC. She is currently working on a memoir about her experience with pelvic floor dysfunction. After choosing to have surgery to correct her issues, she is happy to report that most of the dysfunction is resolved. She and her husband are expecting their first child in July of this year. For more information about Elaine’s published work and her writing process, visit her blog]

I am one of the lucky ones. I only saw three gynecologists who ignored my vaginismus. I only wasted 9 months of my marriage in therapy, convinced that my pain was psychological. My husband never forced me into sex, never punished me for my condition. It only took me six years of treatment to finally find resolution in the form of penetration concomitant with orgasm – MY orgasm.

In November 2010, Discover magazine’s column, Vital Signs, discussed an intern who missed the symptom of painful intercourse. When the doctor asked him about this symptom, he admitted that he thought all women found sex painful. This doctor was shocked to discover this attitude in an “educated” person. I’m not shocked.

Women just don’t enjoy sex that much. That’s the pervasive belief in our society. And women who do enjoy sex are often penalized. We aren’t supposed to enjoy it, after all. We are supposed to be enjoyed. We are objects, not subjects. I still remember vividly an encounter in my recent past, when I had multiple orgasms and my husband had none. I was apologetic! But he had no regrets. He simply smiled and said he was glad I enjoyed myself. He’s a true man, someone who understands that sex is a two-way activity, an encounter between two participants, not between a subject and object. How does this belief play into the diagnosis and treatment of dyspareunia? In every way. My own story serves to illustrate it.

I had my first Pap smear at age 18. I was a virgin, but irregular periods plagued me and so I wanted to go on the Pill. The exam was torture, but every year I went back. My gynecologist was unconcerned, blaming me for not relaxing. She never gave me any tips on how to relax, never suggested anything to try to make things less painful, even when I almost passed out from the pain. My gynecological history post college was sporadic. Still a virgin, I went on and off the Pill, only getting a couple of Pap smears. Each time it was excruciating. I didn’t use tampons – too painful. But I kept that a secret. My doctors assumed that I didn’t enjoy insertion because I wouldn’t relax – that it was my fault, not something beyond my control. After all, women don’t enjoy sex, why would they enjoy an exam?

Prior to my marriage, I went to a friend’s gynecologist, highly recommended. I shared with her my pain issues. I asked her specifically to determine whether there were any reason why sex would hurt (I was still a virgin). This was her chance – her opening to discuss dyspareunia with me, to talk about different causes for pain in the vagina. Surely my medical history, my fear of tampons, and my simple reaction to the exam should have clued her in. She told me to relax because there was nothing wrong with me.

Why did this doctor not even mention the possibility of actual physical conditions that could cause pain during intercourse? Why did she assume that after 11 years of pain during vaginal exams I would be able to relax? I guess she figured I would learn how to grin and bear it, like many women do.

Because of her bad advice, I went to see a therapist immediately after my honeymoon, convinced I was mentally screwed up. After all, physically I was fine, right? When my prescription for the Pill ran out, I went to see a new doctor, a nurse-practitioner who specialized in seeing rape victims. I knew she would be sympathetic. She gave me a tranquilizer to take prior to the exam. It did nothing – my blood pressure was through the roof and I winced at the moment of first contact. And that wonderful woman sat back and told me I needed to see a physical therapist.

The discovery that there actually was something physically wrong with me – that I was incapable of relaxing – that was a turning point in my entire life. I had never heard of vaginismus, vulvar vestibulitis, dysparaunia, etc. I didn’t know that walking around with a constant Kegel was abnormal. (To this day I still catch myself in “locked and loaded” position). Finally I was able to clear the self-blame and self-doubt that was tormenting me and my marriage. I had a physical problem!

I still listen to women who have bought into the lie that we don’t enjoy sex. They say that their vaginas are too small. They say that they don’t enjoy orgasm. They continue to engage in sex that is unfulfilling. I was teaching a group of high schoolers about sex and counseled them to stop having intercourse if it hurt. They all looked at me blankly and then asked why. I was horrified.

We are not sexual objects. We are sexual subjects. I am currently pregnant with my first child, a little girl. A girl conceived during pretty fantastic, orgasmic sex. (Sure, it took 6 years, 3 physical therapists, and surgery, but it was WORTH it). And one of the most important things I hope to teach her is that sex feels good. And if it doesn’t feel good, she will have to be her own advocate and work tirelessly to find the cause and the solution. I hope that the world will have changed somewhat by then – that the medical establishment will have a better understanding of sex as something that is designed to be enjoyable. For anyone.

Vulvar pain in women of color

02/01/2011 at 1:59 pm | Posted in Uncategorized | 2 Comments
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This was cross-posted to Womanist Musings.

For the purposes of this post today, I will be focusing on vulvodynia; however keep in mind that there are other causes of chronic pelvic and sexual pain; likewise there are serious sexual problems besides pain which also deserve attention.

Vulvodynia is a syndrome, a collection of symptoms, centered around chronic vulvar pain, lasting longer than 3 to 6 months. Pain (commonly described as burning, stinging, stabbing, rawness and/or irritation,) may occur in the vulvar vestibule, mons, urethral opening, labia, clitoris, or elsewhere in the vulvar area. Not all instances of vulvar pain are vulvodynia, and for some women vulvar pain may resolve on its own.

Vulvodynia does not have one universal cause; some possible causes include injury, sensitivity to vulvar microorganisms (like yeast,) hormonal changes, muscular problems, etc., though for some folks the cause will remain unknown. For some women, vulvar pain is caused by pudendal neuralgia or pudendal nerve entrapment. Everyone is different, so some women experience pain all the time without provocation while others experience pain only when attempting to insert something vaginally. Likewise, for some women, it is still possible to enjoy sexual activity even with vulvodynia, while for others sex will become too painful to engage in. There are a number of treatments available for vulvodynia, but no single cure, so women with vulvar pain may have to burn through multiple doctors and treatments before finding the right one.

Who develops vulvar pain? I have seen several sources which present similar estimates as to how many women experience vulvar pain at some point during their life – at least, in the United States. According to one 1991 study, about 15% of 210 patients attending a gynecology clinic met the criteria for a diagnosis of vulvar vestibulitis. According to a 2002 release from the National Institutes of Health, about 16% of over 3,000 survey respondents reported chronic vulvar pain. (More on this figure in a bit.) The raw numbers seem to vary more; this same NIH release estimates that up to 14 million US women will experience vulvodynia at some point during their lives, whereas media coverage such as the Dr. Oz show estimate that there’s about 6 million US women currently living with vulvodynia. One thing all these studies agree on is that chronic vulvar pain, while not experienced by a majority of women, certainly isn’t rare either.

However, for a long time, I thought that women of color developed vulvar pain like vulvodynia less frequently than white women. I believed this, because I saw such statements in books, I saw it in studies, I saw it in the media and I went along with it. I realize now that I was completely and totally wrong. Vulvar and sexual pain does NOT just effect white women and in fact the rates of pelvic pain in white and nonwhite women is similar. But how many people still don’t know about vulvar pain in women of color? How many doctors and gynecologists are, like I was, under the impression that their nonwhite patients rarely experience nameable vulvar pain conditions which have treatment options available?

Here’s why I was wrong and why you too should care about women of color and chronic pelvic pain:

One of the first resources I picked up when I started looking for treatments was Dr. Howard Glazer’s The Vulvodynia Survival Guide, which is all about vulvodynia. Here’s what Glazer’s book said about vulvar pain and women of color…

“For unknown reasons, African-American women as a group are the least likely to report vulvar dysesthesia, or any other type of vulvodynia” (Glazer, 19). And “Again, Caucasian women have vestibultis [a specific, localized type of vulvar pain -K] more than any other racial group (Marinoff and Turner, 1992).” (Glazer, 23).

It goes on. In the late 1990s, early 2000s, Glazer organized a survey of women with vulvodynia though his website,, and in his book he reported that 90% of the survey respondents were Caucasian; “Less than 1 percent were of African origin” (33.) Additionally, it’s worth noting here that according to this same survey, participants’ “Socioeconomic status was higher than average; 62% reported incomes greater than $50,000” (33,) and the majority also held “professional, managerial occupations,” and “59% had completed college” (33.) Glazer cautions, “The higher levels of socioeconomic, education, and occupation status is consistent with previous studies. Why? Unfortunately, it’s probably because educated women with access to money for medical care are the most likely to pursue the best, most sophisticated medical treatments (or at least to use the Internet” (33.)

But who is also the most likely group to be in the higher socioeconomic class and have a high level of education, and be in a better financial position to use technology and seek medical care? White people, in the US. Because of this, the design of Glazer’s study itself most likely skewed the results to exclude women of color. However, he went on to state,

Caucasian women reported more vulvar pain than any other ethnic group. African-American wome rarely report these conditions. Researchers aren’t sure why this is true, though it has been commonly observed by many of our colleagues in the International Society for the Study of Vulvovaginal Disease, who practice and teach in various medical settings where women of various races and incomes are seen. Other dark-skinned ethnic groups, such as Indians, do report chronic vulvar pain syndromes (33).

Hmmm, Glazer sure spent a lot of time driving home his point that black women don’t report vulvar pain frequently and that white women do.

But wait, there’s more. The results of an oft-cited but highly controversial, hotly contested study of sexual dysfunction in the US, Sexual Dysfunction in the United States, also stated that black and hispanic women were less likely to report dyspareunia,

The association between race and ethnicity and sexual problems is more variable. Black women tend to have higher rates of low sexual desire and experience less pleasure compared with white women, who are more likely to have sexual pain than black women. Hispanic women, in contrast, consistently report lower rates of sexual problems. (Laumann et al, online).

Additionally, media coverage of vulvar pain frequently reinforces the idea that it’s mostly white women who experience vulvar pain. Stock photos and illustrations that accompany books and articles about vulvar and sexual pain overwhelmingly feature white women. (See for examples, here, here and here – I could easily go on!) The erasure of women of color with pelvic pain and dyspareunia happens on television too, with a few exceptions; for example in 2008 the television show Oprah explicitly reached out to women of color in an e-mail requesting participants willing to talk about vulvar pain. Alas, to this day, although filming has been completed, that episode has not aired on tv. Another exception took place in 2010 on the Dr. Oz program, which ran a segment on vulvodynia. The original 8-minute segment included a guest woman of color who briefly commented on life with the pain condition (unfortunately the second half of this segment has been excised from the online video.)

However, the prevalence of vulvar pain among women of color may have been understated. The study which the NIH release above references is, A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? The abstract contains this critical line: “Contrary to earlier clinical assessments, white and African American women reported similar lifetime prevalences. However, Hispanic women were 80% more likely to experience chronic vulvar pain than were white and African American women” (Harlow and Stewart). Harlow & Stewart’s survey is no fluke; the WebMD article Vulvar Pain isn’t so Rare refers to a University of Michigan study published in the 2004 Journal of Lower Genital Tract Disease, “Although previous reports show the condition is rare among black women, the responses indicated that this is not the case. Black women had similar rates of vulvar pain as women of other races.” (Reed, online).

And as for Dr. Glazer’s claim that women of African descent rarely report pain outside of US settings? Even that has been challenged! In 2005, a study in the Journal of Reproductive Medicine revealed that 22.8% of women attending a general medical clinic in Ghana reported vulvar pain, which was linked to sexual dissatisfaction.

I am certain that effect of emphasizing white women’s reported rates of vulvar pain over that of women of color is silencing to this day. So what’s being done to address this revision in what caregivers should know about vulvodynia?  The NVA’s fact sheet on vulvodynia now reflects that nonwhite women are just as likely as white women to develop vulvodynia. The language explicitly shows a change of perspective, from vulvodynia being thought of as primarily a Caucasian women’s issue to much broader. An NVA newsletter, Faces of Vulvodynia, included identifiable women of color like Karen, Yamalis, Amanda, Michele and Emily, who are willing to be interviewed by the media.

Unfortunately vulvodynia remains difficult to diagnose and it doesn’t help that some doctors remain ignorant of its very existence. Even doctors who do know about vulvar pain conditions may not be up do date with all the research. And doctors who are well-trained to address chronic pelvic and genital pain may be too far out of reach for many patients, both in terms of money and geographical distance. Genital and sexual pain received some media attention in 2010 but it still remains very much a taboo subject, and it is the butt of crude jokes surprisingly often. Society, guided by the long tendrils of patriarchy, pushes women to learn how to please men sexually, and so there is also pressure to perform sexual activity – even if it hurts. It shouldn’t have to be that way. And the quality of sex education is highly variable – I recall my own sex education lacked any mention of pain other than what happens when the hymen is broken.

If you or someone you love is experiencing chronic vulvar and/or sexual pain, some resources available online include the NVA in the US or the ISSVD internationally. A short list of some available treatments is available from the Mayo Clinic’s site.

Guest post – Update from a guest poster

01/27/2011 at 11:11 pm | Posted in Uncategorized | 3 Comments
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[Dear internet, we have a guest poster today! Rhiannon was the first guest poster we ever had here on Feminists with Female Sexual Dysfunction. It’s been a little over a year since her first post with us, and she has volunteered to share a follow-up of what’s been happening with her vulvar pain since then. The following account comes with a trigger warning though, for invasive medical procedures and brief mention of self-harm.]

The wisdom – or not – of pursuing medical options

A lot has happened since my last post. I spent most of the year celibate, trying to embrace that as a queer identify, and not really getting there; in September, I began a triad relationship with a man and a woman who were a couple. It has all fallen apart now, but my relationship with the man folded first, and a big part of that was that we couldn’t have sex.

When I told my GP this, she asked whether I was in treatment for the vulvodynia. I said I wasn’t, and explained how grim the treatment options had seemed before. She suggested that I could get a second opinion.

“Can’t hurt,” I said. I was wrong.

Now, going to the gynaecologist to have your vulvodynia examined is always going to be at least a little painful, because the chief symptom is pain and they have to cause a little in order to see where it is. The classic way of doing this is the cotton-bud test – a controlled and relatively gentle touch to the painful area to confirm its location. I know because I’ve had it done several times in the past.

Apparently this consultant hadn’t heard of it.

I had my history taken by a relatively nice registrar, and I thought that if she examined me it would be okay. Once she’d taken my history, though, she said she had to fetch the consultant because she’d never seen this before – fair enough, nobody can know everything – and I should get ready and wait on the bed. A nurse came in and talked me through the need to take my knickers off and pull my skirt up (and cover the tops of my thighs with that silly little piece of paper they always use… what purpose is that supposed to serve?).

The consultant appeared. He was a big black man who didn’t speak directly to me, just found his gloves and went to have a peer and a poke. I am aware that my prejudices could be showing here; I think that I would have found the behaviour rude in a white doctor or a female doctor, or indeed a shorter doctor, but I might not have been as frightened by it.

My Bartholin’s glands are visibly inflamed, and most doctors see that. I don’t think he noticed them, although I had mentioned that specifically when my history was taken by the registrar; he certainly didn’t try and avoid touching them. I have been examined many times, and it’s never comfortable, but this was very painful. It was as painful as penetrative sex is, in fact.

I gasped and cried out, I nearly screamed, and it must have been obvious because the nurse felt the need to hold my hand.

Afterwards, I was shaking and in tears. I was left alone to get dressed again – I managed to calm down by one of my milder self-harming methods. After what seemed like a long wait, the consultant and registrar returned with what appears to be a hurried print-out of some basic information (I suspect I know which website they used).

“I’ve never seen anything like this before,” the consultant told me. “I’m going to have to ask around and see who I can refer you to.” They said that; the referral letter hasn’t arrived a month later, and if the new consultant will be anything like this one I shall have to think twice about going.

They left me alone with the nurse, who checked I was okay and had one last piece of final ironic advice: “Don’t go looking at the internet and scaring yourself.”

I was too shaken to tell her that the internet is the only place I’ve found comfort in facing vulvodynia.

Guest Post: Interview with Elizabeth on Asexuality

11/01/2010 at 10:17 pm | Posted in Uncategorized | 2 Comments
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[Dear internet, we have a guest poster today! This is a follow-up post that picks up where Guest Post: Interview with K on Female Sexual Dysfunction over at Shades of Gray left off. Our guest poster, Elizabeth, had some questions for me about FSD and HSDD in particular, which I addressed over on her blog. And I had some questions about HSDD and asexuality which I was hoping she would be able to clarify.

To refresh your memory: In summer of June 2010, hearings were scheduled to determine whether the antidepressant-turned-potential-libido booster, flibanserin, should receive FDA approval. The possibility of this drug of questionable value going to market in the near future was met with resistance, especially from certain feminist organizations and activists. There were also some concerns about flibanserin and the type of sexual dysfunction it was supposed to address (Hypoactive Sexual Desire Disorer) from within the asexual community. Elizabeth and I first made contact when we bumped into each other on a thread about the drug over at Ily’s blog; there was some delay between then and the posts you see before you now.

I suggest that if you would like to participate in the discussion here, please check your privilege so as not to step on anyone’s toes. Don’t forget about the intersectionality; it’s possible that we’ve got some folks with sexual problems & dysfunctions lurking in the wings here who put the “Questioning” or “asexual” in LGBTIQQAA. Flibanserin will no longer be pursued by Boehringer Ingelheim so we don’t need to debate it today. As Elizabeth said in the preface to my interview, let’s focus on making each other more aware, understanding & accepting of asexuality and sexual dysfunction.]

My name is Elizabeth, though many in the asexual community know me by my online moniker, the Gray Lady. I am a twenty-something cisgendered female blogger. I am both asexual and a feminist, and I blog about both subjects and how they interrelate. I identify myself as panromantic asexual, and am currently in a committed polyamorous relationship with a trans woman. Although the original subject of my blog is about being in the gray area between sexuality and asexuality and my own questioning where I fit on that spectrum, I now simply identify myself as being a sex-positive asexual. I take an intersectional approach to feminism, and always strive to identify where I have privilege and confront it, though of course from time to time I will fail to see it, as anyone does. I think it should be noted here that not all asexuals are feminists or any of the other things that I listed, and certainly not every asexual agrees with me. I represent only myself, though I try to do my part to help the community. In my leisure time, I can often be found reading, learning foreign languages, or playing Pokemon.

I understand that there is a lot to think about in a definition of asexuality. What are some important points you would like to see people understand about asexuality?

Most importantly, I want people to try to understand the word as we actually use it before trying to enter into a conversation with us. Too often, people make the mistake of inferring a meaning from the word’s component morphemes–that is, they think it simply means “not sexual”–which is very vague and could have a whole range of meanings, depending on how each person defines “sexual.” Some people have such a broad definition of sexuality that from their perspective, it encompasses the entirety of human existence. So at first glance, to some people it seems to be impossible. Others may think that we are referring to celibacy (lack of sexual behavior), an inability to have normal sexual function, or even think we’re saying that we don’t have genitals.

Generally speaking, however, we’re ONLY addressing sexual attraction. What that means is that, while we may be attracted to people in other ways (we might think they’re pretty, or like their personality), and while we are certainly capable of love, that (by itself) just doesn’t translate into a desire to have sex. If we do get “crushes,” they’re not sexualized; for me, if I like someone, the things I want to do with them are things like having deep intellectual discussions, cuddling, sometimes making out (though at other times I find myself grossed out by the thought of doing so), and literally sleeping in the same bed. Or sometimes, when my attraction to a person is purely aesthetic, just looking for a while. For this reason, some of us will use the word “squish” to describe a non-sexualized crush, so that hopefully there will be fewer misunderstandings.

That’s not to say that none of us ever want to have sex for other reasons, but the attraction itself just isn’t it. I never look at people and think anything like, “Wow, that person is so hot, I would so do her/him!” It doesn’t typically occur to me to think about sex on my own without some sort of external reminder, except as some sort of intellectual puzzle. I’ve found that I can have desire for sex, even enthusiastic desire for sex, without experiencing attraction, however. I never really feel this desire as I’m going about my day-to-day life; it only really arises when I’m in a situation where I’m comfortable with my partner and okay with the idea of having sex, and she begins to physically arouse me. That doesn’t mean that when I’m not in that situation I never think, “Oh, that might be nice,” but that kind of thought is usually pretty detached and apathetic, not so much a true desire. My partner and I will still often go months without realizing how long it’s been since we last had sex, even though she is sexual. I think one thing that helps me be comfortable with her is that she is not really sexually attracted to me either, because she mostly prefers guys for sex.

So asexuality doesn’t necessarily mean that we dislike sex, although there are certainly some asexuals who do. There’s tons of variety in the asexual community. There are some asexuals who would prefer to be celibate for life themselves, but are totally fine with sex otherwise. There are other asexuals who are disgusted by even the idea of sex, and don’t want to talk about it or see it in movies, books, etc. Just as there are many different sentiments within the asexual community about sex itself, there are also many different preferences on romance and intimacy. I’ve had people assume that just because I’m asexual, that means that I don’t experience love, or don’t experience romantic love. That’s confusing what we in the asexual community call romantic/affectional orientation (which, just like sexual orientation, describe what gender(s) a person tends to attach romantically to; e.g. hetero-romantic, homo-romantic, etc. And on that note, just to clear this up, it’s not a contradiction to identify as, for example, an asexual lesbian, because lesbianism can refer to either sexual or affectional orientation.) with sexual orientation at best, or assuming a lack of basic human emotions at worst. I think it should be the default assumption that asexuals of ALL stripes, even aromantic asexuals, experience love, even if it is platonic or non-romantic love. There is a wide variety of ways to form close connections with others; some rely on a close group of friends, some get intimacy through their communities, some have intimate relationships that aren’t categorized as strictly friendship or as romantic. What does “romantic” actually mean, anyway? There is no clear definition, and some of us struggle with deciding whether we are romantic or aromantic because of that, or don’t believe there is a distinction at all.

There’s so much variety that really, it’s reasonably safe to say that the only thing that unites us is a lack of sexual attraction significant enough for us to embrace this label. Of course, there are some gray areas as well which I’ve devoted much of my blog to, but that’s a little outside the scope of this.

Is there a difference between asexuality and HSDD, and if so, what is it? What about sexual dysfunction more broadly defined?

Well, as I mentioned earlier, asexuality has to do with sexual attraction, and HSDD has to do with sexual desire or sexual interest. These are not the same thing; it’s very possible to have either one without the other. For example, I’m not sexually attracted to anyone, but with an understanding partner and a different approach to sex, I’ve found it enjoyable and desirable, even though I don’t really have an intense level of interest in it. I’ve found that I tend to fall into a pattern of responsive desire as mentioned above, wherein I don’t really think about sex too often or get “in the mood” for sex without having had any kind of physical stimulation, but being in a safe space with a partner I’m willing to have sex with does allow me to enthusiastically consent, and generally speaking I find that I have no trouble on the physical side.

Of course, I used to have a lot of pain with PIV intercourse, to the extent that my first sexual partner condescendingly explained to me that I have a sexual disability, but that situation was coercive at best, and the real problem there was that I wasn’t able to become aroused enough in a situation that I wasn’t entirely comfortable with, with a person who didn’t seem to really care how I was doing and never bothered asking my permission before touching me. He essentially was writing off any responsibility he had for the way I felt (both physically and emotionally) by claiming that I was just “defective.” Initially, even in a situation where I am completely comfortable with having sex, I do sometimes have pain with intercourse for a variety of reasons, but it’s not very much pain, and it’s mostly due to not being used to the size, not enough lubrication, perhaps a bad angle, something like that. As far as I understand, this kind of pain is relatively common and normal for a person who has intercourse as infrequently as I do. I don’t have any pain with outercourse or any other form of sex. It’s not something that typically inhibits my ability to even have PIV intercourse on the same occasion that I have that sort of pain; most of the time, it is temporary. I’m not distressed about it at all. So I don’t define this as a disability or dysfunction of any sort, though if I did, it wouldn’t be HSDD.

One other thing I wanted to mention is that there was a study that recently came out recently called “Physiological and Subjective Sexual Arousal in Self-Identified Asexual Women” (by Brotto and Yule)” which I want to quote from here. This is just from the abstract, so you don’t have to actually read the full article to see where the quote came from:

“Asexuals showed significantly less positive affect, sensuality-sexual attraction, and self-reported autonomic arousal to the erotic film compared to the other groups; however, there were no group differences in negative affect or anxiety. Genital-subjective sexual arousal concordance was significantly positive for the asexual women and non-significant for the other three groups, suggesting higher levels of interoceptive awareness among asexuals. Taken together, the findings suggest normal subjective and physiological sexual arousal capacity in asexual women and challenge the view that asexuality should be characterized as a sexual dysfunction.”

So at least we do have some scientific evidence that asexuality is not a sexual dysfunction of arousal, in addition to much anecdotal evidence that asexuals are perfectly capable of normal sexual function. However, I also want to note that asexuality and sexual dysfunction can and do sometimes overlap. I know of at least one asexual woman who also has vaginismus, although I have not been in contact with her for a long time now. I’d love to hear from anyone in this overlap who would be comfortable talking about this, because I’m curious how these issues intersect, and how people within that intersection deal with attitudes from both sides.

What are some of the key concerns about HSDD in the asexual community and what (if any) are some ways these concerns might be addressed?

The main concern is that it might be used to delegitimize asexuality–which, quite frankly, a lot of times it is, however erroneously. There’s still a widespread view that asexuality is not a sexual orientation, but instead a disorder, a disability, a dysfunction, or the result of sexual trauma. The DSM-IV specifies that in order for it to qualify as a disorder, it must “result in significant distress for the individual,” however I’m not sure that is specific enough. What kind of distress? There are a lot of people who feel distress about being asexual because they have been taught to feel that it isn’t normal, it’s a defect, and that it’s a huge burden to their romantic partners, who will eventually leave them because of it, or that they’ll never find any romantic partners at all, and that not having a romantic partner and not having sex means they will never lead a fulfilling life. Basically, if asexuality is a sexual orientation, then it is not chosen and we cannot expect asexuals to be happy with it all the time, so simply saying there must be distress as a qualifier, while somewhat of a step in the right direction, doesn’t really work in my view and to be honest, it seems like it was just tacked on without much thought. If we assume that only people who are distressed about their lack of interest in sex have HSDD, and that asexuals don’t qualify because they lack that distress, isn’t the assumption that asexuals are all happy about being asexual? I’ve seen many threads where asexuals (with much embarrassment to admit it) discuss their distress due to being asexual, and I think this mindset only disempowers those people by encouraging them to hide how they feel. Plus, in that study that I quoted from earlier, anyone who felt distress about their lack of sexual interest or level of attraction would have been disqualified from the study, so this leads to issues with gathering representative samples as well. Of course, no one who volunteered did feel that sort of distress, and most likely no one who did would volunteer for anything like that, because of the pressure to present asexuals to the rest of the world as being happy and distress-free, so as not to make it easier for other people to dismiss us all as just disordered.

Now, technically asexuality is not about a lack of desire or a lack of sexual fantasies at all, and in fact it’s possible to be asexual and have either some form of sexual desire* or sexual fantasies, or both. But that distinction is very fine, and not often understood. In practice the two are often confused, and this may lead to a situation where an asexual person who has not yet realized they are asexual will be pressured into seeking treatment for HSDD, further internalizing the message that there is something wrong with them. Asexuality is not yet well known enough that we can expect people to realize that it’s a possibility, in this kind of situation. Sometimes it takes many years before people will come to understand themselves as asexual. I think it would help to have asexuality specified explicitly as something that should be considered. That would go a long way towards helping asexuality gain visibility as well.

* Since it’s been pointed out to me that this term isn’t all that clear itself, I’ll clarify that when I use it I’m not just talking about libido or “sex drive”–which I interpret as a physical urge for release–but also non-physically based desire as well. In other words, I tend to use it more in the sense of having any kind of interest in having sex, aside from altruistic partner-pleasing or coercive situations. Not an interest in the social consequences of having sex, but a desire to have sex itself, even when unaccompanied by a physical urge.

So that’s the practical concern. The other big concerns I’ve seen being raised are primarily ideological. I’ve seen asexuals and feminists alike raise these kinds of concerns. What is “normal,” and who gets to define it? In the case of HSDD, the task of defining such a disorder is essentially the same as authoritatively declaring what level of sexual interest–and by “sexual desire” they do seem to also mean “sexual interest,” as the DSM-V’s proposed revisions make clear (it may be renamed to Sexual Interest/Aversion Disorder)–constitutes a normal level of interest, what constitutes a disordered level of interest. This of course has a significant impact on laypersons’ ideas as well, because it is coming from people who presumably know what they are talking about (although I’ve seen some spectacularly bad… uh, “science” used by those in charge of rewriting the gender and sexuality disorders to justify their claims, so that assumption is not always a good one). If not being interested in sex continues to be considered a huge problem (disorder/defect) by and large by society as a whole, unqualified, then how can we reasonably expect stigmatization of asexuality to decrease? Without any explicit expression that asexuality, while uncommon, is still just a normal human variance, asexuals will still get lumped in with people with HSDD and the current cultural ideology (that all humans are sexual and so a lack of interest in sex is unnatural) will remain the same. Likewise, I think we also should be concerned about potentially having the wrong focus in cases where incompatibilities with one’s partner, relationship problems, or abusive situations may be the cause of the disinterest. Sometimes a lack of interest in or aversion to sex is actually very healthy and adaptive, and this needs to be taken into consideration as well.

Andrew Hinderliter of Asexual Explorations, our go-to guy for information about the DSM, posted an article on the Sociological Imagination which addresses this, and helped me to articulate some of my own views on the subject. As he points out, HSDD describes a symptom rather than a syndrome, and encompasses a wide variety of people in many different life contexts. As context is essentially the determiner for whether or not a low or non-existent level of sexual interest/desire is a disorder rather than a natural human variance or positive adaptation to a coercive situation, I have wondered at times whether this is particularly useful as a diagnosis by itself, or whether it might not be better as a symptom of other diagnoses. However, I also realized that the cause of such a problem may either not be obvious at first, or as with asexuality, just plain unknown. Thus, I think it can serve a purpose as a stand-alone diagnosis, but lots of careful thought needs to go into crafting it.

I’m well aware that careful attention needs to be paid to how this diagnosis works as a barrier for women with FSD from getting the help they need, or how any diagnosis might. If it is a symptom of another problem, that might not be immediately obvious, and so for those people, this diagnosis might be useful to get things started, and can change as more information surfaces. That’s a big if. But I also think that this can be a useful diagnosis in and of itself. Asexuals tend not to realize that you can have sexual attraction or interest in having sex without feeling desire for it. Because it’s a realm outside of our own experiences, we don’t necessarily tend to think about the possibility of this kind of disparity that deeply inhibits a person’s self-expression, this emotional pain that actually does come from an internal source. Although I wouldn’t compare these two experiences, I imagine it might be like a cisgendered person trying to understand what it’s like to feel a mismatch between one’s internal gender and one’s physical, wrongly-sexed body. That mismatch doesn’t exist for us, so we don’t tend to think about the possibility that it might exist for others, or the deep distress that it might cause. That distress alone should be sufficient to qualify for calling it a disorder or disability. I don’t think it’s right to minimalize the way it affects a person’s life by calling it a sexual “problem” instead, though at the same time I do think we ought to be careful not to make “distress or no distress” the sole distinction between people who have HSDD and people who don’t. I think that’s reducing it to an on/off, yes/no type distinction, when it’s really more complicated than that.

Another big concern I’ve seen raised, particularly among feminists and certainly by New View, is whether what is expected of women sexually speaking is centered around a male-centric norm. The argument, as I understand it, is that female sexual desire is very context-dependent, and that “sexual desire” may for many women mean having a sort of desire that is triggered more by physical arousal (in a safe and consensual context) rather than initial interest or attraction. From my own personal experiences, I know that this can be true, but other than knowing that responsive desire is perfectly possible without experiencing sexual attraction, I don’t know what to think about it. Does the HSDD diagnosis itself indeed put women in a position where they are expected to respond the same way as men, or is that more of a cultural assumption? Will the proposed split between male and female SIAD correct that? I don’t know those answers, but more pointedly, is that even the reason why women seek treatment for HSDD? That’s a pretty big assumption, I think. It’s certainly possible that some women do seek treatment for it because they apply a model of desire that’s more appropriate for men, but does that mean that all women who seek (or would seek) treatment for HSDD are doing this? I doubt it. What about women who don’t even have responsive desire? And why assume that no women who might seek treatment are aware of this tendency to view women’s sexuality through a male lens? I do think this cultural tendency ought to be addressed, but I don’t think it’s grounds to dismiss the entire diagnosis.

Switching gears… I want to return to something I mentioned briefly above: the issue of relationship incompatibilities. I feel this needs just a little bit more explanation before I move on to the next part of the question. I’ve noticed that the vast majority of the time, within a relationship where one partner has a much higher level of desire for sex than the other, the partner with the low level of interest gets all the blame for the problems that arise out of that. Rather than viewing this as just another incompatibility with both partners working towards a solution, often it is assumed that only the person with low desire must change, because there must be something wrong with them. A person who is told this over and over again might internalize this and begin to believe it themselves, and in this case might begin to feel distress over this aspect of themselves and want to seek treatment for it. I think many asexuals know this sense of believing oneself to be broken just because it’s what they’ve been told over and over and over again, because it is how they felt before understanding asexuality. I myself have been told many, many times that I must have a sexual disorder or disability, and while I never believed that, to some extent in the past I have considered asexuality to be a shortcoming in sexual scenarios because of it. I would say that this very emotional, touchy subject is what drives many asexuals to discount the possibility that HSDD/SIAD might be a legitimate disorder, and I think we saw that come out in the comments to K’s interview on my blog. But we do need to keep our emotional reactions under control, and realize that we have the privilege of not dealing with this internal pressure that inhibits our self expression.

So, with all that said, how might our concerns about the HSDD/SIAD diagnosis be dealt with, aside from all of us trying to take a level-headed view that acknowledges our own privilege? I’m not sure on how the diagnosis should be worded. I do think we need something that distinguishes between different kinds of distress, not so much as something that delineates specific definitions (being too specific would be exclusionary), but something that at least directs therapists and medical professionals to try to locate the origins of it. It seems to me like no matter how it’s worded, a short list of diagnostic criteria is still going to fail to acknowledge the complexity of all the different things that might be going on, and so I think perhaps having educational materials on asexuality available to be presented at the time of consultation might be a good option. (This of course with the acknowledgment that it might not apply, but is just being presented as a way to empower people with the knowledge that it exists, and ability to decide for themselves. I think it should be handled very carefully so as not to be coercive.) I don’t foresee that happening in the near future though, just because it’s such a tremendous task to get such materials distributed to every therapist’s office, not to mention getting them to understand and accept asexuality. If not that, then at least I think that all therapists and medical professionals should be made aware of both asexuality and the instances where low sexual interest or desire would be adaptive, and of the concerns of women who have FSD. They should be educated on the importance of balancing those concerns, and not assuming that the whole diagnosis is bunk just because it might be somewhat too vague in its description. I don’t foresee this happening soon, but we’re taking baby steps towards that goal, and it’s something that I’m hopeful for in the future.


10/17/2010 at 1:30 pm | Posted in Uncategorized | 13 Comments
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[Dear internet, we have a guest poster today! This is a post by pro-BDSM activist Clarisse Thorn, who blogs at Pro-Sex Outreach, Open-Minded Feminism.]

I’ve been working on a long article about my experiences with sexual dysfunction. It’s a project that’s been in the making for quite a while, but now that I don’t have so many distractions I’m ramping it up.

This is a complicated and difficult subject for me. I have a satisfying sex life now — I’ve gotten pretty good at communicating with partners, setting boundaries, seeking what I want, and masturbating to orgasm. It took me a long, long time to get here, though, and I had to get through a ton of confused feelings. Not just about coming into my S&M identity, though that was certainly a factor, but also dealing with feelings around the orgasmic dysfunction itself — for example, feelings about how my apparent inability to have orgasms meant that I was broken. (I had and still have some vaginal pain, too. Not every time, not even most times, and nothing overwhelming — but enough that I’ve developed coping mechanisms.)

In order to write this article, I’ve been going through a lot of years-old journal entries. One quotation particularly struck me:

[My boyfriend] comforted me the other night when I broke down and cried. I wept and wept and he said it was okay, you’re not broken, there’s nothing wrong with you. It’s okay, he said, not to want sex. But I do want sex, I’m just sickened and terrified and disgusted by it, and I don’t want to be anymore. I want to be able to watch sex scenes and not be enraged and disgusted, to read sensitive ones and not collapse in tears.

I wasn’t entirely sickened and terrified and disgusted by sex, of course: I often liked it. Loved it, really. Sex usually felt good even before I could have orgasms, even before I’d found S&M, even before I’d parsed out my feelings and learned more about sexual media such as porn. And I’ve talked a lot about how awesome and sex-positive my sex education was.

But I knew I was missing something, something crucial and integral to my sexuality. And I hated the way society seemed to always be informing me how to sexually act: I felt crushed into approaches that obviously weren’t working, weren’t meant for someone like me. It was hard to walk the line between craving sex and being unable to stand it.

Here’s another excerpt from my journal, around the same time:

I really hate reading explicit sex scenes. I didn’t used to hate it as much as I do now, and since I broke down in tears during the last one, I guess it’s pretty obvious why. Jealousy and hurt and hatred of the ideals I feel like they’re trying to forge into me, [one ideal being] that love and sex and particularly orgasm are all irrevocably intertwined, and that by missing out on orgasm I’m missing out on not only an aspect of sex but of love.

But mostly I guess the discomfort does come from not wanting to read the intimate details of another’s sex life … and the jealousy for the orgasm, still there, too deep to banish. Christ, it’s fucking ridiculous. I shouldn’t be this miserable about this. It’s so fucking unimportant in the grand scheme of things. — but the tears that startled me in my eyes as I typed tell me just how unimportant it really is to me, I guess.

I started reading some sort of book on having orgasms and wept all through the first chapter because it was so miserably true. And because it was so miserably true I feel as though I ought to read the rest of the book, just give it a chance and go with it, and maybe make it that way, but it hurt so much and I’m so scared that it won’t work, and then I’ll be really unhappy. (A reaction the book even outlined, by the way. Yes, it’s about as true as it gets — the only thing I’ve ever found seems to understand how I really feel about this.)

The book that struck me so much is the monumental For Yourself, by Lonnie Barbach. It’s a famous book. I searched it out at the San Francisco library recently, and spent an afternoon sitting around the Mission branch, trying to locate the passages that once touched me so much. A few quotations:

Do you sometimes feel that you would be happier if sex were eliminated from your intimate relationships altogether? If so, possibly you feel abnormal in this regard, or like a misfit or not whole as a woman. Or, perhaps you just feel that you are missing something everyone else has enjoyed, a part of life that you’d like to have be a part of yours, too. You probably feel as if you are one of only a few women who have this problem. But the truth is that you are far from alone. (page xiii)

A real fear that can keep some women from doing anything to solve their sexual problems is the fear of failure. When Harriet joined the group, she didn’t believe she could become orgasmic. She said, “If I tried, I’d only fail, and then I’d be really miserable.” … Harriet eventually did defy her fears, as did all the other women mentioned. It takes time and effort to counteract these fears. It means saying “I’m afraid” and yet pushing beyond. (page 14)

Is it because you’re embarrassed to ask for what you want at a particular time; afraid your partner will refuse, get angry, or feel emasculated? (page 15)

Empathetic and accurate so far. (As it happens, the only lover I ever directly asked for help during this orgasm-discovery process refused and got angry, which just goes to show that being afraid he might react that way was not all in my head.) Merely confronting so much understanding was hard to face.

But, although I read it a long time ago, I think I’ve figured out what it was that made me unable to read further: the way Chapter 1 ends is a bit much. The last page of For Yourself‘s first chapter contains this:

You have to assume responsibility and be somewhat assertive. Our culture has taught us that a woman should depend on a man to take care of her, which means she can blame him for any mistakes. It’s nice to be driven around in a car, but it’s also nice to be able to drive yourself so you can go where you want to, when you want to. But to do that, you’d have to assume some responsibility.

Well, okay. Except that how do you assume responsibility for something if you have no idea where to even begin? If you know something’s missing but you’re not sure what it is? If you’re sure your partner will be frustrated and resentful when you ask for help?

This is especially complicated by the fact that along with the typical advice of “Take responsibility!”, the other typical advice is “Let go of control!” Over at Lady Sex Q&A, Heather Corinna writes:

Orgasm involves us surrendering to what we’re feeling, and really rolling with it, even if and when it feels very emotionally precarious. It’s control we’re letting go of, really, and that’s harder for some folks than others.

I’ve been an off-and-on sex & gender geek throughout my life, so I already knew these things intellectually. I’d already absorbed these ideas: that I must both take responsibility for my sexuality, and lose control in order to enjoy it. I think even then I knew that both of these ideas are actually good advice. But the problem is that they’re often put in patronizing and less-than-helpful ways. For example, “It’s nice to be driven around in a car, but it’s also nice to be able to drive yourself so you can go where you want to, when you want to. But to do that, you’d have to assume some responsibility.” Condescending as hell! To me, those words implied that I was making myself into a helpless child. Pulling a wounded-bird act and forcing other people to take care of me. I couldn’t stand the idea that I was doing that!

I am frustrated by the insensitive guilt trips that often happen, even (especially?) in feminist and sex-positive circles, where people will sometimes act as if these things are simple, as if it is oh-so-easy to stand up and take on one’s own sexuality and Just Deal With It. Especially when you’re in a situation where you know for a fact that some men you have sex with will resent you if you’re honest about not having orgasms, and yet you don’t know how to have orgasms and aren’t sure how to start on the journey. What then?

Some women end up faking in those contexts (I didn’t very often, back in the day, but once or twice I did). Of course, some feminists and sex-positive writers are especially unhappy about this:

I’m sure I’ll offend some choice feminist who thinks that it’s unfair to criticize women who make the totally autonomous choice to flatter a man with a fake orgasm instead of working towards a real one, but I’m taking a stand on this one. It’s un-feminist to fake, ladies!

I don’t advocate faking orgasms, and I actually also don’t advocate dating a man who gets angry and resentful when a female partner asks him to pitch in. (Oh my God, sometimes I have nightmares that I’m back in that relationship, and it’s been years.) At the same time, the idea that screaming “It’s un-feminist to fake!” will fix the problem is ridiculous. It’s the kind of idea that will just make feminists (like, say, myself many years ago) feel even worse about trying to figure out our relationships while not having orgasms. I see, so now not only am I failing to be responsible, I’m also un-feminist? Awesome.

This is not easy. It’s actually really hard. I get that people have to want to work on their sexuality, in order to do it — obviously I get that. But telling people that they’re being weak or self-centered or un-feminist because they aren’t sure how to do it? Or are actively pressured out of it?

Not okay.

Guest post – On the FSD hierarchy and why it hurts all of us

10/05/2010 at 6:12 pm | Posted in Uncategorized | 9 Comments
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[Dear internet, we have a guest poster today! The following was written by brigid, who wrote me a moving e-mail a few days ago.]

Hi, my name is brigid and I asked K a few days ago if I could do a guest post for feminists with fsd. This is the first time that I have really spoke openly about my pain, ever. I mean it’s not like no one knows that there is something wrong. If the chants of frigid brigid that I dealt with since middle school are any indication a certain ex of mine was blatantly honest with the entirety of the boys locker room that there was something wrong.

So, what exactly is it that is “wrong” with me? My fsd is caused by a condition called endometriosis. Endometriosis is a condition which results in the tissue that lines the inside of one’s uterus to grow on the outside of the uterus, and the surrounding tissues. This can cause the tissues to become inflamed which can result in pain in the surrounding tissues, leading down into the vagina. I also have a condition called allen-master syndrome. This means that my uterus is hypermobile and will tilt at strange angles which creates problems for my cervix, further resulting in pain. So I am basically in pain all the time. It feels like someone is continually stabbing a hot poker into my uterus via my vagina.

Any and all kinds of sexual activity, even those that most people would say are not inherently sexual, result in increase of pain. Any kind of signal firing to my vulva and vagina causes the pain to increase. That means that things like kissing, cuddling, outercourse etc are all off limits to me. Each and every time I try any of those things I end up in agony which doesn’t go away for days and sometimes weeks on end. And don’t even think about masturbation and intercourse. I can’t even touch my vulva most days.

That brings me to the point of my post. A lot of support groups, both on and off the web do not want to recognize women with conditions such as endo as legitimate cases of fsd. We don’t have vulvodynia, vulvular vestibulitis, or vaginismus so we couldn’t possibly go through the same things as women with those conditions. I’m here to change that misconception. The term that K uses for this kind of thinking is the fsd hierarchy. I like that terminology. Because that’s basically what it is when other women with fsd say that their level of pain and suffering is more significant. No one person’s pain is more significant than any others. The levels of pain may be different. The things that one may be able to accomplish with treatment based on the individual and the condition at hand may be different, but we all have something in common. A problem which we can’t talk about. A problem which society tries to pretend doesn’t exist. A problem which for some of us consumes are lives and makes them hard to live. This is something we all have in common. Sexual activity is painful for us. That is something that should bring us together. Turn us into a united front. One which says that we will be treated with respect. One which demands research into ways to better manage our problems. One which supports each woman and encourages her to educate herself about these problems. One which encourages our partners to educate themselves about this. One which will allow all those affected to get an accurate diagnosis and a doctor who knows what they are doing instead of dismissing the pain as “something some women deal with”. I don’t think that that is too much to ask for. We should be striving to break down these barriers. We are all suffering from our problems with our sex lives. Some have it worse than others. Some choose to still have intercourse even though it is painful for them (I admit that I fall into the I have intercourse for more reasons than just it feels good camp) Some choose to be completely celibate, but regardless on your individual decisions, you still suffer from fsd. Our society tries to silence us. By playing the hierarchal game we are allowing them to get away with it. The only way that we as a whole are going to make things better for ourselves is if we talk about it, and encourage others to talk about it as well. By silencing other women who suffer from FSD just because it doesn’t fall under one individual’s narrow view of what fsd is and how it works, we are hurting every woman who needs help. We as a community need to share and embrace our differences. This will allow us to learn more about others and as a direct result about ourselves. So I encourage you today to reach out to another woman with a different type of fsd and talk to her. Share in a mutal discussion about the challenges of your conditions. I think you will be surprised to see how much overlap there really is between us all.

Guest blogging: Reaching out to the asexual community

10/02/2010 at 4:09 pm | Posted in Uncategorized | Leave a comment
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I guest blogged for Elizabeth @ Shades of Gray, an asexual blog. Here is a link to the post: Guest Post: Interview with K on Female Sexual Dysfunction. Elizabeth is trying to maintain a relatively safe space there for commenters including people with sexual dysfunctions; so far the comments have gotten fairly long.

The post went up just a few days ago, but it’s actually been brewing for months, literally, so there was a big time delay between when we first got in contact and when it went up. We both had life stuff going on. If you go there, you may want to check out the introduction to the post for more background. Elizabeth and I communicated first during the middle of the great Flibanserin debacle of 2k10. You are probably by now already aware of the resistance Flibanserin has received from multiple angles, like some sex therapists, feminists and activists. There are also concerns about the drug and the validity of the diagnosis hypoactive sexual desire disorder (HSDD) from within the asexual community.

During this back-and-forth across blogs re: Flibanserin, Elizabeth asked if I would be willing to answer some questions about FSD and flibanserin. I agreed, with the same caveat I’ve repeated before: I’m not a doctor in any way shape or form. So I can’t answer any questions with the same level of authority. (It didn’t come up there, but I also don’t feel comfortable giving out advice.)

But anyway, I tried. Asexuality and sexual dysfunction aren’t the same things. Neither side can ignore the other, especially since it’s possible to have overlap.

Here’s a snippet of what’s going on over there:

Some basics:
What is Female Sexual Dysfunction? What kinds of FSD are there?

Female sexual dysfunction is a broad term encompassing several types of sexual problems with a common denominator of personal distress. A good overview of sexual dysfunction can be found at When discussing FSD in general terms it is important to remember there it is not limited to one specific manifestation. In addition to sexual medicine, there’s a lot to talk about with regard to female sexual dysfunction.

There are a few different ways of looking at FSD. The two ways I’m most familiar with looking at FSD are through the medical model and the social construction model.

I also had questions about female sexual dysfunction for Elizabeth to address from an asexual perspective. I eagerly await a response.

Guest Post – On dealing with doctors

07/26/2010 at 6:02 pm | Posted in Uncategorized | 10 Comments
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Dear internet, we have a guest poster today! The following was written by Simone, who blogs over at Notes for a Feminist Rebellion.

Hello everyone!

I’m a twenty-something aspiring mathematician, who roams the internet under the name of Simone Lovelace. I am Jewish, bicurious, and whiter than the day is long. I’m in a long-distance relationship with a wonderful man, and I have female sexual dysfunction.

I’ve had dyspareunia (pain with vaginal penetration) since I first became sexually active. Over the years, I’ve tried a number of do-it-yourself treatments. I’ve gone through gallons of lube, tried increasingly bizarre positions, and switched to all-cotton panties. Nothing worked. Finally, this spring, I decided to see a doctor.

Since then, I’ve visited several medical professional in two U.S. states. I still don’t have a diagnosis, and the treatments I’ve tried have been useless. Right now, I’m not too concerned about this. Dealing with FSD is a process. If it takes me a while to find the right treatment, then c’est la vie.

One of the things that has surprised me most in my FSD journey is the range of attitudes I’ve experienced from my doctors. These have run the gamut from compassionate and respectful to judgmental and mildly sadistic.

Finding a supportive doctor can be a crucial step in managing FSD. On the one hand, dealing with a judgmental doctor can be incredibly painful. On the other, a compassionate doctor can be invaluable—particularly for someone with a condition as complex and personal as FSD.

Doctor Evil

When I first sought help for my FSD, I was finishing college in southern California, and the on-campus clinic was my only real option. I called up Student Health Services, and got an appointment with a woman I’ll call Dr. H.. Unfortunately, as it turned out, working with Dr. H. was more traumatic than helpful.

Dr. H. was judgmental about my sexual choices, and inconsiderate of my feelings. During my first appointment, I told her about my symptoms, and gave her an outline of my sexual history. Since I was menstruating, Dr. H. couldn’t give me a physical exam that day, but that didn’t stop her from speculating about possible diagnoses. There are a number of conditions that cause dyspareunia, most of which are quite treatable. Some are sexually transmitted diseases, but many are not. Dr. H., however, mentioned only two possibilities.

“Well,” she said, “That could be herpes, or HPV. I’ll have to run some tests.”

I was shaken. It was as though I’d come in with a headache, and been told, “Well, it could be cancer.” An untreatable STD was my personal worst case scenario. I wasn’t worried for myself, so much as terrified that I might have given my boyfriend an incurable infection. We’d always played it safe, but my protection had failed me before. Despite using condoms with every partner, I had gotten a case of chlamydia in the past year.

It’s possible that Dr. H. was simply ignorant of the many conditions that cause dyspareunia, all except HPV and herpes. However, it seems implausible that a doctor would be unaware, for example, that insufficient lubrication causes sexual pain. To me, it’s far more likely that her bizarre behavior was the result of bias.

In retrospect, I’m pretty sure Dr. H. disapproved of my sexual choices. Most likely, she saw me as irresponsible and promiscuous—a “slut.” In American culture, we have an unfortunate tendency to view STD’s as punishment for deviant sexual behavior. Perhaps it was Dr. H.’s whorephobia that lead her to focus on the possibility of that I might have an STD, and ignore other options. And perhaps it was the same prejudice that prompted her to be so cavalier about what, for me, could have been a devastating diagnosis of herpes or HPV.

When I was about to leave, Dr. H. asked me about my positive chlamydia test. I told her that I wasn’t sure how it had happened, but that I’d taken antibiotics, which had cured the infection. Dr. H. responded with a few words of wisdom.

“Given your history,” she said, “the most important thing is that you minimize your number of sexual partners, and practice safe sex.”

Now, safe sex is a good thing. And I don’t think it’s unreasonable to advise someone whose STD status is uncertain to be abstinent. But judging from Dr. H.’s phrasing, she seemed to think I was barebacking with a new man every night. I had already told her that I was in a monogamous relationship, and that I always used protection. Being accused of promiscuity didn’t phase me; what bothered me was being accused of infidelity, and called a liar to boot.

As her comments indicate, Dr. H. used my “history” as an excuse for making wild assumptions about my lifestyle and my physical health. This sort behavior is both immoral and dangerous. A doctor who is busy passing judgement on her patients’ personal lives is in no position to provide quality medical care.

In addition to being judgmental, Dr. H. was indifferent to my pain. She never showed sympathy, even when I was in obvious distress. During our second appointment, she gave me a pelvic exam. Naturally, I found this very painful, and I whimpered a little. At this, Dr. H. asked if the pain was similar to what I felt during sex. When I told her it was, her response was simply “Oh.”

After the exam, Dr. H. told me that everything was normal, and I was free to go. When I asked if there was anything more she could do, Dr. H. responded that painful intercourse was just an issue “some girls have.” She then suggested that my problem could be psychological, and that I might need anti-anxiety medication.

Dr. H.’s claim that dyspareunia was simply a problem “some girls have” was both ignorant and hurtful. It was irresponsible to suggest that I give up hope, just because the exam had turned up nothing. At the very least, she could have told me there was nothing she could do, and referred me to a local gynecologist.

When she dismissed dyspareunia as something “some girls have,” Dr. H. was implicitly refusing to treat the pain itself. There are numerous techniques for managing vulvar pain, from acupuncture to topical anesthetics. But Dr. H. wasn’t interested in treating my symptoms. Vaginal pain, in and of itself, didn’t strike her a something that warranted her attention.

Finally, Dr. H.’s comment about my pain being psychological was absurd. While FSD may have a psychological component, it is rarely a purely psychological problem. Dr. H. had no reason to assume that my pain was of psychological origin, or to recommend psychotropic drugs.

That appointment was the last I saw of Dr. H.. My STD tests, incidentally, came back negative.

I’d like to say that my experience with Dr. H. was a fluke, but I’ve heard similar stories from other women with FSD. It seems that many of us face the sort of problems I encountered with Dr. H.. American culture has highly repressive views about women’s sexuality, so perhaps it’s not surprising that women with FSD have a hard time obtaining medical care. Many doctors are simply uninformed about FSD; others are actively dismissive of women’s sexual issues. Too often, women with FSD must contend with doctors who judge us for our sexual choices; dismiss our problems as unimportant; or tell us that it’s all in our heads.

If at First You Don’t Succeed…

After graduation, I went home to Boston for the summer. There, I paid a visit to my usual healthcare provider, a physician assistant whom I’ll call Carol. In terms of treating my FSD, Carol was not very helpful. For starters, she didn’t give me a diagnosis. By this point, I had done a fair amount of research, and become convinced that I had vulvodynia, a vulvar pain disorder of unknown cause. In particular, my symptoms correspond to a subtype of vulvodynia called vestibulitis. While Carol did mention vulvodynia as a possibility, she made it clear that she knew little about the condition.

Although she wasn’t sure exactly what was wrong, Carol did prescribe some treatments. She gave me a set of vaginal dilators, which I’ve been using daily for the past few weeks, and an anesthetic cream to make dilation less painful. So far, these have proven essentially worthless. The cream burned badly on contact, and any subsequent numbing effect wore off too quickly to be useful. I soon decided I was better off dilating with it. Moreover, I’m skeptical of the dilation treatment itself. I don’t have muscle spasm or vaginal tightness, so why would I need to dilate?

I’m not too bothered by Carol’s inability to instantaneously cure my FSD. Carol is a P.A., not a specialist in vulvar pain disorders, and I didn’t expect her to give me a miracle cure. What I want to stress about Carol is that she was incredibly kind and respectful. During my visit, she was actively supportive in several key ways.

She was careful not to jump to conclusions. Carol took a detailed history, asked numerous questions, and gave me a physical exam. Only then did she begin suggesting possible diagnoses and presenting treatment options. This sort of diligence can be invaluable in any non-emergency medical situation. It’s particularly crucial in treating a complex, multi-factorial condition like FSD.

She took what I said seriously. Carol was never dismissive of my concerns, and she did not treat me with suspicion. Our conversation felt like an exchange, not like an interrogation.

Carol trusted me, even when I said things that didn’t fit the stereotypes about women with FSD. When she asked if I had any negative attitudes toward sex, I responded that I didn’t think that was an issue. I was comfortable with my sexuality, had no moral qualms about intercourse, and enjoyed non-penetrative sex. Carol took my answer at face value and moved on. I cannot overstate how much I appreciated that simple act of respect.

She was open and non-judgmental about sex. Strangely enough, there are still doctors who still blush at the word “vagina.” Carol, on other hand, seemed perfectly comfortable discussing my sexual anatomy.

In addition, Carol avoided expressing any judgement–positive or negative–about my sexual behavior. She showed no disapproval when I recounted my sexual history, and she did not praise me for using condoms. Her focus was always on easing my pain, not on policing my behavior.

Discussing ones sex life with a medical professional can feel embarrassing or demeaning. Due to Carol’s respectful attitude, I was comfortable engaging her in a frank, detailed discussion of my FSD.

She acknowledged that my FSD was a real issue. To Dr. H., my pain only mattered if it pointed to an underlying disease. Carol, however, understood that my pain was a problem in and of itself. She was warmly sympathetic when I told her my story, and proactive about trying to find me a good treatment. I’m not too optimistic about the treatments Carol prescribed for me. Nonetheless, her willingness to recommend treatment options sent a powerful message that she cared about my pain, and was invested in helping me heal.

In a perfect world, all medical professionals would be as genuine, thoughtful, and compassionate as Carol was to me. Sadly, many fail to do so. Sometimes, women with FSD may need to accept disrespectful behavior from doctors, just to get the medical care we need. But I think it’s important to hold our doctors to a high standard whenever possible. It’s important to remember that when we seek medical care, we deserve kindness and respect.

With that, I’d like to open up the discussion to you. Have you seen a doctor for your FSD? Was it a positive experience? Why or why not? What words of advice, encouragement, or warning would you give to women seeking treatment for FSD?

Guest post – Heteronormativity and FSD

04/05/2010 at 7:04 am | Posted in Uncategorized | 6 Comments
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[Dear internet, we have a guest poster today! The following was written by Flora, who provides her own introduction:]

Hi, I’m Flora. I am honored to be a guest blogger here, coming at the issue from a background of having multiple disabilities, which has ultimately resulted in my viewing my FSD as being like any other disability. My views are strongly informed by the social model of disability, rather than by a medical-model approach. (Please remember that the social model of disability doesn’t mean that no one needs medical help, or that many disabilities don’t cause genuine impairment– it’s just that society regards some problems as “normal” and makes allowances for them, prioritizes medical treatment for them, and those problems are therefore less disabling. In any case, what the medical model of disability means, in the language of the disability rights movement, is viewing a disabled patient as a collection of defects and malfunctioning body parts, not as a whole person. Being in contact with this attitude was not good at all for my mental state. I avoided seeking treatment for a long time because the medical tendency to reduce full human lives to collections of symptoms and dysfunctions was so terrifying and dehumanizing.)

I should also mention that an effect of another one of my disabilities is hypergraphia, so fair warning: expect long posts from me. I’ll try my best to not throw in too many extraneous words just for the sake of writing, though.

And, oh yeah… sometimes, I’m angry. Hopefully, everyone reading this should be familiar with the “argument from tone” fallacy. I have a big block of PTSD-related issues to plow through in trying to empower myself and get effective treatment, and I’ve been frustrated by the medical profession and the mental health profession, especially the latter, when trying to talk about this stuff. I’m chipping away at it, very slowly, but long story short, I have a right to be angry about social and medical attitudes towards FSD, female sexuality, disability, and emotional distress, and I can’t always turn my frustration into something you could say at a tea party. It’s not about you, unless you’re a person who actively uses your privilege to perpetuate those attitudes.

I’m not going to go into a lot of detail about when and how I first discovered I had FSD, for now. (I have vulvar vestibulitis and interstitial cystitis, which  developed at the same time and which I thought were one condition for years; they seem to tie in with a few other things I experience, which seem to all relate in one way or another to oversensitized nerves sending pain and injury signals when there is no injury. I probably have vaginismus too, although I think that’s inevitable when nearly every single experience of any type of penetration has been painful.) I was 17 and it was a traumatic time in my life for other reasons, and the bare facts of what happened symptom-wise, stripped away from everything else that was going on emotionally at the time, probably sound a lot like many other women’s.

Basically, things that were “supposed” to feel good or at least neutral were painful, and I was feeling every time I urinated like I had a low-grade UTI that never fully went away. My gynecologist couldn’t find any infection, and my family wouldn’t talk about it with me. I found a description in a book (this was over ten years ago) of vestibulitis, and thought “hey, that sounds like what I’m experiencing,” but I couldn’t find any resources specifically about it. I was afraid to look for them out of fear that I’d end up being told it was all my fault and that there was no hope for me. So I spent years avoiding any kind of relationships, and pretending, whenever I could, that it didn’t exist, although, of course, that didn’t make it go away.

But that’s as much of my personal history as I’m willing to talk about for now, other than to say that pain should always be taken seriously and not blown off. What I wanted to talk about was the role of heteronormativity in the diagnosis and treatment of FSD– whose pain is considered valid and why. Like a lot of people in the world, I’m not heterosexual. I guess the best label to describe my attractions would be “pansexual,” but all of my most emotionally intense relationships have been with women. This apparently changes some people’s attitudes towards whether I need or deserve treatment for my pain. It shouldn’t, but it does. So my first post here is about heteronormativity in FSD treatment.

So… heteronormativity is hard to define, but it encompasses a lot of things. Some of the things I can think of that it includes are: assuming that everyone is heterosexual by default until proven otherwise, that heterosexuality is the most normal and natural means of human sexual and relational expression and superior to non-heterosexual expressions, that sex means heterosexual sex and specifically intercourse, and that heterosexual relationships and sex are more loving, meaningful, purposeful, fulfilling, and gratifying than non-heterosexual relationships and sex. And structuring all sexual and relationship advice around this assumption, all medical guidelines, all erotic material, all sexual toys and devices, all views of the path your relationships, sexuality, and life should take.

It also, in my opinion, includes some other assumptions that leave even certain types of heterosexual relationships out in the cold: the assumption, for instance, that everyone is monogamous and that monogamy is natural/superior for everyone, and that all couples are cisgendered and that being cisgendered is superior and the only natural means of expression.

Anyway, that definition out of the way…

The vast majority of the medical profession is very heteronormative. If you are a woman, you are assumed to have a relationship with a man. If you don’t have one, you are assumed to want one. If you have one, you are assumed to be having intercourse, or to want to have intercourse eventually (waiting till you’re married etc). If you say you are sexually active, you are assumed to be having intercourse. And that even if you do other things besides intercourse, you still see intercourse as the “highlight,” as the only real important sex act.

As an example, here’s a questionnaire. There’s a large section on sexual pain. Great– that’s something that’s bothering most of us, right? There are a grand total of thirty questions you can only answer if you’ve had intercourse in the past six months. Very detailed questions about the onset, type, location, etc, of pain. Of the questions you get to answer if you haven’t had intercourse, a high number of them are things like “When did you last have intercourse? How often was your partner’s penis able to enter your vagina? How long have you been able to tolerate thrusting? How often did you experience pain due to intercourse? Are you now or have you ever been a member of the Communist party?” (Sorry. I… use humor to make this stuff more bearable for me, a lot.) And why all the questions about “penile penetration” and “your partner’s erection”? What if your partner doesn’t HAVE a penis to begin with? Then you don’t deserve as much help, apparently– even if you want penetration of some type.

Is anyone seeing the problem with this yet? A woman in a heterosexual relationship in which she’s at least attempted intercourse is automatically going to appear to have “more symptoms” by the test’s measure of it than a woman who has just the same number of symptoms and the same amount of pain, or more, but isn’t in a heterosexual relationship in which she’s attempted intercourse. And will therefore be regarded as more in need of treatment, as automatically deserving of a higher priority, than a woman in a same-sex or asexual relationship, or one who has never had a relationship or attempted intercourse before, regardless of  sexual orientation.

It would have been just as easy to replace many of the references to intercourse with references to vaginal penetration of any kind, not necessarily by penis– heck, the first things I experienced my symptoms with were fingers and tampons. The one time I was ever in a relationship with a man involving any kind of regular sexual activity, I knew intercourse was already out of the question, because finger penetration was already much too painful for me most of the time.There’s also a kind of covert heterosexism lurking in the idea that somehow, a woman can’t already have an awareness of her own FSD symptoms and know exactly what parts hurt the most before being “enlightened” to it by penile penetration making her go OW. It might also tie into the sexist/heteronormative idea that women are unaware of their own sexuality or lack sexuality until they’re the target of a man’s sexual attention, but in any case, it’s bogus. I did not need a man sticking his dick in me to be aware of the location and severity of my own pain, and I resent the idea that heterosexuality adds extra “credibility” to my pain that I don’t get otherwise, because I can’t check off any of the many tickyboxes about intercourse on a list of symptoms (and thus appear to be showing “more symptoms.” You want to see “more symptoms?” Do a pelvic exam and watch me yelp in pain, no penises required.)

Then again, the way symptom surveys will automatically prioritize you more if you’re heterosexual may stem directly from the unspoken assumption among many doctors and therapists that the only reasons women ever seek out treatment for vulvodynia are so they can have intercourse, or have babies. During my one semi-long-term heterosexual relationship, I tried to explain to a (male) therapist that I was experiencing pain every time my partner or I tried to put anything in my vagina, even something small. He asked me if I was having intercourse with my male partner, and I said no. His response (paraphrased) was, basically, “Well, why is it a problem, then?”

And this seems to be way too typical, from what I’ve seen and heard elsewhere. That a woman who isn’t in a heterosexual relationship, or any relationship at all, or isn’t planning on having children in the near future, somehow has “no reason” to want to not experience excruciating pain every time she puts something in her vagina, or even rubs the skin around it too much. How about, she might want to use penetrative toys in a relationship with another woman, or during masturbation? How about, she might want to be able to use tampons? How about, she might want to not have to worry, or at least worry less, about wearing certain kinds of clothing, or sitting in the wrong position, or what type of fabric her underwear is made of, or what kind of detergent it’s washed in? How about she might not want to be in pain any more?

You’d think the last one would be the most obvious of all. Would anyone’s attitude change if I flipped the question around when they asked me “why do you want treatment for this?” What would they say if I asked them, instead, “Why do you believe I want to be in pain?” Put the onus on them to answer, to account for why they believe I should be all right with pain as my default– not on me for why I should want to at least feel less of it!

Then again, for all I know, the assumption that I should be expected to put up with the pain might be an extension of sexist/heteronormative ideas, too. Naughty woman, getting into a relationship with another woman? Wanting to put things into your vagina for your own pleasure, not a man’s? Well, you deserve the pain, then! The only thing that should ever go into a vagina is a penis, attached to a man, in a committed monogamous relationship! It belongs to men, not to you! And the only time women should ever have sex with other women is where men can get off to it! It’s no wonder your vagina broke, since you weren’t using it properly, didn’t you read the instruction manual?

(Obviously, I’m being facetious, but it’s actually not too far off from what I was told by my mother– her reaction was basically “Why are you putting things in there in the first place? You put things in there, that’s why it hurts! It’ll stop hurting if you leave it alone and don’t touch it!” She had some issues, yes.)

The amount of misogyny that still runs rampant in the fields of gynecology, obstetrics, and urology, though– sometimes obvious, sometimes subtle– is very disturbing. I probably don’t need to give specific examples. If you’re reading this, chances are you probably have either personally experienced it or known someone who has.

And chronic pain problems in patients of any gender (but more often with women, generally speaking) tend to be blown off and pooh-poohed by a lot of people who will try to convince you that you are just experiencing “normal little pains” that are within the reasonable range of what most people expect to have to put up with in the course of their life, and you, you’re just being a spoiled brat with an entitlement complex, thinking you’re entitled to a pain-free life in a way other people aren’t. Except that most people with pain issues of any kind, by the time they get around to actually having the nerve to ask a doctor about it, have already experienced a lot more pain than most people ever expect to have to put up with as any kind of routine thing, and have probably already been told repeatedly (most likely by people who don’t know much of anything at all about how pain works or how it’s measured) that their pain is normal or just caused by some kind of stress or overexertion, so they should just put up and shut up and stop whining.

I was recently trying to write something about how male promiscuity is perceived, versus female promiscuity, and realizing that it was difficult for me to say anything from my own experience. It’s something I have talked with other people about, with friends, about the idea that only monogamous relationships can be healthy ones, and about slut-shaming and fear of rape making it more difficult for women to have multiple partners or open relationships. The thing is, while I can understand all of this on an abstract level, and have wondered abstractly about whether I want to be monogamous or not, it’s not something I want to experiment with now– explaining to one partner “no, you really can’t touch me here, no matter how much you or your other partners liked it, it really hurts” is hard enough, let alone several partners. I’ve had a few opportunities to experiment with responsible casual sex, but I’ve never acted on them, because I didn’t want to negotiate the explanations, because I was ashamed, because I felt (at the time) that my body was inadequate, because it wouldn’t stop causing me pain. Why would someone settle for me when they could find someone who didn’t have FSD?

I don’t have the sex life I want. I haven’t ever been able to have anything close. And the thing is, the one I want isn’t some porn-movie ideal in which everyone always has explosive simultaneous orgasms from intercourse. It’s got a healthy acknowledgment of the fact that even between normally passionate couples, sex just doesn’t always work out. It can even deal with things like requiring lots of advance notice for penetration of any kind. And I’m afraid that the only way for me to get adequate treatment will be to lie about myself, about my relationships, about what I want, because I am afraid that doctors will not take me seriously when I say “I want treatment”– even if it’s just about wanting to experience less pain!— unless they believe that I have a relationship with a man, who has a penis (no relationships with trans men, everyone knows they’re not REAL men!), and that what I want out of the treatment is for him to be able to put his penis in my vagina so that I’ll feel like a Real Woman ™, the end. Oh, and maybe have babies someday too. That those are the only possible  “right” answers.

I’ve heard people say that if men got vulvodynia, it would be taken seriously, and this is probably true, but for both men and women, heterosexuality is still definitely privileged when it comes to who gets taken seriously about sexual dysfunction and who doesn’t, among doctors who even acknowledge it exists.

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