Guest Post: On sexual pain, consent & treatment

08/09/2011 at 10:51 pm | Posted in Uncategorized | 10 Comments
Tags: , , , , , , , , , , ,

[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.

Advertisements

Guest post: The Sexual Subject

03/09/2011 at 4:46 pm | Posted in Uncategorized | 3 Comments
Tags: , , , , , , , , , , , ,

[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 http://elainefbayless.blogspot.com]

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.

Notes on MTV’s True Life: I Can’t Have Sex

12/07/2010 at 9:42 pm | Posted in Uncategorized | 3 Comments
Tags: , , , , , , , , , , ,

Last night, December 6, 2010, at 10pm EST, MTV aired the season premiere of the television show, True Life. The episode was titled, “I Can’t Have Sex.” To produce this program, the show crew followed three women around over the course of several months and presented the impact of chronic pelvic pain conditions on their sex lives.

I watched the episode on television and I took notes. There’s a lot of things going on with and around this episode!

First, in case you missed it, MTV.com has the full episode available for viewing, now! This is what you’re looking for! I do not know if it will remain online indefinitely or if it will be removed in the future, but if you missed the episode here is a chance to catch up to it. It’s 42 minutes long. No subtitles available on the online version. Here is a brief summary with a link to the video. MTV has posted this follow up feature: True Life Check-ins. The follow-up article contains links to helpful resources.

Full disclosure: I sort of “Know” two of the women who were featured in this episode, because Tamra and Tali both maintain blogs. I do not know if Tess maintains a blog. Tamra’s blog is Living with Vulvar Vestibulitis. Tali’s blog is The Rambling’s of an IC Patient. I have not met anyone in person (that I know of) who was involved in filming this episode. But still, I feel a little weird posting about the episode at all, since I can apply a name, a face and a blog archive to two of the women who were on TV. It’s also weird because I have some of the conditions which were examined on the show.

Here is some of my notes taken during this episode, fleshed out a bit:

This is the first episode of MTV True Life that I have ever seen, so I went in not knowing what to expect. I rarely watch MTV and I tried to ignore the commercials that aired between segments. I was anxious about how the show would be edited and whether there would be any commentary provided by a third party. I’m still anxious about how the episode was received by a general audience. The sound to my TV was cutting out for a second at a time here & there so I was having a hard time hearing at some points.

The episode features three 20-something year old white women over the course of several months – Tess (self-diagnosed with vaginismus,) Tali (the episode focused on pelvic floor dysfunction but she has overlapping conditions which were not all given screen time,) and Tamra (diagnosed with vulvar vestibulitis and, later, orthopedic issues.) Chronic pelvic pain is an invisible condition. You would probably never guess from a first impression that these three women were dealing with chronic health problems unless they chose to disclose such information to you. Tamra, Tess and Tali are currently in, have previously been involved in, or are interested in heterosexual relationships. They are all unmarried and do not have children. We saw Tess and Tali’s boyfriends (at the time of filming) on this episode and MTV followed Tamra around on a date and to a social event. All three live in the USA. Except for the introduction to the episode, there was no narrator. That means that everything you heard, was spoken by the women or those close to them. Of course I’m sure MTV did some creative cutting and editing of the material collected. Filming wrapped up awhile ago, so there have been updates and changes in the womens’s lives in the interim between filming and the airdate.

Actual, proper terminology was used throughout the show. Chronic pelvic pain conditions were named, but some conditions that overlap were not mentioned at all (interstitial cystitis, for example, was not explored in this episode. This is a shame – interstitial cystitis is another misunderstood condition which would benefit from careful media coverage.) This episode focused on the impact of chronic pelvic pain on the women’s sex lives. And that means that while you could learn a little about life with chronic pelvic pain from this episode, for a clinical discussion and details on specific conditions and available treatments, you’ll need to look elsewhere.

We see some of the treatments that Tess, Tali and Tamra tried. A dilator kit on television, a TENS unit, a visit to a sex toy shop (Babeland) to pick out a comfortable lubricant. Psychological therapy, and pelvic floor and intra-vaginal physical therapy. (Several scenes where Tali received physical therapy with Isa Herrera looked familiar to me and Herrera talked about muscle tightness which was and remains a problem for me. It was just weird seeing someone else in the same position I had to spend so much time in.) Injections of anesthetic to the pelvic area and oral painkillers. Ice packs as needed. But I didn’t see anything about diet modification or alternative therapies like acupuncture.

Although sex and sexuality were the focus of this episode, MTV did show how chronic pain and anxiety can bleed out into other, non-sexual areas of life. Sometimes, like in Tamra’s case, pelvic and vulvovaginal pain is not limited to sexual activity. This was downplayed compared to the sexual aspects of pelvic pain, however. Because this is a blog about sexual dysfunction, I was okay with the sexual aspects of life with chronic pain for the episode – especially since I’ve been on this kick lately where I want to hear women talk about their own experiences with sexual problems. But keep in mind that if you do have chronic pelvic pain, there may be a lot of issues going on at the same time besides sexual problems. Or it may all be connected.

For example, there was one point in the episode where Tamra was speaking with a therapist. It was an emotional scene. But I thought that the therapist was misinterpreting Tamra’s concerns. Maybe it was just the way the editing was put together but during this scene, I thought that Tamra’s concerns included sex, yes… but they also went beyond relationships and sexual pleasure. However that that is what the therapist seemed more interested in. In this scene, I thought the therapist’s priorities did not match Tamra’s.

Tess was in a 5-month relationship with her boyfriend at the time filming began. She had not been able to have intercourse with him and was upfront with him. She picked out a dilator kit that came with an educational booklet and talked to a therapist to help address her anxiety.

Tali experienced the onset of her symptoms at age 17 and has seen 24 doctors. She was in a relationship with a young black man, Boom, at the time of filming (they have since broken up.) Remember, Tali’s blog is titled, “The Rambling’s of an IC patient” – yet this episode did not talk about IC at all.

Tamra was a student and the episode featured her giving a speech about vulvar vestibulitis in front of a whole bunch of people, as part of a women’s & gender studies class. Hmmm. Tamra had been in a sexually active relationship before developing what would be diagnosed as vulvar vestibulitis (her condition has since been re-examined.) She talked openly about how pain was making it hard for her to date and enter relationships – and pain made hard to enjoy other activities, like dance.

Viewers saw some of the relationship tension that Tali and Tess had, at least as far as their sexual problems went. If there were other problems in their relationships beyond sexual problems and anxiety, that was downplayed for this episode. Tess mentioned to her therapist though, that a previous boyfriend had said abusive comments to her. I thought it was interesting how Tess and her therapist involved Tess’s partner, Antonio, in her treatment for anxiety. Tali’s physical therapist also demonstrated some therapeutic techniques to Boom. (I wish I had had this opportunity to do the same with my partner; however we were in a LDR at the time of my physical therapy.)

Tess and Tali showe improvement with their favored treatments. For Tess and Tali the episode ended on an optimistic note. By the end of the episode, the two couples, Tess and her boyfriend, and Tali and Boom, were having sexual intercourse following the therapies they chose. But for Tamra, she was still dealing with a lot of pain in the end, and with a new diagnosis and the possibility of surgery. She had a labral hip tear and this may account for a lot of her pain. (She has been writing about this on her blog for some time now.)

Overall, I liked the episode. I thought it was good and I am shocked with the amount of time that these topics received. A whole hour-long television show, which works out to over 40 minutes?! Here I was scrabbling around for 2 to 7 minute clips! But there’s always room for improvement. This episode could have given much more airtime to Tali’s related conditions. Any airtime, really, for IC and lichens sclerosus. Just name them, even. In the future, a television program or other media outlet could do a whole episode or article about life with chronic pelvic pain and focus on areas besides sexual activity, because there is so much to life with pelvic pain. But there is that sexual aspect too… Was sexual pain sensationalized in this episode? Hmm… No, I don’t think so, I thought it was pretty frank. It was focused on sex, yes, but realistic to me. The editors certainly took the show in a certain direction. But it definitely wasn’t sensationalized like a recent segment on vulvodynia that aired on a local news channel. And pelvic and vulvovaginal pain was not treated like a huge joke (although Tess and her friends did laugh nervously when discussing vaginsimus.) There was no narrator for this episode and it did not feature an interview with say, a gynecologist, so no one was able to go into great detail about what causes pelvic pain and what treatments there are.
Future programs like this could also take steps to be less hetero-centric, and could actively reach out to more nonwhite women. (For example, years ago producers of the television show Oprah reached out to women of color for an episode about pelvic pain – an episode which has never aired.) And I’m surprised that the episode didn’t list some resources or URLs to information about chronic pelvic pain during the follow up with each of the interviewees. Resources such as the National Vulvodynia Association, The Interstitial Cystitis Association, and The Interstitial Cystitis Network.

So so far, in 2010, there have been a few depictions of vulvovaginal, sexual and pelvic pain, and each of these depictions have been different. There have been strengths and weaknesses with almost all of them. And I’d like to see more topics like this covered going into 2011 and beyond.

Compare and contrast

12/02/2010 at 9:16 pm | Posted in Uncategorized | Leave a comment
Tags: , , , , , , , , , , , , , , ,

My last post presented a review and critique of the feminist sexology text, A New View of Women’s Sexual Problems. It’s a different kind of review. The book was inspired by the efforts of the Working Group on the New View of Women’s Sexual Problems, a group of about a dozen North American women who came together to present an alternative view of sexual problems and dysfunctions, just in time for a  medical conference held about 10 years ago. A New View of Women’s Sexual Problems, the book, builds upon the original New View manifesto.

Today I’d like to present to you a different kind of feminist response to sexual dysfunction – a response from another woman who is intimately familiar with gender studies, feminism… and vaginismus.

As I noted in the New View book review post, I felt like some elements were missing from the essays – notably, it remains unclear to me whether any of the contributors to the original manifesto or the book actually know what it’s like to live with sexual dysfunction – to be torn between what you “Know” is the “right and proper” feminist response to sexual dysfunction vs. the daily grind of living with and responding to it, sometimes just managing. It’s possible that one or more of the contributors did have some kind of sexual dysfunction, and just didn’t disclose such status for whatever reason. But since I can’t know for sure, I still feel like I’m left on the outside of a circle of folks who are not me, yet who nonetheless decide my fate for me.

Alas, my time available for blogging is shrinking, and will continue to do so until some time in January! So instead of presenting another dissertation-length blog post, I’m just going show you an essay today and give some reasons as to why I liked it.

The essay is, A certain remoteness telling vaginismus, by Fulvia Dunham. I thoroughly enjoyed this essay. If you usually like what you see here on this blog, then I would strongly recommend that you read it. It’s one essay in the anthology Illness in the Academy, published by Purdue University (whom I would like to thank, along with Google Books, for making A certain remoteness in its entirety available to me as of today. I did have difficulty viewing it on my mobile device, however, and I am not certain if Google Books format can be picked up by all screen readers. Keep in mind, allocate your page previews carefully if you want to read the essay in full online.) According to Amazon, Illness in the Academy:

investigates the deep-seated, widespread belief among academics and medical professionals that lived experiences outside the workplace should not be sacrificed to the ideal of objectivity those academic and medical professions so highly value. The 47 selections in this collection illuminate how academics bring their intellectual and creative tools, skills, and perspectives to bear on experiences of illness. The selections cross genres as well as bridge disciplines and cultures.

Other essays in the book talk about life with chronic illnesses, conditions, and disabilities – to mention a few, some contributors have or are close to someone with diabetes, endometriosis, depression, autism, cancer.

And yet vaginismus – a sexual problem, a sexual dysfunction, a variation of normal, a medical condition, a gynecological disorder, a disability, a symptom of a relationship problem – what is it really? – is included right alongside these more readily-recognized health conditions – though certainly the conditions included have varying degrees of public awareness and social acceptance. The editor of the anthology, Dr. Kimberly R. Myers, did not excise the essay on vaginismus as too titillating due to its sexual nature or as irrelevant due to being a relationship problem. Here, it is unquestioningly given the same treatment as any other medical problem. Seeing vaginismus included in the same place as more readily recognized chronic conditions was a shock to me. And this book was published in 2007, so it’s ahead of the curve! I find myself asking if, because vaginismus was part of this collection, if that means there’s openness to the idea of looking at sexual dysfunction as disability even offline…

Clearly, there is a need to understand vaginismus as a matter of health:

Exchanges with family members were uncomfortable; people were usually tentative and shy, occasionally asking if I’d fixed “my little problem,” implying that it was a bad habit of aversion I had to correct rather than a problem or illness with which I needed help… I think the unspoken assumption in many of their minds was that if you can’t perform normally in sexual terms, you’re unfortunate – but not in need of a hand, as you would be if you had a recognizable illness (151).

All the emphases in the quotes are in the original.

The author of the essay in question talks about how she sought assistance from professionals trained in treating vaginismus, though she herself does not appear to be an expert herself – there’s no pH.D or M.D. or M.S.W. or other certification given next to her name. She’s a regular person, like me. Much of what Dunham writes about appears to have taken place while she herself was a student (which makes sense, given that the anthology is titled Illness in the Academy!)

What I like best about Dunham’s essay is that there’s no filter in A certain remoteness. Dunham was given the opportunity to speak in her own words. No one is presenting snippets of what she said in the greater context of some other theory. She’s just saying: What she did, what she went through, what she saw and heard, and what was on her mind when it happened.
I suppose right now, I’m creating a lens, an artificial filter, just by framing this post the way that I have chosen. But that’s what the link to the essay is for – you can see for yourself.
In contrast, in the New View book, short statements from women with sexual dysfunction were presented by professional women, as case studies in support of the New View manifesto. When someone says or does this, she really means that.

Because there’s no filter, there is a stream-of-consciousness, indicated by italics and bolds in the text, which weaves throughout A certain remoteness; usually flitting under a sea of text, always near the surface,… then *Boom!* it pops out for just an instant, and is gone… only to leap out again a few paragraphs later, a brief flash of uncensored turmoil over a carefully constructed treatsie.

But here and there we can catch a glimpse of it, Fulvia’s free stream-of-consciousness,  jumping out of the formal, the factual, and the philosophical:

and if your body is closed, if you can’t let anyone in, if you can’t talk about it easily because no one knows what you’re talking about, if you’re obligated to remain closeted because people often forget what you’ve told them, then you’re simply repressed – closed – out of the loop – out of circulation – unable to come out because you can’t let anyone in, because there’s no language with which to come out, and because nobody cares (149)

(As a side note, some of my unedited draft posts look like this before going live!)

Another interesting feature of Fulvia’s essay is the way she addresses language. In an eerie coincidence, frequent commenter Flora and sometimes contributor left a note here last night addressing how Dr. Tiefer in particular treats language – it’s a very important tool. It has power. Words mean things. But not everyone thinks that way, and to emphasize language over other modes of communication can create new, unique hurdles.
And sometimes, words have limits. Sometimes, language isn’t as powerful as it should be – because there are no words to express what you are really feeling:

Then they ask me about the man with whom I have parted ways two months before, after having been with him for two years. I say that things are fine; everything’s amicable enough, and he usually calls me every couple of weeks from Los Angeles. when he told me, it was new year’s eve, and then waking up in the middle of the night just after, him near me, trying to tell him that he was all over for me, that i’d never have intimacy with anyone now, because no one would have the patience, that this was the last dance, impossible, that he was relegating me to life among those who remain alone – trying to explain – the words were broken – that although i wasn’t sure i wanted children, i wanted the possibility I say that we’re exchanging emails and phone calls fairly often. and it would never be possible again and doomed and no access cut off a certain remoteness – his looking at his watch to see if it was midnight yet They have to catch me as I begin to fall backward off the chair. (153)

Dunham explicitly says, “The words were broken.” Fulvia was trying so hard to articulate everything she was feeling at the time of her breakup. But she just didn’t have the words available. How do you talk about vaginismus when you’re not even supposed to talk about vaginas, about pain, about sex? So you grope around looking for words, looking for something that comes close to expressing what’s on your mind in a way that another person can understand but the language that’s available doesn’t match what you want to say, so you wind up saying something that maybe has a totally different meaning. Maybe what really conveys the emotion is a scream, or a work of art, or a song, or something that does not yet exist.

Dunham herself may even be familiar with the New View’s work:

Given my later training in gender studies, it became tempting to try to believe that this wasn’t a “problem” or “dysfunction:” it was simply a “difference.” But given the imperative we receive in our culture to express ourselves as sexual beings, the messages we’re sent that suggest we’re incomplete, uptight, wound-up, or repressed if we can’t or don’t, it doesn’t feel like merely a difference; it feels like a defecit. It also doesn’t feel like just a difference when the desire is there, but the means of expression are not. It feels like an insurmountable obstacle. (151)

Being familiar with gender studies and possibly with the New View’s work in combating the medicalization of sex, Dunham struggles with questions about what that means for her, as someone living with vaginismus; as someone who needed and sought medical assistance to address it:

am I succumbing to compulsory heterosexuality, the heterosexual imperative, the pressure to become more valid through an ability to participate legibly in the sexual economy? Their sign says “No passing zone.” Rather than seeking to overcome this, perhaps I should use this with which I have been fated to disrupt the usual equation between “intimacy” and “penetration.” Should I question the usual assumptions about what constitutes sexual success and fulfillment? – challenge the commonplace equation between sexual fulfillment and fulfillment? (154)

She knows. She knows she knows. You know? Dunham is familiar with gender studies and feminism. She’s heard it all before. The critiques of sexual dysfunction from a social construction perspective are there. But she also knows that there’s something more going on… something that even feminist-informed social construction sometimes cannot breach:

Is it wrong to want my vagina to open? (154).

This simple question. This one, simple question… is the same one I find myself asking after reading through books like Sex is Not a Natural Act and A New View of Women’s Sexual Problems. Am I doing something wrong? Am I now obligated to expand my sexual horizons rather than having that available as an option? Is it okay for me to get medical help for vulvodynia & vaginismus, and whatever else I may encounter in the future? In so doing, am I medicalizing sex and making it harder for TAB women to enjoy sex as they are? Or do I have the one and only free pass to sexual medicine, because dyspaerunia is the only valid and important sexual dysfunction? But if that’s the only valid sexual dysfunction, then what about my friends? Dunham seems to understand what it feels like, to be stuck in the middle.

And open her vagina did. Dunham continued to seek help addressing her vaginismus, and eventually, after 15 years, she did find satisfactory resolution through physical therapy in Montreal, Canada. She no longer needs to talk about vaginsmus – “Perhaps I am at the point where I can – and even should – put all this to rest” (154). But Dunham still remembers the whole experience, vividly – and much like Susanna Kaysen, it has left her sexual identity fundamentally changed… Dunham, in the end, came out of the experience, as Q for Questioning, or possibly even Q for Queer, inspired by a definition proposed by Eve Sedgwick. Dunham now has the option to engage in heterosexual PIV intercourse, if she so chooses… will she so choose? Even if she does not exercise this option, Dunham does not express resentment towards the doctors who helped her reach this point; she has nothing but gratitude towards them. I suppose the social system of medicine available in Canada helps – in the USA, she may have faced a different set of challenges with the cost treatment and insurance.

There’s a lot more to the essay I didn’t address here; I just picked a few parts that resonated with me. Reading A certain remoteness alongside A New View presented a refreshing contrast, and I would like to see more essays and creative works like it.

In defense of “Dysfunction”

10/25/2010 at 7:25 pm | Posted in Uncategorized | 5 Comments
Tags: , , , , , , , , , , , , ,

I identify as having female sexual dysfunction. For me, it’s an accurate and neutral term, as honest as describing my eye color or my gender as feminine. (It is, however, a personal thing which I won’t disclose to everyone in my social circle, and you’d never guess with a first impression.) I wouldn’t say I’m exactly happy about having sexual dysfunction, but I’m no longer ashamed of it, either. (At least, I try not to be.) Some folks may question why I say I have sexual dysfunction, since it’s such a controversial term. …Then they find out that the main sex problems that are causing me so much trouble are pain due to vulvodynia and vaginismus. So long as folks know what those two conditions are, the questions about my self-identification tend to back off. Still, there are some experts in the professional field who question the validity of sexual pain as a sexual dysfunction, questioning if it should instead be classified as purely a pain condition. Then, even if sexual pain was considered a chronic pain condition independent of sexual dysfunction, that would still place me on the disability spectrum.

Since I have FSD, I have vested interest in learning more about it – what it is, what treatments are or aren’t available, how it impacts individuals’ lives (if at all,) etc. It’s not just reading though – I’ve talked to and received feedback from women who themselves have FSD in one or more forms. I’m especially interested in how FSD is perceived and what people say about it! It’s meta, and its fascinating. So what are people saying about it? When I read about FSD, I notice a few familiar themes pop up repeatedly…

Again & again I’ve run into mainstream articles and published journal studies like, “Big pharma’s newest fake disease.” “Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance.” “The making of a disease: female sexual dysfunction.” Magazine articles like “Lust, Caution.” Slogans like, “Sex for our pleasure? Or their profit.” Blog posts covering FSD – or rather, not covering it, because it’s not a valid diagnosis to cover in the first place. Instead, almost all of these articles focus on the role of Big Pharma in the promotion of sexual dysfunction, with the end goal of selling medication for huge profits. The idea goes something like, if a commercial enterprise can create and then capitalize on sexual anxiety, then there’s a potentially huge market to make big bucks off of. After all, who hasn’t dealt with some sexual insecurity issues?

But who is the target audience of these articles? What do these articles say to and say about women who experience sexual dysfunction? How am I, someone who actually has sexual dysfunction, supposed to react when I see “‘Sexual Dysfunction’ in women: Myth or Fact?” as a header on page 543 in my 2005 version of Our Bodies, Ourselves? I’m standing right here, so my immediate reaction is to wonder how much able-bodied privilege (in terms of not having FSD) the editors were stewing in to overlook the fact that FSD is a broad topic that goes beyond libido alone and that perhaps some of their readers would have sexual dysfunction. The above articles make some good points to consider, but I feel very shut out of these conversations. There’s plenty of talking about, but not so much talking with.

To put it very simply, with both the medical and social construction models of FSD, sexual dysfunction is “Bad,” it’s something you don’t want. Both models contribute to the stigmatization of sexual dysfunction.

Briefly, the medical model is like, “You don’t want to be dysfunctional, right? So here take this pill/use this device/have this surgery and you’ll be cured! BTW here’s the bill…” (In practice however, it doesnt always work out that way – it can take a very long time before patients find a doctor who will be willing to listen to sexual problems and then offer intervention. And even prescriptions can have only minimal effects on the problem, plus they come with side effects.)

The social constriction model is more like, “You don’t want to be dysfunctional, do you? Not to worry; you’re not! It’s just that culture’s views of sex are so screwed up and limiting, these limits create sexual anxiety.” (If guided by a therapist through this process of coming to terms with sexual problems, there will still probably be a bill at the end of a long process of changing your world view.) Sounds great, however I’m uncomfortable with the promotion of guilt and feelings of foolishness if you do use sexual medicine that I’ve seen under the social construction model. I am concerned about the means used under the social construction model. For an example let’s return to this comparison of guys with erectile dysfunction to Jackie Gleason of the Honeymooners:

I am a 37 year old man with erectile problems for 2 years. I have used 50 mg. Viagra 4 times. All of those times have resulted in a very good erection and intercourse. The side effects are headache, upset stomach, stuffy nose, and facial flushing… About 30 mins after taking Viagra I take 2 Tylenol and a Tums and start drinking water. After about 15 mins I take another Tums and use a nasal spray for my stuffiness. I will continue this combination and it will work for me.

This sounds more like a Jackie Gleason routine rather than a romantic evening, but I think it is close to the reality of what life with these drugs will be like… How does his sexual partner feel about the whole drama with the Tums and the nasal spray and the Tylenol?

Found in Sex is Not a Natural Act, location 1109. No one wants to be a shill of the pharmaceutical industry, right? So don’t take that pill and whatever else you need to feel stable. It makes you look foolish anyway, bumbling around like that. The author, Dr. Leonore Tiefer, implies that this gentleman’s partner must think he’s a huge joke. Uh-oh – I go through a“Whole drama” with my stretching & dilator exercises when gearing up for PIV sex.

All of these articles I listed above imply that sexual dysfunction is something new and invented only within the last few decades, guided by the invisible hand of the marketplace. Sexual dysfunction, or increased awareness of it, is something to resist the spread of in the future. It’s something to fight against – like there’s something inherently wrong with being or thinking of yourself as sexually dysfunctional, and especially like there’s something wrong with wanting and needing medical help in the bedroom. The aim of the resistance is noble enough; protect women from being exploited medically, in relationships, and financially. But the means used to achieve that goal don’t always do a good job of acknowledging the reality of life with sexual dysfunction for those that do have it.

Some therapists who take a very strong social construction approach to sexual problems state that whatever you’re going through, it’s not a dysfunction:

So as this latest chapter in the medicalisation story closes, let’s be very clear. Women do experience sexual problems that cause them distress, discomfort and dissatisfaction. These are often linked to other factors and do need attention, but they are not a clinical condition or a dysfunction, and they do not require a new and separate diagnosis. A summary of common reasons women experience problems with sex can be found here.

(Emphasis mine.)

So one of the common themes I keep running into, particularly in feminist, social construction-informed spaces, is this idea that female sexual dysfunction isn’t a valid diagnosis. This view is gaining popularity – it’s covered in women’s studies classes: There’s so much sexual diversity that it’s not fair for doctors or Big Pharma to dictate who does and doesn’t have a “Normal” experience. We don’t really know what “Normal” means, even. And indeed, it is well within the realm of normal and fine to have low or absent sexual desire, it is normal and fine to have orgasms that don’t necessarily rock your world. Everyone’s different. Generally, authors who take a strong social construction approach to sexual dysfunction admit that yes, sexual problems do sometimes happen and yes, they’re real. However…

Nonetheless when sexual problems do happen, it’s not a dysfunction. Don’t call it that. Sexual problems are real, but sexual dysfunction isn’t.

What’s scary to me personally about the above quote is also that sexual pain in and of itself can be caused by a clinical condition (like vulvodynia.) My painful sex and all the issues that stem from that is merely a problem rather than a dysfunction?

The very existence of sexual pain is also a source of internal conflict that I haven’t been able to reconcile because depending on who you ask, sexual pain either is a valid and important sexual dysfunction or else pain as dysfunction is still a myth. I cannot figure out how sexual pain can simultaneously be a sexual dysfunction and not a dysfunction, and also sexual dysfunction is something that isn’t legitimate. I also can’t figure out why pain as dysfunction should be elevated to the pantheon of reality (whether it’s considered a pain condition or a sexual dysfunction) but other non-painful sexual dysfunctions shouldn’t be recognized as such.

The problem is that calling sexual dysfunctions by the euphemism, “Sexual problems” does not recognize the degree to which the sexual problem(s) interferes with someone’s life. According to this article from Harvard.edu,a key component of what separates a sexual problem from a sexual dysfunction is personal distress.

I have a few overlapping sexual problems, which cause a lot of anxiety to this day. My problems can (and do) bleed out into other, non-sexual areas of my life, so when that happens it’s impossible to ignore. To this day I can’t afford to slack off too much on my pain management exercises (like the stretches,) because if I do the muscle tension & pain comes back. Other times, the pain is well-managed but the fear remains. This is a serious problem for me; I think about it a lot and it interferes with my quality of life. And I’m one of the lucky ones who was nonetheless able to find significant improvement through medical intervention.

Lots of people have sexual problems that do not pass the threshold into dysfunction. These problems are nonetheless important and valid experiences, or at least as important as it is (or not) to each individual. But I suspect that the person who has a sexual problem does not experience the kind of anxiety and distress that I do from sexual dysfunction. Does someone with a sexual problem as opposed to a sexual dysfunction feel the need to think 12 steps ahead of every sexual encounter and have all kinds of contingency plans ready if and when something does go wrong? Do people without sexual dysfunctions even think of contingency plans in the first place? Do people with relatively minor sexual problems think about what’s going to happen as they age? How would I know? I would think that someone with a sexual problem but that feels overall pretty comfortable with themselves hasn’t had to spend buttloads of time and money searching for a professional prepared to compassionately handle their sexual complaints.

Calling sexual dysfunctions by the euphemism “Sexual problem” lumps all problems and dysfunctions together, and it minimizes the reality for those with major distress. Refusing to acknowledge the personal distress that accompanies sexual dysfunction equates my long-term pain (which I worry about) with the handful of times that I’ve been unable to orgasm from masturbation (which I’m not worried about. I do not perceive these two personal problems of mine as equal. I did not weep for months when I was unable to orgasm a half a dozen times in my life, but I did weep for the hundreds of times I was unable to comfortably insert something into my vagina.

But no it can’t really be that bad, right? It’s just a problem, strongly influenced by some intangible outside force.

It’s ironic when you think about it – part of the resistance against the term “Dysfunction” is because it’s totally not fair to classify every little sexual variation as a sexual dysfunction. Doing so maximizes the assumption of negative feelings regarding sexual performance. But by refusing to leave room for dysfunction, the distress that may be caused by a sexual problem in and of itself is minimized. The phrase “Sexual problem” misses half of what I’m dealing with here.

Refusing to acknowledge the reality of sexual dysfuction erases what is for some people may very well be a valid medical conditon. A few months ago, frequent commenter and occasional guest poster Flora picked up on the similarities between the way vaginismus and non-sexual, invisible chronic conditions were handled:

Some older studies on CFS/ME were on people who were told that their minds were unconsciously manufacturing their symptoms because they wanted to get out of a hectic work life, and called it “yuppie flu.” It happens with purely neurological things, also; it used to be widely believed that autism was symbolic of “withdrawing into yourself” due to child abuse or neglect. So it’s… nasty but also in some ways unsurprising that people would try to interpret vaginismus along the same lines.

This is really happened. But just because you can’t see it, doesn’t mean it’s not real. Not every bodily phenomenon has to have a deep symbolic meaning behind it… Sometimes things just happen.

So when someone insists that sexual dysfunction is a purely social construct with no medical validity, that is getting stacked on top of a long history of denying the validity of many chronic conditions and disabilities – some of which disproportionately effect women, and which may overlap with sexual dysfunction. I don’t see what’s so new & revolutionary about that.

It’s an act of erasure when someone who is not me, who doesn’t even know me, declares, “You don’t have FSD because it isn’t real.” Oh no; this is quite real. And I’ve worked really hard to accept and incorporate sexual dysfunction into my identity. It’s part of who I am, it will follow me into any future relationships I may have, and to embrace that was not a decision made lightly. But still I must be all wrong; I’m not dysfunctional… It must instead be the case that I am foolish, gullible and brainwashed. Snap out of it. Now isn’t that so much better than having something wrong with you?

But wait!

There’s widespread controversy about sexual dysfunction, yet even among sex therapists, there is not a unified agreement on what is and isn’t sexual dysfunction, whether or not it’s a valid terminology, and when/whether medical intervention should be acceptable. There are some sex therapists out there who accept the validity of sexual dysfunction and who would not rule out medical treatments.

For example here’s Dr. Marty Klein on anti-flibanserin activism:

It’s accurate, of course, to say that there isn’t a single level of desire that’s “normal.” But women who experience dramatic drops in their desire know there’s something wrong. And isn’t it obvious that one definition of “healthy adult” is the experience of sexual desire when the conditions are right?

Millions of women (and their partners) know their lack of sexual desire causes suffering. Whether taking a drug is the best treatment for any woman isn’t the point. Dismissing B-I’s drug and its marketing as “disease mongering” is terribly disrespectful to the many women who struggle with low desire.

You may know Dr. Klein as a Ph.D., sex therapist, as the blogger behind Sexual Intelligence, and as the author of several books about sexuality. So he’s been working at sex education and therapy for literally decades. Yet after everything he’s seen, after raising his own questions about the validity of certain diagnoses such as sexual addiction, still, he acknowledges the importance of potential treatments for low libido types of sexual dysfunctions.

Still don’t believe me when I say that there’s disagreement among sex therapists about what constitutes sexual dysfunction? Here’s another well-known sex educator, Dr. Carol Queen, on nomenclature, in response to a reader query:

Question: Hello. I am twenty years old and unfortunately suffer from sexual dysfunction. Before seeing your blog on Good Vibration’s website I had no idea this was an issue with other woman. I was wondering if you knew where I can find help, any kind of help with this issue. I didn’t know there were people who studied this or that I could talk to. So if you can, please help me out. Thank you so much.

…it is really pretty common for young women to have sexual issues that might be called “dysfunctions.” Keep in mind that it is only a dysfunction if you are unhappy about it. If you have low libido, or have a hard time getting aroused, and you don’t have or want much sex and don’t feel troubled by this, it is simply the way you are, not a dysfunction. If, however, you are concerned about it, then that language might be appropriate.

…In short, unless you have really gone on a hunt to get good information, the schools and the culture have not made sure you learned enough about sex to have *good* sex. And this does not make YOU dysfunctional — if anything, it means our society is dysfunctional!

…So far I haven’t really said anything about sexual dysfunction itself; I’ll do that now. It’s possible that in spite of what I said above, you *do* have some sort of sexual dysfunction, but it’s likely that it is something that can be helped via knowledge. It’s not as likely that you need some sort of medication, which is good, because so far, the pharmacological remedies available to women to help us with our sexual problems are, at best, untested and insufficiently understood.

Emphasis mine. What’s this? Dissent among the ranks! Here, Queen explicitly recognizes that every once in awhile, sexual dysfunction is a valid and proper terminology. Unfortunately even when it is, there still aren’t a lot of medical options available for many sexual dysfunctions. Knowledge helps, but it only takes me so far. You may recognize Dr. Queen as a prolific author and editor of sexuality anthologies and she’s a sex-positive Ph. D., sexologist and activist – so like Dr. Klein, she has seen plenty of shit go down in the realms of sexuality and politics.

So these two sex therapists who are open to recognizing sexual dysfunction and treatments for it, aren’t at all fly-by-night therapists, or in the pockets of Big Pharma. These two have been around long enough to have seen the positive and negative effects of sexual medicine.

Humm… I guess that if you’re seeing a sex therapist for sexual dysfunction, how you’re treated, what language you’re allowed to use to describe your experience, how you’re allowed to identify and what options are made available to you are going to depend on who you’re talking to. I guess that’s why it’s so important to find a sex therapist who’s right for you if you choose to go that route.

Of course, I speak only for myself here. I’m comfortable with the term sexual dysfunction, but not every other woman with a sex problem is, (especially since not every little problem is the same thing as a dysfunction) and probably very few folks will embrace it, perhaps for some of the reasons enumerated by experts on the social construction model of sexual problems. Remember though, I do not claim to be an expert on the topic by any means; don’t have a Ph.D. or a journalist resume to flaunt (yet); I just blog so I don’t know everything. But I’ve come to terms with it – I’ve come to terms with the term. I’m starting to think that this binary vs. mode between the medical model and social construction is creating some messed up language on both sides.

Symbolism, archetypes and stereotypes: What experts have said about vaginismus

07/21/2010 at 7:03 pm | Posted in Uncategorized | 6 Comments
Tags: , , , , , , , , , , , , , , , , , ,

While browsing for interesting (and often outrageous) coverage of sexual dysfunction via Google Books, I’ve occasionally stumbled across experts (doctors, sexologists, laypersons, etc.) interpretations of vaginismus and the women who live with it. I’d like to present some of my findings to you now. Full disclosure: I haven’t been able to finish every book I’d like you to look at today.  But on the other hand, I’m not doing a full book review today either and I am not certain what context, if any, could redeem the following passages.

One of the points Dr. Leonore Tiefer made in Sex is Not a Natural Act (yes we’re returning to this title again) is that we need to look at sex symbolically. Sex has meaning beyond the obvious that we can see and feel, and to understand sex and sexual problems, we need to figure out the meaning behind it. Consider some of the following quotes with emphasis added by me (thanks to Kindle’s word search feature:)

“It’s the symbolic investment that makes sex ecstatic” (location 1215).
“The first [story about doing the ‘Viagra tango,’ as she puts it] is about how Viagra the pill, but more importantly, Viagra the symbol, may affect the sexual conduct and experience of women and men in many parts of the world” (location 1315).
“[Orgasm is] just a reflex. It’s the symbolism that makes it feel so good” (location 1195; available online.)

And it goes on like that at a few more points throughout the book. We need to look at the symbolism of sex, phalluses, the Viagra family of sexual medicine, etc. We need to pull the curtain back and understand the why behind a woman’s libido crash. Some contemporary examples of where understanding sex and symbolism would be helpful are with the very expression “Sex symbol” and with sexual imagery used in advertisements.

There’s just one potential problem: Some so-called experts on women’s sexuality have already done that – looked at sex, women, women’s sexuality and sexual problems symbolically – and the results haven’t been pretty. Sometimes the ugly things people say about FSD and the women who have it doesn’t come from hack journalists and misogynist comments on message boards. Sometimes – often times – it comes from the professional sphere and trickles down.

Let’s focus on vaginismus as an example. Vaginismus, if you didn’t already know, can be described as an uncontrollable spasm of the pelvic floor and vaginal muscles, usually during sexual activity. It’s most obvious when attempting penetrative activity, like sexual intercourse, but it may also occur with a dildo, tampon use, or during gynecological exams. The spasm may be strong enough to completely prevent an object from entering the vagina, or it may be possible to insert something, but with pain. As such, it can be the cause of dyspareunia (painful sex.) Vaginismus is often recognized as a sexual dysfunction, however, some sexologists question the validity of sexual dysfunction broadly as a diagnosis at all and vaginismus in particular. For some folks like me, vaginismus a chronic problem connected to medical issues, other times it’s situational.  Some folks say it’s purely psychological and can be treated without physical intervention, others say there’s a physical component and that it can be addressed physically.
Vaginismus does not necessarily require any treatment at all, but when folks with vaginismus do seek assistance to address it, that assistance may come in the form of talk therapy with a counselor or sex therapist, dilator use, learning how to kegel, or more extreme medical intervention such as botox injections (not for cosmetic purposes) or physical therapy.

And some sexologists have described vaginismus symbolically.

One of the first, if not the first, books to deal with vaginismus exclusively is 1962’s Virgin Wives: A Study of Unconsummated Marriages, by  Leonard J. Friedman. It’s out of print now, but you may still be able to find a used copy online or through your library. I first came across this title while slogging through Linda Valin’s When a Woman’s Body Says No to Sex: Understanding and Overcoming Vaginismus, a book about vaginismus, from the perspective of someone who has personal experience with it. Valins acknowledged Friedman’s contributions to her own book, but alas Google Books does not offer me the complete text of Virgin Wives or a preview version to pursue at my leisure.

However, because authors like Valins have referenced Friedman’s work, we can get a pretty good feel for what he thought about women with vaginismus. Valins is a big fan of his, so it probably isn’t all bad – but I found the following disturbing.

Last week, I tweeted one of my findings regarding symbolism and vaginismus, from Google’s preview of 1987’s Sexuality and Birth Control in Community Work, by Elphis Christopher. Based on what I can see in Sexuality and Birth Control in Community Work, Friedman described three archetypes of women who tend toward developing vaginismus:

(1) ‘The Sleeping Beauty’: this occurs where the woman denies her own sexuality and waits for the man to awaken her sexually. Unfortunately, she often chooses a ‘safe’ partner, i.e. a man who is uncertain of his own sexuality and may suffer from impotence. He is often praised as a ‘good,’ nice boyfriend because he did not attempt pre-marital intercourse.
(2) ‘Brunhilde’: this refers to the woman who is always looking for a man strong enough to conquer her. She usually chooses as sexual partners men whom she despises.
(3) ‘Queen Bee’: this refers to the woman who manages to get pregnant without allowing penetration so that she can claim the pregnancy for herself.

What… the… fuck…?

I have no reasoned, rational response to this. Do I need to explain the multiple layers of Wrong with this picture to you?

We got here, above all, the assumption of heterosexuality, and according to these personality types, if you have vaginismus you are likely to be:

1. a woman who refuses to own her own sexuality and instead waits for some guy to come along and give it to her. But for some reason the author decides that a man with basic human decency who did not coerce his partner into sex simply must be sexually insecure and possibly “Impotent” (as if there’s anything wrong with having erectile dysfunction.)
2. I don’t know wtf this is – Some kind of Viking archetype I think where a woman who doesn’t settle down with any ol’ jerk and who doesn’t take shit is asking too much. Or else if she’s got vaginismus, it means she must hate her partner.
3. I don’t know wtf this is either. I think term is dated because I had to look it up. I think this archetype is supposed to conjure up images of a bossy lady who, frustrated with vaginismus, gets pregnant the “Wrong” way – minus the ejaculation of a penis inside of her.

So, what the fuck, which one of these archtypes am I then? Anybody here identify with one of these three archetypes? Does anybody here appreciate being described like this? Does anybody here in a relationship appreciate having your partner described like this?

“Now wait, K,” you may be saying. “That paragraph starts out talking about non-consummation generally, and then the next paragraph is about vaginismus.” Fair enough, so let’s make an effort to double-check and make sure that we’re talking about the same thing. Here’s a website that mentions the three archetypes of women who are prone to vaginismus, and it says:

Friedman (1962) describes three types of women inclined to vaginismus:
* the sleeping beauty (father-type relationship with partner and various feelings of guilt)
* the Brunhilde (the woman perceives sex as a battle between the sexes, and the male dominance has to be opposed)
* the queen bee (the woman perceives sex as dirty and sinful, she is afraid of pain in coitus and, in principle, she wants to get pregnant)

Again, what… the… fuck…?

Still don’t believe your eyes? I’ve got one more piece of evidence I can present, from the Science/Fiction of Sex: Feminist deconstruction and the vocabularies of heterosex. I’ve been picking it up and putting it down every once in awhile, browsing random passages – because every passage is so cerebral. This book is hard. Alas, unless you’ve got a copy of the book you won’t be able to read page 210 so let me fill you in. This is, as the title says, a feminist deconstruction of sex, so the author does not necessarily endorse what I’m about to show you.

Annie Potts references the work of Eve Adler, who submitted an article to the British Journal of Sexual Medicine in 1989. I have tried to access the journal article myself but have not yet been successful through my usual means. Adler described several archetypes of women with vaginismus, including one of particular interest to Potts:

Less commonly seen today is the primary vaginismic patient, Sleeping Beauty; an emotionally immature woman awaiting a sexual awakening without taking responsibility for it. These ‘good girls’ have often been brought up to believe that sex is bad or dirty; she had to save herself for marriage! This type can appear quite ‘little-girl-like,’ pristine, clean an tidy and very controlled generally; or she may look quite sexy, enjoy sex play and experience orgasm with clitoral stimulation. Her partner is often ‘a gentleman’ in every sense: an unassertive, gentle, literally non-pushy man who may well have hidden anxieties about his own sexual abilities (Adler 1989 in Potts 2002)

What… the… fuck… What is the meaning of this bullshit?!

“Emotionally immature?” “Little-girl-like?” “Unassertive?” This is in print, people! This is how women with vaginismus and their partners have been described. In books and journal articles. What about descriptions like “Creative and resourceful?” Or “Resilient?” How about some of that?

Don’t be too angry with Annie Potts for re-printing that passage above though; she analyzes it, though you may not agree with her analysis either…  It gets far out there when she starts talking about vaginismus as a form of political resistance against a phallocracy, and hey did you ever notice how phallic your fingers and a newborn baby are.

Let’s go a little deeper and focus on Sleeping Beauty since she keeps popping up re: vaginismus. The myth of Sleeping Beauty has been reinterpreted by various authors. According to one interpretation by Joan Gould, when Sleeping Beauty pricked her hand and fell into an enchanted sleep, the spindle that cut her represented a phallus and sexual maturity; the blood that came out of the injury represents menstruation. Sleeping Beauty was protected from spindles (sex and puberty) by her royal family up her 15th birthday – the age by which many girls reach menarche. The sudden appearance of sex and adulthood upon her (and Snow White, too, for that matter) was too much to bear all at once. The sleep she fell into was not necessarily a passive time; she spent the century mulling over impending adulthood and all the responsibilities that came with it. At a predetermined time, a prince came to wake her up and she was transformed into a woman ready to act as an adult. Usually we think of the awakening as romantic, stemming from a kiss but some versions have her shocked out of her sleep by rape or nursing her babies – conceived in sleep during rape, the perpetrator long gone (Gould, 86-126). Gould’s explanation of the myth of Sleeping Beauty, coincidentally, also addresses the myth of Brunhilde. However we cannot ignore the well-known 1959 Walt Disney version of Sleeping Beauty, in which Aurora was at last rescued from an evil witch’s spell by an active, handsome prince – who she was scheduled to be married to anyway. We need to think about that version too, especially since Disney’s Sleeping Beauty was released by the time Virgin Wives was printed.

Edit 7/22/10 – The boyfriend suggested I add more pictures to the blog. Here’s a picture of Disney’s Princess Aurora, Disney’s Sleeping Beauty.

Disney Aurora

Disney Princess Aurora

[Image description: A picture of Disney’s Princess Aurora wearing an iconographic pink dress.]

Is this the true face of Vaginismus? What the hell does she have to do with vaginismus? You think of vaginismus, what’s the first thing you think of, Disney, right? No. (Via.)

But wait, there’s more! Last week, when I Tweeted a link to my findings about archetypes of women with vaginismus, @NevillePark responded back with a very good question:

Wow. Uh, dykes, genderqueers, masculine folk, trans guys, etc., can’t have vaginismus? NEWS TO ME #youreadthisstuffsowedonthaveto

Indeed, good point! Because Friedman was looking at unconsummated marriages back in the 1960s, the most likely scenario is that he wasn’t interested in anyone who wasn’t cis- and heterosexual. After all, marriage was then (and remains to this day in the US on a federal level) defined as a legal union between man and woman. I would love to get my hands on a copy of Virgin Wives just to confirm that he had no interest in queer sexuality and vaginismus.

Alas, I cannot offer a complete answer to the question @NevillePark raises. However, we can turn to another body of work for partial credit.

Last week on Google Books I found Sexual Salvation: Affirming Women’s Sexual Rights and Pleasures, a book about women and sex, with an interest in often marginalized groups of women. I’m surprised to report that it does have a Kindle e-book edition (though the Kindle version is out of my price range right now! $63?! For a sex therapy textbook!? That’s not on the budget!) Overall it sounds interesting and potentially valuable – the Amazon summary says the author spends time talking about feminism and marginalized groups of women, including seniors, disabled women, and sex workers. And I can see from looking at the indexes to Sexual Salvation and (once again for the millionth time,) Sex is not a Natural Act that the authors, Naomi B. McCormick and Dr. Leonore Tiefer, respectively, reference each others’ work. Hmm…

The discussion of vaginismus starts on about page 190, preceded by a discussion of dyspareunia (painful sex) and followed by a discussion of sexual dysfunction, especially in men, and then sex therapy.

There’s a lot we could talk about with this one section of the book, but for now let’s focus on the following:

Taught that the only “real sex” is sexual intercourse, heterosexual women are susceptible to two sexual problems that are largely unknown to lesbians, dyspareunia, painful coitus, and vaginismus, involuntary spasms of the vaginal musculature which prevent penetration. (McCormick, 190).

Well there’s an answer. This leaves room for the possibility of lesbians to experience painful sex and vaginismus, but according to McCormick, that’s almost unheard of. (An unfortunate side effect of establishing profiles of ‘typical’ patients for diagnosis of problems though, is that if you don’t fit the profile, you may have to work even harder to get a caretaker to take your complaints seriously.) She does, however, go on to describe situations in which a lesbian may find herself in a heterosexual relationship and experiencing vaginismus, and some pages later, she describes a lesbian couple coping with cancer and sexual problems including genital pain. Meanwhile, the Vaginismus Awareness Network goes on to address two myths about vaginismus and sexual orientation (Emphasis mine):

A woman MAY be a lesbian if she has vaginismus, just like she may be a lesbian even if she was able to have painfree intercourse with a man.

This myth seems to spread from the belief that lesbians won’t have penetrative sex. Though that may be true for some of them, others will use strap-ons etc and have ‘intercourse’ too. So clearly vaginismus has little to do with one’s sexual orientation since so many heterosexual women in love with their partners have it. It has more to do with lack of knowledge of one’s private parts, lack of information on their PC muscles, lack of sexual education and lack of kindness…

You know, I don’t always agree with the VAN. I have the sexual education I need to understand my own anatomy and how to do a kegel, and my partner is kind to me, yet somehow I still have vaginismus. Maybe we shouldn’t paint all women with vaginismus as one big homogeneous group. But compared to the other Freudian analyses described above, even I prefer this. I’m very uncomfortable by the way women with vaginismus have been described in literature like what I’ve shown you today. For how long were these archetypes and stereotypes repeated and used in clinical settings? To what extent do the myths and stereotypes about women with vaginismus still exist, and what effect do they have now?

Navigating PIV sex with a history of painful PIV

07/14/2010 at 8:17 pm | Posted in Uncategorized | 20 Comments
Tags: , , , , , , , , , , , , , ,

NSFW/TMI Note: The following post will contain frank (but not explicit or sexy) language about sex. There are no pictures but since we’re having grown-up talk, the content will go behind a WordPress cut. Everything should still appear in your RSS feeder, but if you’re reading from the main page, you’ll need to click to go on. Thanks!

Continue Reading Navigating PIV sex with a history of painful PIV…

Feedback understanding the difference between BDSM and painful sex

06/01/2010 at 6:10 pm | Posted in Uncategorized | 1 Comment
Tags: , , , , , , , , , ,

Last week, I posted an e-mail exchange between me and Ms. Sexability, about reconciling BDSM with a history of painful sex. It’s a question I’ve been struggling with as I become interested in BDSM and kink, and one I don’t think I would be able to resolve in a vacuum.

While I was thinking about this, I saw a blog post at A Femanist View, where SnowDrop Explodes had posted a quote he found to reflect the difference between BDSM and abuse. I’ve been reading A Femanist View for awhile, where I frequently enjoy SnowDrop’s posts about feminism, sexuality, BDSM, and the occasional book review. (He blogs about other topics like politics too, but those listed above are the posts I most like reading.) Seeing as he had just talked about the difference between BDSM and abuse, I wondered if he had any feedback on the difference between painful sex and BDSM, if indeed there is one. I was particularly interested to hear what he had to say, since he is a top. And according to The Topping Book, that means that he is someone who “Can eroticize giving someone an experience that would be unpleasant in real-world interactions” (location 98).

Of course I know that feedback from one person cannot and should not be considered the universal response. Everyone has different experiences and builds their own definitions of sex and kink. I would likely get a different answer if I asked anyone else. However I felt that asking someone who I know is experienced with BDSM would be a good place for me to start exploring, so that I’d have some advance notice on what to expect.

As with the last e-mail, some parts of the following exchange may be triggering.

I asked SnowDrop Explodes,

What…
Would you say the difference is between BDSM & painful sex?

And this is his reply (e-mail is being used with permission.)

The first difference is that BDSM doesn’t have to involve penetrative sex of any kind (v, a or o).   So SM play can be a turn-on for both even when “normal” sex isn’t an option.

The chief difference, I think, goes back again to that quotation: “Half of a relationship is the individuals, the other half cooperation.”   When a medical condition results in suffering (e.g. painful sex), then that comes neither from the cooperation of the parties, nor from their individual make-ups.   It’s an interloper, in effect.   And it’s an interloper whose presence is entirely not consensual!   In terms of my personal sadism, I like to be the one who’s in control of my partner’s pain, pleasure and combination of the two.   Even from a purely selfish perspective, if some medical condition causes her pain when I don’t plan for her to feel pain, then that’s extremely unwelcome.   Of course, the overriding concern is always for her safety and wellbeing (i.e. other-focused rather than self-focused) but I did want to get that point in as well.

In a BDSM relationship, where some condition causes sex to become painful, the ideal would always be that the partners involved would cooperate to find a way to carry on, and to make sure that the best available treatment programme was implemented – in a BDSM relationship, I would expect sexual relations to adapt to the condition.

Additionally, I disclosed,

I am particularly interested in your answer since you are a sadist. (No accusation – I think I’ve seen you describe yourself as such.) I realize this is a pretty broad question…

Like okay, I’m at least ~open to BDSM activity but I’m most hesitant to get into the S/M stuff because i don’t know how to reconcile painful sex with the “Good” kind of pain.

You’re a sadist so if you were dealing with someone with a history of painful sex how would you go about doing that?

And he addressed this with,

The starting point is always communication and cooperation.   Even though I’m very much Dominant as well as sadist, it all starts with these principles – I get to take control only once we both know what we want from the other.

I’m a masochist as well as a sadist, and you mention the distinction between “good” and “bad” pain – something that is all too familiar to me from the gout episodes I’ve had.   I think one of the key distinctions between “good” and “bad” pain is the power of choice that’s involved.   “Bad” pain is generally something unplanned, and it’s something over which no one has any real control – there’s no way to safeword out of it, and no way to avoid it once it’s there.   There are other distinctions as well, and not all “bad” pain is of this kind (for instance, I always find needles to be “bad” pain, however planned it is and however short-term I know it’s going to be).

So, I would use my understanding these points to talk things through with a (prospective) partner whose history includes painful sex.

The way I would talk about it would put her in control of the situation.   My favoured modes of SM play are non-penetrative anyway – spanking, and other impact-play is top of the list – so pleasurable sexual encounters wouldn’t need to involve any penetrative sex.   I would talk to her about the concepts surrounding pain as a gift from masochist to sadist.   This means that she can determine when or if she wants to try penetrative sex, and to frame any accompanying pain as a part of her gift to her partner.   That framing doesn’t work for everyone, I am sure, which is why she has to remain in control.

To make sure she had control of what was happening to her, she would have a safeword the use of which would immediately stop everything.   I would not be comfortable with engaging in penetrative sex until I was confident that she knew and understood and *felt* that I would feel no negative reaction to her stopping things, because my first concern is for her.

Naturally, this means that it would be a slow build-up over the course of a relationship before we tried anything involving penetrative sex.   In the same way that a sub or masochist partner can set “hard” and “soft” limits, and it is not unusual to see those shift and change over the course of a relationship, I would expect to treat penetrative sex in the same way – she gets to set the pace of how far she does or doesn’t want to go with it.

All of this would be to help put her in control of how much or how little pain she is okay with, just the same as any other kind of SM activity – safewords, negotiation, understanding, preparation, all being key elements to consensual BDSM sex.   I would also hope that I would be able to communicate and have it understood that there was no need for her ever to consent to penetrative sex at all, if she wasn’t comfortable with involving that pain as SM play.

It occurs to me that your question also seems to be asking how I would approach introducing her to SM play in general.   I think I would approach it with the same care as I would anyone who was new to the physical world of BDSM, so any early encounters would involve light pain only, both of us getting used to her reactions and again, letting her set the pace for how much and how quickly.   We’d explore different kinds of pain and find out what is “good” pain for her, and what pain she finds “bad” or unenjoyable.   Then we’d build on that as the relationship develops and it becomes clear to her how much control over events she’s willing to surrender to me as her sadist partner.

So the basis would be the same as any BDSM relationship: communication, building trust, getting to know each other, making sure that all activities involving pain are consensual and controlled (or controllable), and above all, making it fun for everyone involved.

I suppose one final word needs to be said, about whether or not this whole description depends upon the assumption that she would feel pain anyway.   The idea of including painful sex as a negotiated form of SM play almost seems to put pressure on her to feel some sort of pain from penetrative sex, and of course that’s not a good idea either, so I would be careful about letting it be about potential, rather than actual, pain – so that if it turns out that it doesn’t hurt when she does it with me, then it doesn’t seem like *that’s* a failure, either.

Going back to what you said about your own openness towards BDSM, but not sure how to reconcile “good” pain with painful sex: I think the advice I would give there is what I described in my outline of how I’d deal with the issue with a partner if she had a history.   Different people experience different kinds of pain as “good” or “bad” – I don’t like needles, others love them; some people hate scratching, I love it!   So you can treat “painful sex” as “bad pain” (at least at first) and instead try some of the other sorts of pain that our bodies have to offer, and see what works for you.

I think this is a very interesting response. He is also familiar with “Bad pain,” like the gout he describes, and there’s nothing fun or planned about it. It shows up whether you want it to or not.

And there’s a lot of communication going on in this scenario – this being a scenario in which a woman partner who lives with dyspareunia is also submissive, or receptive to a top. (Eventually I’d like to think and talk about topping with a history of sexual pain as well.) Any new activity is introduced gradually and limits are allowed. And even if you’re engaged in a S/M scene, there’s still no need to engage in penetrative/insertive activities, which would cause pain. It sounds to me like SnowDrop is reluctant to ask a woman engage in penetrative activity, knowing that doing so may hurt. Even though he enjoys BDSM activity as a top, SnowDrop doesn’t want to cause unwanted pain!

We e-mailed back & forth a little bit more,

Some of the sexology & self help books I read recommend incorporating BDSM activity into your sex life when there’s a problem, but they never explain *How* you would go about doing that. I think there is a difference between BDSM and painful sex too – for one thing with BDSM there’s some enjoyment from the sensation and activity, but with painful sex it’s no fun at all.

And he replied,

The thing about the self-help books strikes me as strange, because if BDSM isn’t your thing, it’s not going to help (no matter how useful it might seem).   I recall that there was a proposed study into the way masochists’ brains process pain compared with vanilla folks’, but it didn’t get approved for funding, which is a shame – it might have revealed something useful about pain management.   I think for some masochists, a lot of it is about context (for example, a lot of masochists who are also submissive say that there’s a world of difference between a spanking that’s for fun, and one delivered as a punishment), but I know that doesn’t work for everybody (or for every type of pain).   So I guess maybe the self-help books are trying to help their readers to put the pain in a better context so it’s associated with pleasure instead of “bad sex”.   But again, unless you are predisposed to making that link, I’m not sure it could ever work for most people (besides which, painful sex may well be the type of pain that isn’t amenable to such an approach in the first place).

I think some people assume BDSM is just an extended form of foreplay, while for others it’s the whole point of the sexual interaction (which is why it’s possible for me to say that it needn’t involve penetrative sex at all).

And he also wished me luck.

A couple more points were made on the last exchange. Although I’m becoming interested in BDSM, I know that it’s not going to be right for everyone. It’s not a panacena for pain or dissatisfaction with your sex life. And that’s okay too! I believe that many of the principles involved with BDSM (notably, clear communication,) can carry over into vanilla relationships, but not everyone wants to engage in the activities usually associated with kink. There is nothing wrong with that, if it’s not for you, it’s not for you. Pressure to perform any kind of sexual activity is still pressure.

That’s all I’ve got on BDSM and painful sex for the time being! I’d like to return to this topic some time in the future to look at topping, and see if I can get some practice under my belt in the near future.

Guest Post – 10+ years with vaginismus

03/23/2010 at 8:01 am | Posted in Uncategorized | 4 Comments
Tags: , , , , , ,

[Dear internet, we have a guest post today! The following was written by someone who prefers to remain anonymous actually, with her permission, make that an adventurous virgin.]

Picture the scene….I’m 18 and in my 1st year at university. It’s a Thursday night and I’m getting ready to go out dancing with my friends and boyfriend at that time. We start off in the usual bar and finish up in the usual place. We’ve all had a good night and it comes to going home. My boyfriend suggests we go back to his place. I nod and we start walking up the road. As the alcohol wears off I remember that I don’t want to do that at all and start thinking of reasons why I can’t sleep with him tonight. A taxi comes along and I run to get it and go home. That’s a typical Thursday night out for me.

Fast forward to the next morning and a typical conversation with friends before class goes something along the lines of: “Why didn’t you stay at his place last night? Haven’t you done it yet? He won’t wait forever. Just get it over with.” I knew that being an 18 year old virgin at university was a little freakish, so I was left with no other choice-I had to end the relationship.

Now, here I am 11 years later, still obsessing about the same thing. Except now I know that there’s a name for what I experience and I’m working on it. I remember the day very clearly when I discovered the term vaginismus. I had been going out with my current boyfriend for about 3 years. We had tried to sleep together many times and failed miserably each time. I was totally freaked out by this. I didn’t know what was wrong with me and I was far too embarrassed to go to my doctor. Everyone else around me was able to have sex no problem and I really didn’t want to say to anyone that I’d been going out with someone for 3 years and we hadn’t slept together yet. It was just presumed that we had.

Anyway, one Sunday night my brother, who was working in a shop, brought me back a magazine that was out of date. The first article was entitled “I couldn’t have sex with my boyfriend.” I was extremely interested and read it over and over again. It was like reading about myself! In the article the girl had had a couple of boyfriends and each time she couldn’t have sex with them, they had broken up with her. Now she had a new boyfriend and was using dilators with him. After a few months of using them, they were able to have sex. In 2 minutes my world changed. I discovered a name for my problem, I wasn’t the only one in the world who had this problem and there was a cure!

It took me about a week to tell my boyfriend about the article. I didn’t know how he would take this information. I needn’t have worried-he seemed happy too to know this. And so the research process began. Every few months I would spend hours online reading stories from other women and their partners. I read about treatments, doctors, causes, things I should and shouldn’t do. I had so much information I didn’t know what to do with it. Some articles said it was a psychological problem and that I should see a therapist. Some said it was a muscle that needed to be stretched. Some said it needed surgery. I didn’t know what to believe.

I started thinking about why I might have it. If it’s psychological, then it’s easy to think of a reason why. Growing up in a Catholic society, I went to an all-girls primary school where the teachers pointed out that anyone who got pregnant outside marriage or had an abortion would go straight to Hell. This was followed by a Catholic all-girls secondary school, where I was taught by some nuns, who obviously shared that opinion! I was so terrified of getting pregnant before finishing university, that I refused to let anyone near me. By the time I was in a long term relationship, the fear of getting pregnant was so huge, that I would be physically sick at the thought of sex. I can’t remember the amount of times that I ran out of places to get sick because I thought that I might have to have sex.

So now I’m 29, going out with the same guy for 9 years and everyone is asking me when I’m going to have a baby. Society is so confusing: you spend your early teens being told that sex is wrong and not to let a boy near you, then in your early 20s you’re supposed to be having loads of it with as many people as possible in as many different styles as possible, (but keeping all this hidden from the older generation) before you meet “the one” and then you settle down and you’re supposed get married. Then, all the people who told you in your early teens that sex was wrong are asking you when you’re going to have a baby. How are you supposed to go from staying away from boys to having babies?!?!?!?! It’s just not logical!

Living in a society where now everything is connected to sex and not being able to have it is really hard. Practically every product is advertised using sex. Members of the opposite sex will find you sexy if you use a certain shampoo, wear certain make-up, drive a certain car, drink a certain drink etc…. Little girls aren’t happy with dressing up in their mother’s clothes anymore. They have to have mini versions of what their mother’s wear, but they’re still being told to stay away from boys! So where does that leave me??? I finally got around to seeing a doctor and getting a set of dilators. I’m finally making some progress and I can see some light at the end of the tunnel, physically anyway. I don’t think I’ll ever be able to get my head around the mixed messages sent to girls in society though!

Vaginismus and biofeedback on Dr. Oz

03/15/2010 at 6:06 pm | Posted in Uncategorized | 7 Comments
Tags: , , , , , , , , , , , , , ,

What this? Dyspareunia appearing on television twice in three months? On the same show? I think we’re on a roll here, people. Or at least Dr. Oz is. Well sort of, anyway.

Sometime in March 2010, the television show Dr. Oz aired a short segment on vaginismus, and on March 8, the segment was added to the Dr. Oz website. Click the link to see for yourself. (No transcript available @ this time.)

Vaginismus is condition in which the pelvic floor muscles, including the muscles in and around the vagina, tense up. This tension can be occasionally uncomfortable in and of itself if you’re aware of it as I am, but more frequently, it can cause pain if you try to insert an object into the vagina while the muscles are tensed up. That means that it can make PIV sexual intercourse painful, or prevent it altogether. The pain & prevention of certain acts involving the vagina isn’t limited to hetero sex though – you may have difficulty with pelvic exams at the gynecologist’s and with using insertible menstrual products like tampons and cups.

Unlike a few months ago when Dr. Oz did vulvodynia, this time he did not have a representative from a vaginsimus awareness organization on the show. Perhaps this is because there is no such nationally recognized vaginismus organization (that I’m aware of,) as there is with the National Vulvodynia Association. There are patient-led organizations, treatment clinics, support groups, and doctors prepared to address vaginismus, yes. But for some reason Dr. Oz did not have anyone from one of these groups on the show to talk about it. Instead, he called a random audience member, Ronnie, onto the stage.

I think it is no coincidence that on this episode, without the direction of someone experienced in dealing with vaginismus, it was treated more flippantly than vulvodynia was a few months ago. Vaginismus was compared to panic attacks, localized to the pelvic floor.

For some reason, this comparison generated a lot of laughs in the audience.

I don’t understand that comparison. While I struggle with general anxiety, I have never experienced  a bona fide panic attack, so I cannot compare the two. My understanding is that panic attacks are acute episodes of intense fear and terrifying sensations. For me, the pelvic floor tension is a chronic problem, though it may be made worse in anticipation of penetrative activity. I’ve heard comparisons of vaginismus to a blink reflex, but this is the first time I’ve heard it compared to a panic attack. At one point, Dr. Oz compared vaginismus to a back spasm – this makes more sense to me intuitively, but a back spasm and a panic attack are not the same thing.

What really bothered me about comparing vaginismus to a panic attack though, was Dr. Oz’s & the audience’s reactions – laughter. What part of a panic attack is funny? What part of vaginismus is amusing? Sex and pelvic floor problems must be a laugh riot to anyone who’s never experienced them, har-de-har-har. This laugher could have been prevented or addressed by Dr. Oz, but if he said anything to the audience about the seriousness of the situation for people who are bothered by vaginismus, (and I don’t have any reason to believe that he did,) that part didn’t make it to air.

Dr. Oz showed Ronnie and the audience a computer-generated animation of what happens during a pelvic floor spasm. The muscles of the pelvic floor around the vagina and rectum draw in, making entry difficult, painful or impossible.

Dr. Oz focused briefly talked about possible causes for vaginismus, starting with physical, tangible causes for vaginismus – notably infections and menopause. I’ve experienced pelvic tension from infections – stress and physical discomfort. He also briefly noted “Psychological causes,” but did not detail what some of these causes may be. (I’m uneasy about framing vaginismus as a purely psychological problem, as it manifests & can be treated physically. Nonetheless psychosexual counseling may be appropriate for some women with vaginismus. I’ll pass on that though…) This few-second crash course in causes of vaginismus was disappointing. More detailed lists of possible causes (the experience will vary from person to person,) is available on several websites, such as the list on vaginismus.com or the Vaginismus Awareness Network.

Dr. Oz then moved on to possible treatments for vaginismus – or rather, only one treatment, biofeedback. On the one hand, I was glad to see biofeedback for vaginismus covered in great detail, as I’ve had a positive experience using it, and it’s non-invasive. It is also an option for treating vulvodynia, on the caveat that not all vulvodynia patients benefit from it. But on the other hand, that only one treatment was covered in detail is another drawback, as he did not talk about other therapies available, such as at-home dilator use, counseling, physical therapy (which can be combined with biofeedback,) botox, or just leaving it alone and not seeking treatment. Biofeedback is not readily available to everyone who may be interested in it; trained professionals prepared to show patients how to use it may not be local, and even when it is an option, there’s a risk that it can be prohibitively expensive – the equipment setup shown on the Dr. Oz show isn’t cheap!

Dr. Oz showed Ronnie an insertible biofeedback sensor, to be used vaginally. Dr. Oz pulled Ronnie over to an examining table, although this being a mainstream daytime TV show, he did not demonstrate using the probe on Ronnie. Instead, as a stand-in, Dr. Oz proceed to demonstrate how to use a biofeedback device using external sensors intead, applied to Ronnie’s arms. The camera panned over to a laptop with biofeedback software running on the screen and…

…Wait a second… that looks familiar… wait… Huh?!

Woah!

Wait a second – I know that software! Wait, that white box that the wires are attached to – I know that thing! I think that’s the same setup we used at my physical therapist’s office. I recognize the interface. I believe that this biofeedback device is from the Prometheus Group. (It’s probably way out of price range for patients, so if you’re thinking about getting that set up, you’ll probably be better off looking for an alternative. I think that setup is really designed for clinical settings rather than at-home use.)

Oooh… I know exactly what’s going on there! Allow me to explain (TMI alert!!!):

Essentially, biofeedback shows you when your muscles are tensed and when they’re relaxed. My physical therapist taught me how to kegel efficently using biofeedback, although Dr. Oz never uses the word “Kegel” on the show. One of my problems was, since my pelvic floor was basically always in a state of tension, I couldn’t relax it on my on at first. I didn’t know what that felt like. The graphs from the biofeedback software showed me the difference between tense and relax states. I was pretty bad when I first came in – a tense and relax state had almost no difference in graph height. Eventually, I got better at it, and learned how to spend more time in a relaxed state, so the peaks and troughs displayed on the graph became bigger. Keeping the pelvic floor relaxed is still a struggle for me, since I must have spent years in spasm or near-spasm, but it’s better than it was.

If you’re apprehensive about inserting something into your vagina, especially in a clinical setting, don’t worry – You don’t necessarily need to insert a vaginal sensor in order to practice pelvic floor biofeedback. As an alternative, there are external sensors that stick to the skin instead. I have never used the insertible probe, I have always used external sensors for pelvic floor biofeedback. These external sensors can be applied to muscles around (not inside) the vagina, and with proper training the external sensors can be just as effective as the probe. External sticky pads are used once and then thrown away.  I felt absolutely no pain or discomfort from the external sensors. Wires connect the disposable sticky probes from you, to the white box, to the laptop.

Possible drawbacks to the external sensors are: They can be tricky to apply to the right spots, aren’t super-sticky (may fall off after awhile, but you’ll probably be done by the time that happens anyway,) and they don’t work when wet. (That means if you dilate while the external sensors are attached, be careful to keep them dry – don’t let lubricant get on them.) Nonetheless, they do work, and they do their job well.

Whether you go with the insertible probe or external sticky pads, the sensors measure muscle tension, I seem to recall the units of measure were in microvolts. There is a moving graph on the computer monitor. It will refresh every few seconds. When  your muscles tense and relax, the lines on the graph react in kind – more tension, the line on the graph rises. Relax, and the line on the graph falls. Eventually you learn the connection between the stuff on the computer screen, and what you’re feeling, so you learn how to control those muscles.

This particular software shown on the Dr. Oz program also has an audio feature. Once every few seconds (your PT can program the interval,) a voice will say “Work,” and you’re supposed to tense the muscles of interest on purpose. When the voice says “Rest” a few seconds later, you’re supposed to relax as much as you can. The graph will tell you if you’re on the right track.

The software on the show also has a save feature, so you can monitor your progress over time.

“Why are there two graphs?” For pelvic floor biofeedback, most of the sensors were attached to the muscles around my vagina, and one sensor was attached to my abdomen. So one graph measures your pelvic floor tension, one graph measure the abdominal tension. This is because when pelvic floor patients first learn how to tense & relax those pelvic muscles, they may be incorporating the abdomen muscles more than necessary. You don’t necessarily need to have both graphs on at the same time though.

I may be making this all sound more complicated than it actually is. When you’re actually having it done it makes sense, at least, after awhile, and so long as your therapist is well-trained.

At the conclusion of the biofeedback demonstration, Dr. Oz briefly mentioned that it can be used to learn how to relax in general. He also advised that vaginismic patients ask their OB-GYN about biofeedback. It’s not bad advice but… unfortunately in practice, for some reason, there are still gynecologists who do not know what vaginismus is or how it can be treated. There are still gynecologists who frame it as “All in your head, have a glass of wine and relax.” If you think biofeedback may be right for you, and your current gyn refuses to or is unable to help you, you may need to seek out another doctor, or you may need to seek out a different treatment, if you want one at all.

Overall, while the segment did biofeedback justice, I would have preferred to see vaginismus in general given more detailed coverage, or, to have seen the title for the segment changed from “Vaginal panic attacks” to “Treating vaginismus with biofeedback,” which would have been the more accurate title. The audience laughter was inappropriate and insensitive.

This coverage of sexual pain leaves much room for improvement.

Next Page »


Entries and comments feeds.