Tags: experts, female sexual dysfunction, FSD, guest post, health, medicine, pain, pelvic floor dysfunction, relationships, sex, sexual dysfunction, sexual health, vaginismus
[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.
Tags: blogging, health, interstitial cystitis, media, news, pain, sex, sexual health, television, vaginismus, vulvar vestibulitis, vulvodynia
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.
Tags: archetypes, books, experts, female sexual dysfunction, Feminism, FSD, myths, pain, psychology, relationships, sex, sexism, sexology, sexual dysfunction, Sexuality, Sleeping Beauty, stereotypes, vaginismus, what
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.
[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?
Tags: BDSM, blogging, communication, female sexual dysfunction, FSD, little help from my friends, pain, sex, submission, vaginismus, vulvodynia
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,
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.
Tags: dilators, guest post, media, relationships, school, sex, vaginismus
[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!
Tags: biofeedback, experts, female sexual dysfunction, FSD, health, media, pain, sex, sex education, sexual dysfunction, sexual health, television, TMI, vaginas, vaginismus
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?!
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.