Sexual Healing by Dr. Margarita Kressin

Because of what I do, people often open up to me and people ask sex questions. Recently, (let’s call her) Norma complained to me that it hurt to have sex (official medical term is dyspareunia). Nothing hurts any other time, but definitely with sex, there is pain.

How long has it been going on?

10 years.

10 years?! Why did you not get help?

I thought it was just part of getting older. (She is in her late 50s) Besides I didn’t think there was anything we can do for it. So I just dealt with it. But now it’s getting worse that we have had to stop since I was in tears.

Dyspareunia is a common condition and can actually happen at any age. It can be due to a multitude of factors from fibroids, STDs, vulvar issues or vulvodynia, vaginal dryness and atrophy, or muscles of the pelvic floor issues. An examination is necessary to rule out any life-threatening condition.

I told the patient to see her gynecologist to rule out any gynecologic pathology and if there is nothing they could find, and if she still has pain with sex, then I can certainly see her.

She was thankful that there could be a reason and a name to her condition. She was most relieved to find out that it was just “not in her head” and that it wasn’t because of her husband.

The lesson is that pain is never normal. Unfortunately there are cases where it can be the normal if this becomes a chronic pain condition. There are studies that show that if we can get to the patient soon after the pain starts (in this case — pelvic pain seen within a two-year onset) there is a greater chance of curing the patient compared to a patient who was seen after two years. So the second lesson is that the sooner you get your pain taken care of the better the chances that this gets cured.

Libido or sex drive in women is a difficult thing to paint plainly. There have been three sexual models that have been proposed to try to explain sexual function in women: the Linear Model, Basson’s circular model and Rosen’s biosociophysical model.
 
The linear model goes like this: We start with being sexual stimulated (visually or tactile), then get aroused which heightens. Then orgasm comes and then recovery. Few women, we think, respond this way. This fits more males and how they respond sexually.
 
The Basson model takes a neural women (neither aroused nor stimulated), but then arousal can come via foreplay, massage, etc. … then libido follows. We think more women respond this way than the linear model.
 
A good analogy to this theory is like going to the gym. Let’s face it, very few of us want to exercise (author included). But we get dressed, put on our shoes, drive to the gym or go outside and begin exercising. Whether we run, use the elliptical or treadmill, or use weights, in the beginning it is somewhat painful. And, at times, we try to talk our way out of it. Then the heart rate goes up. We start to feel good. We start sweating, get into a rhythm, and actually get into it. Sometimes you feel so good, you keep going, longer than what you had planned. Then the run ends, you're sweating, you feel good, the endorphins are going and then you say, "Wow, that was awesome! Why don’t I do this everyday?!" Sex is like this.

I tell my patients and their partners to not expect that the women will start initiating sex. But, sometimes, all it needs is a little foreplay, a little motivation. Help her get her sneakers on and put her on the treadmill. The goal is to enjoy it once the treadmill starts going, and for her to stay on it long enough to feel good.