As a GP, I see too many young women suffer through painful sex

Painful sex is common. In my work as a GP, I see a steady stream of moderately uneasy 22-year-olds, underwhelmed by their sex lives and ashamed of it.

I see one, and then there’s a spate of their friends. They think there is something wrong with their body. They say sex has always been painful, and for some of them it’s now agony, but they grit their teeth and make the noises they have learned from movies.

Young women are presenting to GPs complaining of painful sex.

For some women it eventually becomes impossible. Some of them don’t know what it feels like to be physically aroused, after three or four years of sexual activity. That is a tragedy. To those 22-year-olds, I say the following.

It could be thrush, bladder irritability, pelvic muscle spasm, chlamydia, endometriosis. We will consider those things. But we must bear in mind that many young guys are watching porn sold to them by men who have a vested interest in dehumanising women. They're not exactly learning from the Sensei of Superlovers.

Professor Gail Dines, anti-pornographer scholar and activist, puts it simply: "Men learn about sex from porn, and in porn nothing is too painful or degrading for women."

Pain with sex is reported at something between six and 25 per cent of women, but research into the effect of increasing porn consumption on female sexual dysfunction is mostly anecdotal.

The anecdotes go like this: more and more women are reporting a first sexual experience that sounds like a guy copying something he’s seen in hardcore porn.

And the vagina remembers.

The thing with dyspareunia (penetrative sex that hurts) is that each painful experience entrenches subconscious fear and aversion, which leads to pain and dryness, which leads to fear and aversion, which leads to panic and frustration, which leads to pain and dryness, and so on.

Many women don’t tell their partner because they don’t want him to think he can't turn them on. Some guys don’t know their partner is in pain; she is too good at faking. They are trying to be good lovers but rather than asking the real, live woman in front of them, they choose to do their research online. Most just don’t know what to do when a woman’s vagina closes like double doors, which is what happens if you have enough painful sex.

The solution? Time.

The treatment for established dyspareunia is essentially to stop having penetrative sex for a significant period of time. Like, months. This is an excellent test of a relationship and takes an investment of trust, time and love. It’s also an opportunity for everyone to get really good at oral sex. At least that’s how I frame it when the jaws drop in dismay. You could also circumnavigate each other’s bodies and map all the erogenous zones, or at get really good at mahjong.

Investing in your next 60 years of sex is worthwhile and, really, why would you even want to be with someone who didn’t like making you happy-moan? The best kind of guy will accept the challenge.

Vaginas are clever; they have long memories. When the signals for impending sex come in they remember the pain and close up shop, which obviously makes things more painful. Resetting this response means the brain, nerves, vagina and vulva all need to forget that sex is like having your nails extracted while you have to keep smiling.

Gradual, calm, and enjoyable reintroduction of penetration by various methods is the key: her fingers, followed weeks after by his fingers under the guidance of her fingers. Lubrication is our friend, and should be purchased in bulk. The penis is last to the party, and sends a polite request for admission prior to his arrival.

Most of the time women complaining of painful sex do not have any physical abnormality, but it’s worth seeing a doctor to rule out some easily fixed culprits, particularly if you’ve previously had non-painful sex and now it's hurting. Pelvic physiotherapists can help with muscle retraining and relaxation. A psychologist can assist if anxiety is part of the problem.

I don’t like to use the word “should” but I’ll make an exception.

Sex should be fun and funny. It should be good. You should be able to express your desires, because they are good desires.

It’s okay to want foreplay without penetrative sex. It’s okay to not be ready for penetration three seconds after someone throws you against a wall. It’s okay to pause and chat a while, to say you don’t want anal sex, or to call time on painful sex. It’s okay to turn genitalia into puppets and reenact Les Miserables if it helps you get comfy with each others’ parts. If arousal sometimes takes 45 minutes of him touching your ankle while you watch Tangled, then so be it.

For only once you've mastered the rules can you break them.

Dr Elizabeth Oliver is a Sydney GP. She tweets at @thatladydoctor.

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