Common Female Sexual Problems 
Associated with Painful Sex

by
Mary M Buxton LCSW, Inc.
AASECT Certified Sex Therapist

(Note: Links are to headings on this page which can also be reached by scrolling.)
 

Vaginismus or Unconsummated Marriage

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Please email Mary or
phone 408.371.4847.

Definition

Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina when penetration with penis, finger, tampon, or speculum is attempted.  The disturbance causes marked distress or interpersonal difficulty. 

There are varying degrees of intensity.  There is not a sensation of contraction and the woman is unaware of these muscle spasms.  Vaginismus may occur with or without pain. This condition can be absolute or situation specific.  Careful history taking by the sex therapist and exam by an OBGYN are helpful in making this diagnosis.

Prevalence of pain during intercourse (includes vaginismus) 14.4% (Laumann et al., 1994).

Causes

The cause of this conditioned muscle contraction is sometimes hard to determine.  Usually there are several influences that contribute to the condition occurring.  Please see section above:  General Factors that Contribute to Female Sexual Disorders. 

Treatment

The treatment can include exercises that address the following steps:

  • Watch sexuality education videos and read books
  • Partner may be requested to attend some or all sessions
  • Positive sexual mind-set
  • Discuss negative sex training, expectations, and traumatic experiences that you associate with sex
  • Relaxation training
    • Learn and practice deep breathing
    • Learn progressive muscle relaxation
  • Develop awareness and voluntary control over the tense muscles
  • Kegels exercises
    • Practice penetration with graduated dilators or fingers with lubrication
    • Possible referral to Physical Therapist skilled in treating pelvic floor muscle problems
  • Beginning Intercourse
    • Woman astride position with graduated steps, employing the learning above
    • Stop, calm yourself and talk about any discomfort
    • Develop conscious awareness of thoughts before, during and after a practice session

The most important element in this treatment program is that the woman patient has a sense of control. 

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Vulvar, Vaginal and Pelvic Pain

Definition

Dyspareunia is recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.  The disturbance causes marked distress or interpersonal difficulty.  The disturbance is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder except another sexual dysfunction and is not due exclusively to the effects of a\ substance (drug or medication) or a general medical condition.  The types are lifelong/acquired, generalized / situational, and due to psychological factors/due to combined factors.

Prevalence of pain during intercourse (includes vaginismus) 14.4% (Laumann et al., 1994).

Causes

There are a variety of physical and psychological conditions that can cause vulvar and pelvic pain.  Please see section above:  General Factors that Contribute to Female Sexual Disorders. 

This is a multidimensional pain problem that is influenced by a variety of factors including thoughts, emotions, behaviors, and couple interactions.  Women afflicted with this disorder report significantly lower levels of sexual desire and arousal, lower frequencies of intercourse, and lower orgasmic success than women without dyspareunia. 

Dyspareunia is often accompanied by a hyper tonicity of the muscles in the outer 1/3 of the vagina and pelvic area that occur as a conditioned response to the pain. 

Careful history taking by the sex therapist and exam by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems are essential in making the diagnosis and beginning treatment. 

Treatment

The treatment can include exercises that address the following steps:

  • Watch sexuality education videos and read books or workbooks
  • Physician assessment and treatment
    • Careful exam and subsequent medical treatment by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems
    • Referral to a pain management anesthesiologist for specialized medications when necessary
  • Partner may be requested to attend some or all sessions
    • Develop a joint understanding of the multidimensional treatment for this problem and reduce blame and shame
    • Validate couple strengths and encourage non-intercourse lovemaking to maintain the emotional bond
  • Positive sexual mind-set
    • Discuss negative sex training, expectations, and traumatic experiences that you associate with sex
    • Discuss impact of sexual pain condition on the individual and the sexual and couple relationship
    • Develop coping statements to help you develop an active rather than a passive attitude toward this pain problem
  • Relaxation training
    • Learn and practice deep breathing
    • Learn progressive muscle relaxation
  • Develop awareness and pain management techniques
    • Identify where the pain is located through self-exploration
    • Keep a Pain Diary
    • Learn cognitive restructuring to cope with the before, during and after phases of the pain experience.  This technique will help you to react differently to your pain
  • Develop voluntary control over the tense muscles
    • Kegels exercises
    • Practice penetration with graduated dilators or fingers with lubrication (pain level permitting)
    • Possible referral to Physical Therapist skilled in treating vulvar and pelvic floor pain and muscle problems
  • Beginning Intercourse
    • Woman astride position with graduated steps, employing the learning above
    • Stop, calm yourself and talk about any discomfort
    • Develop conscious awareness of thoughts before, during and after a practice session

The most important element in this treatment program is that there is a multidimensional approach to this treatment.

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Sexual Aversion Disorder

Definition

Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

Prevalence: Sex is not pleasurable 21.2% (Laumann et al., 1994)
Pain during intercourse 14.4% includes vaginismus (Laumann et al., 1994)
Trouble lubricating 18.8% (Laumann et al, 1994)

Causes

There are a variety of physical and psychological conditions that can cause sexual aversion.  Please see section above:  General Factors that Contribute to Female Sexual Disorders.

Treatment

  • Gradual, slow pace of treatment
  • Developing boundaries to protect physical and emotional safety
  • Challenging Negative Sexual Beliefs
  • Developing Positive Sexual Attitudes and Motivations
  • Assertion training
  • Conditions for Good Sex
  • Graduated massage, self touch and partner touch exercises

The most important element in this treatment program is that there is a slow pace of treatment based on the client’s sense of safety and comfort with proceeding to the next step.

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Sexual Arousal Disorder

Definition

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.  The disturbance causes marked distress or interpersonal difficulty.

Causes

There are a variety of physical and psychological conditions that can cause sexual aversion.  Please see section above:  General Factors that Contribute to Female Sexual Disorders. 

Treatment
  • Addressing relationship, physical and medical factors that contribute to the problem
  • Challenging Negative Sexual Beliefs
  • Developing Positive Sexual Attitudes and Motivations
  • Assertion training
  • Conditions for Good Sex
  • Graduated massage, self touch and partner touch exercises
  • Exploring fantasy and erotica

Problems with Sexual Desire and Frequency 

Problems with sexual desire and sexual frequency are some of the most common and complicated concerns that cause individuals and couples to seek sex therapy. 

Definition

Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity.  The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.

Prevalence

Studies report Hypoactive Sexual Desire diagnosis ranges from 14 - 63%.

Causes and Barriers

  • Biological
    • Hormonal factors, health/major illnesses, street drugs, medications, and age and aging
  • Emotional
    • Religious, cultural, and family messages about sex.  Self and body image concerns, inhibitions regarding sexual fantasies, sexual trauma history, masked sexual orientation issues, lack of information, unrealistic expectations and fears of intimacy and closeness, and lack of differentiation from family of origin or from partner.
  • Relationship
    • Stored anger, resentment and chronic conflict, need for power and control, not attracted to partner, disagreements about conditions and reasons for sex, inability to negotiate differences as a fundamental relationship problem.
  • Unrealistic Expectations
    • Initial infatuation stage vs. deeper, more calm stage of attachment (not all-consumed with sex).  Real love is built on communication and intimacy.  Sex becomes a part of the whole relationship, not the center of it.
  • Lifestyle / Culture
    • Life in the fast lane, role overload, fatigue, unrealistic expectations for sex, body image and relationships from media influence.

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Treatment

Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below.  Others won’t.  There is usually a hidden part of sexual problems, the emotional part that is unique to each individual and /or the couple.  Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.

Improving Communication About Sex

Do sex checks.  State what I want in positive respectful terms.  Talk about sex more often.  Listen carefully and non-defensively to what my partner has to say.  Be willing to try what my partner suggests while respecting my own sexual limits.   Refrain from blame and criticism.  Praise my partner daily.   Talk about my resistance and hesitancy to communicate about sex.

Good Sex Takes Effort Once You’re Past The Infatuation Stage of Relationship

  • Sexual excitement is made not born
  • Cultivate sexual mindfulness

Finding Time in Your Busy Life

  • If you don’t make an effort, forgetting to have sex can become a habit
  • The key to a good sex life within a busy life is planning

Finding Couple Time and Making Sex a Priority

  • Ask for help and say no.  Divide the labor.
  • Find couple time - overlap shifts, extend day care, meet for lunch, cancel appointments, enforce bedtime, use the media, use baby sitters, relatives and friends or trade with other parents.
  • Regular date nights, 15 minute face to face talks daily and romantic weekends away.

Conditions for Good Sex

  • Turn off the TV, computer
  • Go to bed at the same time, and earlier in the evening
  • Light meals and little or no alcohol
  • Feeling rested and connected
  • Candlelight and flowers?

Restore Touch & Affection So That Touch Does Not Equal Sex

  • Eye contact
  • Touch gently during conversation
  • Sit close on couch
  • Spoon
  • Hold hands

Romantic Love Starter Kit - Cultivate Good Feelings

  • Say “I love you”
  • Send me a card in the mail
  • Bring me a flower
  • Do a chore without being asked
  • Go for a walk and talk with me

My Sex Tackle Box - Be prepared!

  • Lock on the door
  • White noise or radio near the door
  • Phone off in bedroom
  • Special underwear & sleepwear
  • Massage oil
  • Videos, erotic books & magazines
  • Birth control & lubes

Better Sex Through Chemistry?

  • Sex is more than just chemistry
  • Drugs may reduce or enhance libido
  • Consult with your physician

Where to Get Help

  • Many people often need the boost of professional help to get the many aspects of their sexual concern sorted through and resolved.
     
  • I offer individual and couple counseling services with a specialization in sex and couple therapy.
     
  • For referrals to a sex therapist in your area, contact www.aasect.org

________________________

Adapted from:

  • Clinical  Update on Sex Therapy, course notes, Linda De Villers, Ph.D.
  • Cognitive-Behavioral Pain Management for Dyspareunia:  A multidimensional Perspective, S. Bergeron, PH.D., 2000.
  • Diagnostic Criteria from DSM-IV,American Psychiatric Association, 1994.
  • Great Sex for Moms, Valerie Raskin, M.D., Simon & Schuster, 2002.
  • Hot Monogamy:  Essential Steps to More Passionate, Intimate Lovemaking, Love, et al, Plume, 1999.
  • The Mother’s Guide to Sex: Enjoying Your Sexuality Through All Stages of Motherhood, Anne Semans & Cathy Winks, Three Rivers Press, 2001.

2/17/15

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Mary M Buxton LCSW, Inc. - Sex & Couple Therapy - Licensed Clinical Social Worker  #LCS 7780
15951 Los Gatos Blvd., #14, Los Gatos CA 95032 -  Phone: 408. 371.4847 -  Email Mary

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