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A while back we wrote about a national sex survey that found one-third of women experienced pain during sex. There were skeptics back then who thought, nah, that can't be possible, otherwise we'd be having a nationwide conversation about how to fix such a huge problem. But now, the lead author of that study, Debby Herbenick, a researcher at Indiana University, co-director of the Center for Sexual Health Promotion, and a sexual health educator at the Kinsey Institute, confirms those numbers in a follow-up survey.
We discuss these surprisingly high numbers, and other new findings, in the second episode of our new podcast, The Checkup, which is just out at Slate.com here. (To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)
The theme of podcast #2: "Matters Below The Waist." This segment features frank talk about sex problems — and some solutions. We delve into Herbenick's fascinating research on pain during sex and more (including personal insights from one of our hosts...) and speak with a physical therapist who specializes in various treatment options that can help women deal with this rarely discussed but incredibly widespread problem.
Not to leave men out, we also explore a little-known disorder called Peyronie's disease, in which the erect penis becomes crooked, sometimes making it difficult to have intercourse. (Yes, this came up during the Bill Clinton impeachment era, and there's more on that in the podcast.)
Herbenick's initial survey of sex in America was the largest nationally representative study of sex in the country; her team surveyed 6,000 men and women, ages 14-94, and asked them about their sexual behavior.
Results of the latest survey (which Herbenick says were presented at an International Society for the Study of Women's Sexual Health annual meeting) are expected to be published in several months.
In the meantime here, lightly edited, is more from my interview last week with Herbenick, also the author of several books, including Read My Lips: A Complete Guide to the Vagina and Vulva and Sex Made Easy: Your Awkward Questions Answered-For Better, Smarter, Amazing Sex:
DH: We did another national survey of sex in America. And this time, knowing that we had this stark difference between how women and men experience pain during sex – only 5% of men reported any degree of pain, and most of theirs was mild, too. We did ask a series of follow-up questions. This time, for people who did experience pain, we collected information about how long the pain lasted, where in their body it was located, whether they told their partner, what they did in response to the pain, and we also separated it by vaginal and anal intercourse.
RZ: What else did you find?
So the first thing that was important is the 30% number is still there. And that’s important because it does show that it’s a stable and reliable estimate, which some people in the media had questioned [whether] it could really be that that number of people experienced pain --
Gee, I wonder what gender those members of the media were, the ones who questioned that number?
You might be surprised. The person who expressed the most surprise was a female editor at a very well respected newspaper. She said that if this many women were experiencing pain, we would know, because women would be talking about it.
I’m biting my tongue right now.
Yeah, a female reporter wanted to write on this, but her editor said this would be coffee talk, I guess, if it were the case, and it’s not. So – but, it did drive me to want to learn more, and make sure this number was right, so we were driven to ask more questions and follow up. And so that number is stable and reliable. And again, we see most of the reports being mild. I can’t remember all of the numbers off the top of my head, but a sizable number of women don’t tell their partners they’re in pain, and it’s mainly for reasons of not wanting to kill the mood, not wanting to interrupt sex, and some say they know it’s fleeting and know it’ll pass. One woman was kind of funny and made a comment that it would take longer to tell her partner than it would for sex to finish.
Oh my god! Is that where we are?
DH: A reality for some couples, sometimes sex is very quick. So there were a lot of reasons women didn’t tell their partners, and for the small number of men that experienced pain, there were similar reasons that they didn’t tell their partners. They didn’t want to ruin the mood, or hurt their partner’s ego.
And what about the secrecy part, which really intrigues me, in addition to not telling their partners, did they seek outside help, did they go to a doctor?
Mostly they’re not. When I imagine a lot of this pain, I imagine most of it isn’t pain that needs to be addressed with the doctor. Some of it is.
Maybe not a doctor, maybe a physical therapist – which is what I did. [You can read my personal saga on getting treated for painful sex here.]
You know, I think there’s a lot of things going on. Some of this could be a common experience, some kind of bumping up against the cervix, or kind of rough, vigorous, exciting sex that just feels that way – but it could be pain related to endometriosis, or how the floor muscle issues, to vulvar skin issues – there’s no doubt that at any given time, when you have undiagnosed or poorly diagnosed conditions that are causing the pain...
I think women who experience moderate to severe pain or even small fleeting pain that bothers them, or occurs from time to time, it’s always worth bringing to the attention of a healthcare provider who can look into it. And if they can’t find anything, they can’t find anything. But they shouldn’t give up. Because sometimes it takes visits to multiple providers to get good information. Whether it’s a diagnosis or just, hey, you’ve got through menopause and maybe you should be using a vaginal moisturizer. Or lubricant is good for many couples too.
Was there anything in this new data that struck you?
The prevalence of pain during anal intercourse struck me. That’s probably not terribly surprising to many people, you know, the anus doesn’t lubricate on its own, I think we still lack a lot of good data on anal sex, to know how many women engage in sex because they want to versus they just want to please their partner, but very high rates of reported pain during anal sex, around 70%. More often, moderate pain.
What does this say about our cultural climate?
We generally often shake our heads and think, gee, why don’t women desire sex in the same way that men do? And many women, most women do desire sex, though everyone’s desire goes up and down, but I think when the overall experience of sex is dotted by pain, even when it’s small, in terms of time frame, even when it’s mild, it’s just a different way of experiencing sex. And I think we lose sight of that sometimes, that if you do experience some discomfort from time to time, you’re going to be more likely to say, “uhh, I don’t know if I feel like doing that today.”
Right. You know, it makes me think, I wonder if the providers are aware of the extent of this? I know women who had an initial discussion with a doctor, for instance, and the doctor said, “Oh, you had a baby, this is how sex is going to be from now on. It’s not going to be as good.” Or, “Oh, you just went through menopause, suck it up. It’s not going to be as good as it was when you were twenty.” And that’s not really so.
Yeah, that’s a common story that I hear. Some years ago I was on an episode of the Tyra Banks show, and there were some of us who started talking as experts on the show, and one of them was an OB/GYN, and someone asked about sex after pregnancy, that was her immediate response, that nothing is the same after you have a child. And although it’s true that life changes, and bodies change after you have a child, I don’t think that’s sufficient information. Because things can be improved, and that doesn’t help to women, to say “Welcome to the new norm”. And the same is true for menopause.
So given the last research and this new data, what’s your takeaway on this particular issue?
My takeaway is that some degree of pain is common for women in sex. Fortunately, most women don’t experience chronic, ongoing pain, but some do, and all women, regardless of how rarely or how often or how significant the pain is, deserve attention for that, and should be bringing it to their health care provider, and also should be talking about it, or it would be helpful if they talked about it with their partners....
You know, sometimes I think we shield our partners from what our experience of life is like, whether that’s what sex is like or what our health is like when we go to the gynecologist’s...or make a baby or go through menopause, but giving a partner insight into your life is helpful. It helps you become more intimate, it helps them understand what your lives are like, and you hopefully have more compassion and empathy for each other, so you can be more caring, and hopefully your partner knows to be careful and sensitive and gentle.
And I assume it’s kind of this vicious cycle where you have pain, you don’t talk about it, you anticipate the pain the next time, you still don’t talk about it, and probably the pain gets worse with your anticipatory anxiety over it. And you dig yourself into a kind of hole over it, I’d imagine.
Yeah, our study didn’t ask on that, but certainly other studies have focused on this anxiety that women will experience in anticipation of sex that may make sense. And it makes sense – it’s no different from other things. If sometimes you had food that was awful, like if you had a friend that was a bad cook, and half the time you ate it, it was awful, you know how your mouth waters for something amazing, versus “oh gosh, I have to eat it because my friend made it.”
This program aired on September 2, 2013. The audio for this program is not available.
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