Sex-related pain can also happen to young women

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When Noa Fleischacker, 30, from Chicago, first had sex in college with a young man she had started dating, she described the experience as “impossible”.

“It was like something was wrong, there was nowhere for me to go. It was like ‘what in the world is going on?’ said Fleischacker.

She kept trying for years with the same partner with no penetration success; the only other person who knew was him. “I really thought I was the only person in the world” with the problem, Fleischacker said. “I felt really alone and I felt really embarrassed about it. I felt like I had to do everything to keep it a secret and not talk about it with people because it was just a very uncomfortable thing to explain.

After learning that an acquaintance had dealt with similar issues throughout her marriage, she finally worked up the courage to tell her primary care physician. “His first reaction was, does your boyfriend know how to have sex? said Fleischacker.

Her boyfriend knew how to do it, which she explained to her doctor. Penetrative sex was just too painful for her and they had found other ways to be intimate.

Fleischacker is one of many women in their 20s and 30s who suffer from female sexual dysfunction, experts who care for women in this age group have said. This is often shocking to many women – and their partners – who grew up thinking that sexual problems only affect older women.

“We make a lot of incorrect assumptions that young adults have easy, completely satisfying sex all the time, when in reality, many people in this age group struggle,” says Mieke Beckman, university certified social worker and sex therapist. from Michigan, who works with many women in their 20s and 30s.

“Female sexual dysfunction is an umbrella term for all sexual health issues that bother a woman,” said Rachel Rubin, a board-certified urologist with a background in sexual medicine and assistant clinical professor of urology at the Georgetown University. This “encompasses sexual health issues like desire issues, arousal issues, orgasm issues, and of course pain issues,” she said.

Even many doctors don’t recognize that young women can have sexual dysfunction, Rubin added, largely due to a lack of education in many medical schools and even in specialty residencies such as obstetrics. and gynecology or urology.

“There’s very poor education when it comes to sexual pain conditions or sexual medicine in general,” especially when it comes to young women, Rubin said. “Too often [they] they are told that it is all in their head and that they should have a glass of wine and relax.

Sara Ann McKinney, director of the Vulvar Clinic at Beth Israel Deaconess Medical Center and professor of obstetrics and gynecology at Harvard Medical School, agrees. “Many of the conditions associated with female sexual dysfunction…are too often attributed to the post-menopausal state, but many can actually occur before menopause, and women can wait decades for a diagnosis, resulting in years of pain. [and] emotional pain”.

A 2008 study found that 24.4% of women aged 18-44 had what they described as distressing sexual problems, slightly less than the 25.5% of women aged 44-64. A 2016 study estimated that 41% of premenopausal women suffered from sexual dysfunction. globally. Many of these women suffer.

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“We have shown that by the age of 40, about 8% of women will experience vulvar pain that has lasted for 3 months or more,” Bernard Harlow, professor of epidemiology at the Boston University School of Public Health, whose l team looked at pain that limited or prevented intercourse, wrote in an email. “In an earlier publication that studied women aged 18-64, we showed that the large proportion of prevalence is concentrated among women in their 20s and 30s.”

There are several causes of female sexual dysfunction – even for any given woman, several factors can contribute. For example, “there are generally three reasons why people have pain on penetration – at least superficial pain on penetration – hormone problems, muscle problems, and nerve problems,” says Rubin.

Fortunately, good treatments are available. They include oral and topical medications, muscle injections, and even surgery, depending on the condition. These medical treatments are often combined with physical therapy and sometimes sex therapy.

“Realistic expectations are [that] sex shouldn’t hurt, this treatment should be given in a biopsychosocial setting – it’s not all in your head – but what it does to your head is very important as it leads to a lot of trauma and mistrust of the medical community,” Rubin said.

Pelvic floor physiotherapy, which focuses on the muscles of the pelvic floor, is a mainstay in the treatment of several conditions affecting sexual function, particularly pain. The goal of therapy for young women is often to help relax the pelvic floor muscles to allow for easier insertion, although this may vary depending on the specific diagnosis. The therapist will first assess the patient and then suggest home exercises in addition to the work done during the sessions.

Unfortunately, a major problem is the limited number of pelvic floor physiotherapists. Plus, costs can add up for weekly therapy appointments.

“It’s a huge expense, and I already have an amazing health care plan,” said Nicole, 26, who lives in New York and asked that her last name not be used for health reasons. privacy. Nicole was diagnosed with pelvic floor dysfunction after seeking a second opinion for painful sex. Despite the high cost out of pocket—sessions cost $200 each until she hit her $2,500 deductible—she kept coming back because she saw small, but noticeable improvement.

Beyond the price, many women are unaware that these treatment options exist. If they realize this, they are often faced with waiting lists of several months due to a shortage of qualified providers.

“I have a lot of patients who say to me, ‘I didn’t even know there were doctors doing this,'” McKinney said. that you might not be able to google and get to those blogs where they talk about “going to a vulva specialist”. ”

For young women who have access to treatment, most can expect significant or complete improvement, doctors and therapists have said. “It just depends on what happens and for how long, but with the right intersection of medical and physical therapy care, many of our patients don’t experience any pain,” said Stephanie Prendergast, pelvic floor physical therapist and co-founder of the Pelvic Health and Rehabilitation Center. “They do what they want to do. It’s terrible that many women suffer for as long as they do. … I can’t stress enough not to give up.

A 26-year-old woman, who lives in DC and asked that her name not be used for privacy reasons, first considered her excruciating pain normal for first sex when she was 20. suffer before I started realizing it wasn’t normal.

“I was just too tight, too dry – just something wasn’t working. So I thought I was in the wrong setting, with the right person, in the mood,” she says. “But as I kept trying to have penetrative sex with other people in future encounters, I basically had the same problem.”

When she first brought up the subject with a doctor, she told him to use more lube and continued the visit. Eventually, her pain became so debilitating and isolating that she avoided sex.

“I just had such a negative association with having sex, talking to a partner about the possibility of having sex – I just didn’t talk to partners about the possibility of having sex because it was like this secret that I knew it wouldn’t be work, but they didn’t know it yet,” she said. “It’s frustrating to feel that the relationships didn’t progress or ended because of this thing that was really out of my control at the time.”

Finally, at age 25, she went to a new gynecologist who diagnosed her with pelvic floor muscle dysfunction and referred her for pelvic floor physical therapy. After months of treatment and exercises at home, she finally felt comfortable going out again. Now 26, she has been with her boyfriend for 11 months and has regular, painless sex.

The gynecologist “was super validating and to this day [she] is the best doctor I’ve ever seen, and I told him. I was like, ‘You’ve really changed my life,'” she said.

Netana Markovitz is a resident physician in internal medicine at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston.

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