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pain in the V – a look at vulva/vaginal pain

by – Kai, lead somatic sexologist

Women often suffer in silence with genital pain conditions. In this blog article, I approach the topic of vulva vaginal pain. I use the term VV when talking about the vulva vagina. I often find it easier to use VV as it represents the whole of-the female genitals. Just referring to the vagina would be anatomically incorrect. There is so much more to female genital anatomy than just the vagina. Some vulva/vagina humour here.

Genital pain can affect our whole body. Pain can disempower you sexually. Especially if your sexual experiences have always been pleasurable. I understand the disempowerment of genital pain and empathise well with it. I also have lots of experience and knowledge in relation to genital pain conditions. Many woman find it difficult to approach health care professionals to discuss their genital pain. This results in isolation, shame and generally a lack of support. This is often frustrating for clients – they blame themselves for the problem. For some woman, genital pain prevents them from dating and new sexual partners. Others live in a sexless world and cannot even bare to self-pleasure.

Many woman seek me out as a last resort because they have not been able to feel relief elsewhere.

Sometimes genital pain conditions have a pathological cause and it’s important to diagnose and manage these. If a pathological cause has been ruled out by a gynaecologist or medical practitioner, then physical-emotional interconnections might need to be explored. The complexity of vulva/vaginal pain responses can be attributed to negative sexual stimuli, phobia of vaginal penetration, cultural and religious elements, situations of sexual abuse, previous rough sex that caused pain, negative emotional response, lack of adequate arousal and lubrication, sexually transmitted infections, scar tissue/adhesions … and much more.

More so recently, one school of thought for woman who experience pain during sex relates to whether or not their partner is circumcised. A circumcised penis can lead to painful penile vaginal penetration. Such painful penetration can play a role in ongoing chronic vaginal pain. The theory is that a circumcised penis lacks the natural gliding mechanism of the foreskin inside the vagina. This may result in a different friction response between the vaginal wall and penis.   Additionally, nerves have been lost in a circumcised penis and scarring is present. Because of this many men apply and require vigorous stimulation. They thrust harder and deeper compared to penises with a foreskin. If your partner is circumcised this could be a cause of your pain. See article here on male circumcision on the sexual enjoyment of the female partner. Or O’Hara and O’Hara’s work here for an easier read.

Genital pain for woman is real. It disheartening to hear stories from woman who have gone through life experiencing sexually related or chronic genital pain. Some woman have faced situations where cause of there pain has not been pin pointed. Some have been told that its all in their head. Others are offered physiotherapy, psychotherapy such as cognitive behavioural therapy, and drugs to manage pain which generally don’t offer much relief. The scientific evidence on such therapies is limited. Some reasons for this include assessing and researching the subjectivity and nature of pain, the cause of pain, shame of pain, lack of research in these areas. Mostly I think such therapies don’t have a holistic approach and fail to address the many components that are attached to vulva/vaginal pain conditions.

Research from the U.K. suggests 1 in 10 woman who are sexually active report painful sexual experiences.

When you are unable to enjoy sexual pleasure because of pain, this creates a spiralling and negative affect on your sexual wellbeing and relationships. Often woman who have chronic genital pain will avoid sexual contact with their partners, or forego sexual pleasure all together. Many Woman get to a point where they have exhausted all professional avenues of clinical treatment such as physiotherapy, or vaginal dilation. Often a clinical/medical approach to these conditions increases sexual anxiousness and fails to help. Another reason woman may not get relief is that many healthcare professionals lack formal tools in dealing with sexual pain and sensitivities talking/managing genital issues.  Often, woman are exposed to a healthcare system that is time poor and does not have the ability to manage chronic genital pain conditions such as vulvadynia or vaginsmus.

Genital pain conditions are incredibly complex. Somatic sexology and sexological bodywork offers a combination of holistic modalities that can help woman overcome their pain. Such modalities include talking and exploring their sexual being, sexual mindfulness and meditation, breath work, relaxation exercises such as body erotic massage, vulva/vaginal remediation massage (external and internal) with desensitisation, learning how to use arousal to increase vulva/vaginal lubrication. Exploring movement and positions for comfort. Teaching your partner slow/soft penetration. Differentiation between pain and pleasure and harnessing brain neuroplasticity changing the way you feel and think about your pain. Exploring and learning about your vulva/vagina can also provide foundations to work with. Many of the modalities we offer are not available from a medical practitioner, specialist or physiotherapist.

Unfortunately, there is no magic solution to managing such conditions. It takes time and patience. As well as someone who understands and is willing to work through the sensitivities with you. Pain is subjective so what works for one woman may not work for another. It is essential to explore and work through many facets of managing or eliminating such pain.

If you are someone who experiences painful sex or unable to self-pleasure due to pain why not contact me to discuss some of these modalities further. I am a firm believer that everyone should be able to experience pleasure in life. If you would like to read more about pain click here to access this article.