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Painful sex and mental health have a surprising relationship

You're not alone. And it's not all in your head.

6/20/2021 1:35:00 PM

You're not alone. And it's not all in your head.

You're not alone. And it's not all in your head.

"You don't have to just have bad sex for the rest of your life."Even patients with known physical sources, like being prone to infection, can develop this anxious, self-perpetuating aversion to penetrative sex. They get nervous about causing another infection, can't relax the pelvic floor fully, which can leave urine in the bladder — thus making infection more likely.

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More often, Dr. Bahlani sees patients who've reached a level of debilitating distress because they've been punted to different medical professionals who fail to treat the whole picture of a person, instead making assumptions that don't solve the issue.

"Patients are kind of gaslit a little because there's so few people who can actually diagnose and treat these disorders," she said. Often, imaging and lab tests can appear perfectly normal even when the pain generator is more physiological than psychological."We need to show patients that both these components go hand-in-hand and are treatable. You don't have to just have bad sex for the rest of your life."

The cultural influences of painful sexYou can't just address the physical disease and expect everything to be OK though, Ossai said. Healing the psychological and socio-cultural factors connected to chronic pain with sex requires as much validation of an individual's specific circumstances and environment.

"Social and cultural narratives do play into it. But it also depends on what culture you're coming from," said Ossai. For example, both she and Dr. Bahlani serve various religious groups in their communities, with patients who are from Catholic Latinx, Jewish Orthodox, and South and East Asian religious backgrounds. While it's important to never generalize or stereotype, often,"if you grew up in an environment where there's a lot of cultural shame surrounding sex, it can be a little bit of a steeper climb."

"Social and cultural narratives do play into it. But it also depends on what culture you're coming from."On the whole, everyone struggling with these chronic pelvic penetrative pain disorders can benefit from expanding definitions of what constitutes as sex.

Medical research and patriarchal society, Ossai noted, put penetrative sex on a pedestal as the ideal of sexual functioning. Asone recent paperon women with endometriosis (another source of chronic painful sex) pointed out that"no data on orgasm rates in different sexual activities are available." Treatment that encouraged couples to try noncoital sex did, in fact, raise rates of satisfaction.

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Societal pressures around penetrative sex can make patients feel like they're not"normal" or"fixed" until they can have it, which might exacerbate stress and anxiety-induced reflexive pelvic floor clenching that often worsens pain.

"We are all educated culturally, in school, at home, in heterosexual society, that sexy time is just penis in vagina, that's always in the back of a person's mind," said Ossai."If we just started by saying: Sex is an activity that you engage in where you explore your pleasure, that gives you joy, happiness, fulfillment — and you can experience sex with nipple play, vaginal play, anal play, mouth play, whatever."

But also, practitioners must be respectful of a patient's unique socio-cultural expectations of sex and what successful recovery means to them. For example, certain religious beliefs view sex as being only for procreation, not pleasure. So some women seeking treatment won't feel fully healed until they're able to get pregnant from penetrative sex.

Some studies do suggestthat women of Hispanic origin are more likely to develop vulvar pain symptoms than white women, though again, the exact reason for this higher prevalence is unknown. Regardless of whether it's from biological, environmental, or cultural factors (or any combination), the more important data point is that they were also less likely to seek treatment even with access to healthcare.

As a first-generation American born to Nigerian parents, Ossai comes from a family that practiced female genital mutilation for generations. She worries clinicians (particularly white ones) can impose their biases and assumptions on patients with different cultural backgrounds, creating a judgmental environment that doesn't treat them on their own terms.

"We should focus on the patient's distress as a measure. You might have a patient with pain with sex, but it doesn't impact their pleasure or sexual functioning. Or a patient who has a very mild pain with sex that is incredibly distressing to them. That should inform how we address the pain," Ossai said.

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Spreading education on pelvic pain can be key to working through socio-cultural obstacles.Image: vicky leta / mashableBiases in medicine can have serious impacts on how effectively certain demographics and communities are treated for conditions,especially Black women

. In her experience, Ossai has seen the cost of that when Black women come to her with chronic pelvic pain."They're just ready. They're like, 'I'm tired of this.'" Read more: Mashable »

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