Earlier this week, a patient told me she had been experiencing pelvic pain. As I gathered more information, I asked her if she had had discomfort or pain during sex.
"Yes."
"Was it to the degree that you had to stop?"
"No."
"Did you want to stop?'
"Yes."
This is unfortunately not uncommon. Countless patients have matter-of-factually talked to me about pain with sex that they simply ignored for the sake of pleasing their partner(s) or avoiding "awkwardness". Many more don't necessarily have pain, but sex never quite feels good. They don't enjoy it, and they don't look forward to it, but they keep doing it. Still others don't take important precautions - using condoms for STI prevention, receiving the HPV vaccine, utilizing their contraceptive method of choice - because of some other person's opinions and priorities.
Even as an OB/Gyn, I have to typically pry a little for my patients to share these issues with me. These aren't often presenting problems but more likely details discovered during discussion. When patients do begin to share, many times it's preceded by a "TMI" disclaimer.
Women are rarely taught to value their sexual pleasure and safety and instead consider it an afterthought or even a nuisance.
Our society shapes this attitude from an early age. Insufficient sexual education in and out of school plays a big role in this. It was a long time ago now, but what I remember of sex ed in school was learning about the basic functions of menstruation for women and erection and ejaculation for men (in addition to seeing a bunch of frightening pictures of the results of STIs). The focus for women was our reproductive cycles. Women are just supposed to figure out how to be discrete with our tampons and pads so we don't make anyone else uncomfortable, and when it comes to sex, not have intercourse so we don't get pregnant. The focus for men was what actually happens during sex, with the end goal of sexual activity framed as male orgasm. In some places this type of education has changed for the better, but in other places it has become worse. In addition to being incredibly heteronormative, sex ed often completely ignores the concept of pleasure for women.
Media messaging worsens the situation. This has become more and more clear in the context of the #metoo movement. So many news stories focus on the poor man whose life has been ruined by public allegations of sexual assault rather than the woman who was violated. (Note: I am in no way suggesting that sexual assault can only be committed by a man or that all victims are women. People of all genders may be assailants or victims.) The repeated emphasis on Brock Turner's former success as a Stanford swimmer, for instance, overshadowed the suffering of his victim, Chanel Miller (who recently released her memoir "Know My Name"). We see responses to stories like these such as "What's the big deal?" "It's not so bad." "She probably wanted it." "That's what happens when you get drunk." The message to women and girls is that our bodies are not our own and instead exist for the taking. If we dress a certain way, act a certain way, say a certain thing, have a certain sexual history, or go to certain places, we are told we are just offering ourselves up for the sexual gratification of someone else. It doesn't matter if it results in physical, emotional, and/or mental pain for us.
There are commercials on TV all the time about the many online services where men can go to obtain medications for erectile dysfunction. It's great that men have this type of medication available and that it's easy to access, but when was the last time you saw a commercial that had anything to do with women's sexual health?
When politicians take on patriarchal roles to limit access to contraception and abortion services, they are telling us that women should only have sex to make babies. Men, though? They can have sex with whoever they want whenever they want. Several "pro-life" male politicians have been implicated in affairs, sexual assault, and pressuring their wives or mistresses into pregnancy termination.
No one is immune to this. I knew I wanted to be a physician before I was ever sexually active, yet I still made my share of poor decisions and also many times responded in unhealthy ways to sexual treatment toward me.
We have to make this better.
We need to empower women and girls to know that they are in charge of their bodies. Comprehensive sex ed should be universally available and include information on sexual enjoyment and safety for all people. The concept of "enthusiastic yes" rather than "lack of no" should be a part of all discussions of consent. Journalists need to structure their work in a manner that considers the humanity and worth of victims and doesn't celebrate the accolades of criminals. Pharmaceutical research should focus on improving sexual health for all genders. Political decisions regarding sexual and reproductive health should be guided by medically-accurate information. These are just some of the steps of society-wide change toward sex positivity.
Know that your sexual health is important. If you're having sex, it should be fun and not distressing or painful. You should take steps to keep yourself safe, like using condoms and receiving the HPV vaccine. Talk to your physician or other healthcare practitioner about any concerns you have, and please know that there's no such thing as too much information for your OB/Gyn.