Pain with sex can happen to young women, too
She continued to try for years with the same partner without successful penetration; the only other person who knew was him. “I really thought I was the only person in the whole world” with the problem, Fleischacker said. “I just felt really alone and I felt really embarrassed about it. I felt like I needed to do everything to keep it secret and not talk about it with people because it just felt like this very uncomfortable thing to explain.”
After learning that an acquaintance had dealt with similar issues throughout her marriage, she eventually worked up the courage to bring it up to her primary care physician. “Her initial reaction was: Does your boyfriend know how to have sex?” Fleischacker said.
Her boyfriend did know how, which she explained to her doctor. Penetrative sex was just too painful for her and they’d 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 said. This is often shocking to many women — and their partners — who have grown up thinking sexual problems affect only older women.
“We make a lot of incorrect assumptions that younger adults have easy, totally satisfying sex all the time, when the reality is that many people in that age group do struggle,” said Mieke Beckman, a social worker and certified sex therapist at the University of Michigan, who works with many women in their 20s and 30s.
“Female sexual dysfunction is a big umbrella term for any sexual health concerns that a woman is bothered by,” said Rachel Rubin, a board-certified urologist with fellowship training in sexual medicine and an assistant clinical professor in urology at Georgetown University. It “encompasses sexual health concerns like problems with desire, problems with arousal, problems with orgasm and, of course, issues surrounding pain,” 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 specialized residencies such as obstetrics and gynecology or urology.
“There is a very poor education when it comes to sexual pain conditions or sexual medicine in general,” especially when it comes to younger women, Rubin said. “Too often [they] are told it’s 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 an instructor of obstetrics and gynecology at Harvard Medical School, agrees. “Many of the conditions associated with female sexual dysfunction … are too frequently attributed to the post-menopausal state, but many in fact can occur before menopause, and women can go decades before getting a diagnosis, resulting in years of pain [and] emotional suffering.”
A 2008 study found that 24.4 percent of women between ages 18 and 44 experienced what they described as distressing sexual problems, just slightly lower than the 25.5 percent of women ages 44 to 64. A 2016 study estimated that 41 percent of premenopausal women experience sexual dysfunction globally. A large proportion of these women have pain.
“We have shown that by the age of 40 about 8 percent of women will experience vulvar pain that has lasted for 3 months or longer,” Bernard Harlow, professor of epidemiology at the Boston University School of Public Health whose team looked at pain that limited or prevented intercourse, wrote in an email. “In an earlier publication that studied women 18-64 years of age, we showed that the large proportion of prevalence is concentrated in women in their 20’s and 30’s.”
There are several causes of female sexual dysfunction — even for a given woman, multiple factors may be contributing. For example, “typically there [are] three reasons why people have pain with penetration — at least superficial pain with penetration — problems with hormones, problems with muscles and problems with nerves,” Rubin said.
Fortunately, good treatments are available. They include oral and topical medications, muscle injections and even surgical procedures, depending on the condition. These medical treatments are often given with physical therapy and sometimes sex therapy.
“Realistic expectations are [that] sex should not hurt, that treatment should be given in a biopsychosocial framework — this is not all in your head — but what it does to your head is very significant because it does lead to lots of trauma and distrust of…
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