When Sex Isn’t “Normal”: women’s sexual problems, common myths and how to get help

By Emma Mathews

beehive sexual wellbeing clinic chester

Sexual problems can be tricky to talk about. Women frequently encounter problems for years before getting the courage to ask for help or try and google their symptoms and end up more confused than when they started due to conflicting and often inaccurate advice.

Some women choose to confide in friends who give their own biased opinions on what is “normal” and what to do about the problem. Studies have shown a correlation between increase in anxiety since the age of the internet; too much choice leading to increased uncertainty, leading to worry and anxiety.

 

 

Myths and social media

Social media has also had a dramatic impact on anxiety and mental health generally, with people comparing their own lives and relationships with the posts of social media contacts, leading to the need to continuously portray happiness and perfection, which includes their romantic relationships. I have come to believe there is a factory somewhere producing men who are “wonderful, kind, funny, clever, supportive, brilliant dads, brilliant son in-laws, amazing” to just mention a few of the partner-related superlatives I frequently notice posted on social media. These partners are also described as “my rock” and “my soulmate”. Alternatively, perhaps peoples’ relationships aren’t as perfect as they like others to think, but when everyone else has such virtuous partners, who wants their social contacts to know their own partner is just a mere human with faults and irritating habits?

 

We also have the problem of media portrayal of women and their bodies, including what their genitals should look like, leading to women feeling as though they’re not normal. There is no normal, genitals come in all shapes and sizes and are unique to you. Pornography images of women portray neat (often photo-shopped) vulvas, this most certainly is not normal.

support for sexual wellbeing chester

 

Another misrepresentation is what should happen during sex. Lots of women believe that they should be able to reach climax during penetrativesex, however only about a third of women achieve climax this way. Those who don’t often believe there is something wrong with them. I often see women (and men) who believe they are not having sex, or “proper sex” if it doesn’t involve penetration. Sex does NOT have to involve a penis in a vagina, if it feels good, then do it, if not then there are many other ways to find sexual enjoyment and fulfilment, with someone else or on your own. However, some women do want to be able to have penis in vagina (PIV) sex, for various reasons, including conception and are unable to.

 

Vaginismus and dyspareunia

Vaginismus is a condition where the muscles in the vagina involuntarily contract (tighten), which means they are unable to have PIV sex, and for some women they are also not able to use tampons or have medical interventions, for example a smear test, where a device called a speculum needs to be inserted. There are varying degrees of this problem, some women can insert tampons and have speculum exams, it’s just when it comes to PIV sex that they run into a problem. So, there are varying degrees of the problem and it can be situational. Another problem is pain during PIV sex, this is called dyspareunia. Some women experience this pain at the entrance, for others they feel the pain deeper in the vagina. Often these problems happen at the same time, it makes sense that if PIV sex is painful then the muscles in the vagina will tighten to protect the body from the pain, and if the muscles involuntarily tighten, it makes sense that this will be painful if something is inserted, be that a penis, tampon or speculum.

 

There are a variety of physical reasons why vaginismus and dyspareunia occur including urinary tract infections, yeast infections, sexually transmitted infections, endometriosis, pelvic inflammatory disease, lichen planus, lichen sclerosus, eczema, psoriasis, vaginal prolapse, difficult childbirth and age-related hormonal changes causing reduced lubrication and vaginal dryness. There are also many psychological reasons why vaginismus and dyspareunia occur including fear that PIV sex will be painful or cause damage, fear of pregnancy, performance pressure, negative or traumatic past sexual experiences, negative or traumatic past medical procedures or childbirth and negative messages about sex during childhood and adolescence.

 

If experiencing vaginismus or dyspareunia, it can be helpful to see a gynaecologist to check out physical causes and a psychosexual therapist to check out psychological causes. Often sexual problems seem to be physical, as people experience physical symptoms. However often there is a psychological aspect that keeps the problem going. For some women, even if the sexual difficulty is purely physical in nature, the problem may have impacted on their sexual relationship and they may wish to discuss this and be given strategies on how to get their sex life back on track. Key questions to consider when thinking of seeking help are “has the problem impacted on my relationship, or made me avoid relationships?” “Does the problem make me feel anxious, depressed or afraid?”

Vulvodynia

Vulvodynia is a condition where there is pain, burning and discomfort in the vulva that cannot be linked to a specific cause. This pain may or may not be triggered by touch and may be felt in one area or across the whole vulva. Women with vulvodynia often have a normal looking vulva, there may be no visible signs of a problem, however, redness and inflammation can sometimes be present, and itching is common. Typical vulvodynia symptoms may be intermittent and short-lived, or symptoms can be persistent. Although symptoms can seem to come from nowhere, there can be a link with sexual intercourse, certain types of exercise, inserting tampons, irritating contraceptive creams or spermicides, sitting for too long, using perfumed soaps, wearing non-breathable underwear, wearing tight-fitting trousers, contact with chemicals such as chlorine, presence of bacteria, residue urine or pressure on the bowel or bladder. It can also be caused by injury or irritation to nerves, muscle spasms, changes in hormone levels, being hypersensitive to yeast infections, allergic reactions, excessive use of antibiotics or vulval cells responding in an abnormal way to trauma, infection or inflammation.

 

Desire, arousal and problems reaching sexual climax

sexual problemsThere are various physical causes for these difficulties, arousal depends on the body’s circulatory and neurological systems. Problems that can cause arousal and climax problems include reduced blood flow to the vagina, pelvic nerve damage, infection and thinning or drying of vaginal tissues. Hormones also play an essential part in arousal, therefore menopause, birth control medications and pregnancy can impact on arousal. Some antidepressant medications can also impact on sexual desire and arousal, as can diabetes and cancer treatment medications. There are also many psychological reasons why women don’t feel desire, don’t get sufficiently aroused or reach climax during sex. These include relationship issues, poor body image, depression and anxiety and psychological trauma.

 

Another common reason however is lack of adequate sexual education, poor communication with sexual partners and unrealistic expectations. From a biological perspective, women are more likely to feel desire and initiate sex around the time when they are ovulating, as this is the time that they are likely to conceive, this is our natural biological make-up. However, there are other emotional drivers when it comes to sex, the drive to maintain a relationship for stability and security. Men of course are different; they can create a pregnancy at any time of the month; therefore, their biological drives often give them the desire to initiate sex more frequently. I often see heterosexual couples who come to me saying it’s nearly always the man who initiates sex, they see this as a problem, and the woman is left feeling as though she is not normal, or the man feeling as though he is not desired. Basically, does it actually matter who initiates sex? So long as the context is right, women are perfectly capable of becoming aroused. Context can include many factors - has there been relationship conflict? Are you under stress? Do you have young children who are in and out of your bedroom constantly? Do you have teenagers in the house and worry they will hear your sexual activity? Is there good sexual communication in terms of you being able to express what you like sexually, and does your partner actually listen to this? Do you trust your partner? Do you feel desired by your partner? And many more…

 

I’m often asked what is normal in terms of frequency of sexual intimacy, there is no normal. Some couples are sexually intimate a few times a week, other couples may be happy with once or twice a year, this just needs to be negotiated as a couple, and sometimes compromise needs to be reached. And remember when I say sex, it does NOT have to include PIV sex! When sexual problems occur or poor sexual communication becomes a problem often couples get into a pattern of not only avoiding sexual contact but also avoiding any physical affection as one or both of the couple worry that an intimate gesture will lead to sex, they start over-thinking and put too much meaning to gestures of affection. As humans, feeling bonded with others and physical touch is essential for our wellbeing, so when physical contact is avoided, this can impact on our emotional wellbeing and relationship.

 

Remember, there is no ‘normal’ when it comes to sex and there is no such thing as ‘proper’ sex, if it feels good, is consensual, is with another human adult, or on your own, its okay. If, however, you’re a woman and you feel you have a sexual difficulty then talk to a psychosexual therapist or gynaecologist. The Sexual Wellbeing Clinic team can assess, support and offer treatment to help you to overcome your sexual and relationship problems and help you take the next steps towards achieving a happy, healthy sex life.

https://www.sexualwellbeingclinic.com

Who is on the Sexual Wellbeing Clinic Team?

Beehive Healthcare Chester | Health and Wellbeing Centre | EmmaEmma Mathews

Psychosexual TherapyEmma can also offer a comprehensive range of treatments for psychological problems, see the following link for further details

https://www.emmamathewstherapy.com

mr ash alam chesterMr Ash Alam

Gynaecology: Ash can also offer a comprehensive range of treatments for gynaecological problems, see the following links for further details

Women's Health & Wellbeing Clinic

https://www.merseygynaecologist.com

Ian Pearce

UrologyIan can also offer a comprehensive range of treatments for urological problems, see the following link for further details