By Reina Stewart

For many people, sex is an important part of life. But what if sex hurts? What if it keeps hurting, but you continue to do it? Is this common for young women?

These questions were explored in a recent study by Elmerstig, Wijma, and Swahnberg (2013). Their research on this topic works to broaden our understanding of the various ways sex may be experienced and the prevalence of painful vaginal intercourse.

What did the authors address?

Previous research regarding the prevalence of pain during and/or after vaginal sex is not extensive [1]. The main goals of the study were to identify the prevalence of pain during and/or after vaginal intercourse among young women, to determine the proportion of women who continue to have vaginal intercourse regardless of pain, and to consider facilitating factors. It has been suggested that the initial pain may be an involuntary muscle contraction of the outer vagina, which may serve as a defense against a perceived threat (vaginal intercourse in this case), and that may lead to chronic pain [3]. It has also been suggested that striving to be the ‘perfect woman’ may drive young women to continue engaging in painful vaginal intercourse [2].

What did they do?

Questionnaires developed by the researchers were distributed to women (18-22 years old) attending private and public schools in Southern Sweden. The central questions addressed included:

  • Do these women experience pain or discomfort during and/or after vaginal intercourse?
  • Do they continue to engage in this form of sex regardless of pain?
  • Do they pretend to feel pleasure despite discomfort?

What did they find?

  • Roughly half (47%) of the women who had performed vaginal intercourse reported feeling pain during intercourse

Why did women continue to engage in intercourse despite pain?

  1. Prioritizing the pleasure of their sexual partner
  2. Feeling less important than their partner during sex and sexually unsatisfied
  3. Struggling to decline sex

The above items (1,2, and 3) were even more frequently experienced by women who experienced pain during vaginal intercourse and did not stop regardless of pain, compared to those who felt pain during vaginal sex and chose to discontinue.

The most commonly identified reason for enduring uncomfortable vaginal intercourse was “I don’t want to spoil things for my partner”, and one of the most frequently selected reasons for pretending to enjoy this form of sex regardless of pain was “the partner may be disappointed if I don’t enjoy vaginal intercourse.”

What do their findings indicate?

The principal message of this study is that pain during vaginal intercourse is frequently felt by young women. Many of these women continue to have vaginal sex while feeling pain, and a common reason for this is important to consider: they are prioritizing the sexual pleasure of their partner. This notion is alarming and may contribute to a cycle of sexual anguish that these women experience.

Moreover, it has been suggested that pain felt during sexual encounters may be (or may lead to) a vaginismus-like response [3]. More specifically, repeated intercourse may reinforce the production of pain, which may act as a defense mechanism, and perpetuate the perception of sex as threatening [3]. Eventually, this experience may lead to chronic sexual discomfort [1].

The common experience of painful vaginal sex among young women demands the consideration of contributing factors. In one study, a common version of the ideal female construct includes a desire to please and satisfy others [2]. This belief, along with other societal norms, may contribute to sexual dissatisfaction and feelings of inferiority by females [2]. Essentially, it is crucial that medical professionals stress the importance of female’s sexual satisfaction to gain more traction as a relevant issue and worthwhile cause outside of a clinical environment.

What could be done differently next time?

The limitations of this study provide some direction for future research. The primary limitations are as follows:

  • The study is a cross-sectional design, which means that change across time could not be examined.
  • The findings may not represent the entire Swedish population (or the global female population for that matter) as no large cities were included in the sample, nor was northern Sweden

Note:

  • The word “pain” is used interchangeably with the word “discomfort” throughout the study.
  • Vaginismus is the involuntary muscle contraction of the outer vagina.

Sources:

[1] Elmerstig E, Wijma B, Swahnberg K. Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. J Psychosomatic Obstetrics & Gynecology 2013;34:82–89.

[2] Elmerstig E, Wijma B, Sandell K, Bertero¨ C. ‘‘Sexual pleasure on equal terms’’: young women’s ideal sexual situations. J Psychosom Obstetr Gynecol 2012;33:129–34.

[3] van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:328–31.

 

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