I’ve long had a chronic vaginal pain condition. When I was 24, my boyfriend and I tried to have intercourse for the first time; though I was prepared to experience some discomfort, the pain was unbearable. Over the next year, we tried to have penetrative sex multiple times, and it always felt like my muscles were spasming, so I’d jerk away in pain. It confused me. After all, I’d been taught that sex is supposed to hurt in the beginning. “Usually pain is glamorized when female leads lose their virginity,” Steph, a woman with vulvodynia, a condition that causes chronic vulvar pain, says. Pop culture’s penchant for painful first-time sex scenes made it difficult to recognize that the agony I experienced was abnormal.
Sex Education, the good-natured British comedy that premiered on Netflix in January, follows a shy, insecure teen named Otis (Asa Butterfield) who reluctantly uses the information pressed on him by his sex-therapist mother (Gillian Anderson) to become his high-school’s resident Dr. Ruth. Sex Education’s premise allows the show to portray a wealth of subjects, and its plot line about painful sex discussed the issue in a way I’d never seen before. The plot concerns Otis’s classmate Lily (Tanya Reynolds), who wants to lose her virginity before graduating, but screams in pain and pushes her partner away when they try to have intercourse. “It’s like my vagina has lockjaw,” she says to Otis, embarrassed and confused about why her vagina “betrayed” her. Though Otis isn’t a licensed sex therapist, he diagnoses Lily with vaginismus, a condition that causes the muscles at the opening of the vagina to involuntarily contract, making penetration painful and sometimes impossible.
“Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors,” a 2016 study published in the Journal of Sexual Medicine, notes that between 10 and 28 percent of American women experience chronic vulvar pain and that such experiences are still shrouded in stigma and shame. Because penetrative sex is considered key to healthy heterosexual relationships, women who can’t “perform” often blame themselves. When researching the effects of vulvodynia for their 2008 article “If Sex Hurts Am I Still a Woman?” Kathryn Ayling and Jane Ussher met women who referred to themselves as “‘worthless” and who “privilege[d] their partner’s need for coitus over their own need for pain-free sex.” These women, like so many others, internalize the harmful idea that painful sex is their fault. Many don’t even mention experiencing pain to their partners because they’re embarrassed. A close friend of mine wanted so badly to be “normal” that she consented repeatedly to sex, clenching her teeth through agonizing pain because she thought it was easier than admitting the truth.
That’s one reason online support networks for women with vaginismus were teeming with excitement that Sex Education highlighted this all-too-common problem. “Seeing such a taboo diagnosis on TV is [a relief],” says Miki, who belongs to a private Facebook group about vaginismus. Another woman, Kate, says, “I was really happy and shared a clip of the scene with my partner and my mother.” For more than a few of these women, this episode of Sex Education was the first time they saw conditions that cause painful sex addressed at all. The feeling of isolation these women experience is compounded when even medical professionals are skeptical about vaginal pain. Some doctors tell women that the pain is “all in their heads,” that enjoying sex will make the pain go away, or that uptight personalities and need for control are the real cause of their discomfort.
When I told my own gynecologist that I couldn’t tolerate a pelvic exam and that penetrative sex hurt, she said I just needed to relax. She prescribed sedatives and told me to come back for an exam once I’d taken them. But even after I returned, loopy and tranquilized, my muscles spasmed in pain with the introduction of the smallest speculum available. My primary care physician was similarly dismissive when I told her that I experienced excruciating pain with penetration—that it felt like there was simply nowhere to go inside my vagina. She laughed, a look of confusion crossing her face. “Are you sure your boyfriend knows what he’s doing?” she asked, before telling me to stop avoiding pap smears. And many doctors remain ill-equipped to diagnose chronic vulvar pain: A 2013 study published in the Sexual and Relationship Therapy Journal found that 35 percent of American women with provoked vestibulodynia (another type of chronic vulvar and vaginal pain) had to visit doctors’ offices more than 15 times before getting a concrete diagnosis.
I saw multiple specialists and gynecologists, where I was given multiple diagnoses: vaginismus, vulvodynia, vestibulodynia, and hypertonic pelvic floor muscle dysfunction. With each new diagnosis came different medications and treatments, a trial-and-error process that eventually brought me to a specialist in vulvo-vaginal disorders who diagnosed me with an abnormally thick, rigid hymen and potential vaginal muscle dysfunction. Dismissing vaginal pain is a part of a larger pattern of women’s pain interpreted within medical establishments as an emotional, rather than physiological, issue. In “The Girl Who Cried Pain,” a 2001 article in the Journal of Law, Medicine, and Ethics, Dianne Hoffman and Anita Tarzian write that “women are more likely than men to have their pain attributed to psychogenesis whether or not that is a cause of their pain…for those women whose pain is exacerbated by emotional disorders, the healthcare provider’s bias against psychological contributors to pain may lead them to undertreat the pain.”
Though vaginal pain can be caused by trauma and psychological stress, and the pain itself can begin a psychological cycle that’s difficult to break, it doesn’t mean the woman has control over her physical symptoms.
Otis initially falls into this trap: When Lily first describes her pain and disappointment she felt when it ruined the “perfect” night, he suggests that her Type A personality is at fault, that her expectations of perfection caused her body to tense. Lily is confused by the idea that she is subconsciously cock-blocking herself: “But I want to have sex,” she tells Otis. “So why would I do that?” To illustrate, Otis takes Lily to a steep hill and tells her to ride her bike down it so she can experience the release of giving up control. If only it were that easy: Like Lily, many women with vaginismus are told they can banish their pain just by relinquishing control, but treating these conditions is much more complex.
Though vaginal pain can be caused by trauma and psychological stress, and the pain itself can begin a psychological cycle that’s difficult to break, it doesn’t mean the woman has control over her physical symptoms. “Stop stressing” is almost always useless advice. Muscle spasms, pelvic floor dysfunction, increased sensitivity in nerve endings, and hormonal side effects from birth-control pills can all initiate or contribute to the pain. Prescribing an attitude change to resolve these conditions invalidates real pain, as well as access to information and treatment options. “Not one doctor had ever said the word [vaginismus],” marvels Sarah, who only learned there was a term to describe her symptoms when she watched Sex Education.
She’s had excruciating pain during intercourse for the last eight years, and every doctor she’s seen has told her to ignore the pain, stop stressing, try to relax during sex. But Lily and Otis prompted her to track down information and join an online support network. “It gave me a name,” she says. Yet, Sarah is concerned that Otis’s treatment plan perpetuates some of the myths and stereotypes about chronic vaginal pain that have always keep women silent and clenching their teeth. Sarah and others with vaginal pain worry that it might reinforce the very myths that have kept us from researching, diagnosing, and taking our pain seriously. Still, Sex Education opens the door for women living with vaginismus and other conditions to have honest conversations about their symptoms—an important step toward acknowledging the prevalence of chronic vulvar and vaginal pain and beginning to break down the stigma and silence.