FINDING PLEASURE WITH CHRONIC PAIN
March 4, 2015
by Helen Frost
I used to love sex. I used to be bold and assertive in my desires. I loved the powerful feeling of taking my lover into my arms as he tried to leave for work, and drawing him back to bed or to the kitchen counter. I loved the noisy, awkward, funny where-do-I-put-my-arm element of sex. I loved the way sounds would burst unwilling from me, both intimately mine and unfamiliar. I loved the sweet moment of dissolution, that juddering unmaking of self, and the aftermath of liquid honeyed limbs.
I used to see my body as, among other things, a vehicle for my own pleasure and desire. But a year and a half ago this ceased to be true. I do not remember the instant when sex no longer was joyful for me. I don’t know if it was a moment, a traumatic jolt of pain, or a slow failing of my body that brought an end to the familiar easy comfort and pleasure of sex. I remember moments…
…It is early morning and in the half-light I am stretched on my side, playfully feigning sleepiness, in a position my partner and I favour for a languid morning fuck, only this time the slow rhythm of his penis brings with it sharp new unfamiliar pain. A few weeks later he comes inside me and his semen burns as it drips down the outside of my vulva.
These descriptors, even now, seem hyperbolic to me, even after reading other women’s accounts that use the same phrases; they feel melodramatic, ungainly on the page. Goldstein et al. quote a patient who describes the experience as “like having knives inside [her]” or another woman who describes the pain as having “a lit cigarette lighter” in her vagina. A series of metaphors are drawn out: tearing, stabbing, and burning. The odd thing is that, even as pain became the norm rather than the exception, I said nothing. As penetrative sex became something I dreaded, rather than initiated, I continued to have it without mentioning my discomfort to my partner. Perhaps I did this because I was still clinging tightly to the idea that “I am a woman who loves sex,” or because, despite being a feminist who studies rape culture, I had begun to internalize a terrible shame at the as yet unnamed failings of my body.
I increasingly came to experience my discomfort as a form of unspeakable or shameful contamination. My now almost continuously dry and uncomfortable vagina was something I simultaneously refused to deal with and couldn’t ignore. Finally, I went to see my OBGYN and told him my story, expressing my increasing anxiety. Handing me a mirror, we looked at my vagina together. He took a Q-tip and gently pressed my vulva and watched as I recoiled in pain. I will later learn that this is called the classic cotton swab test and is designed to show that the body is experiencing neuropathic pain, a painful response to normally non-painful stimuli. He reassuringly walked me through my anatomy: the pinkness of my vagina and vulva, the lack of discharge on my labia, that there were no immediate signs of an STI or a yeast infection. In fact, he assured me, all looked healthy. At that moment, like the first time I looked at my vagina at age fourteen, I was taken in by its loveliness, by the unpredictable folds of pink flesh. For the past few months I had been so disassociated from by own body by pain, that the relief of really looking at and acknowledging my physicality was overwhelming.
After some discussion of the contours and temporalities of my pain—at times continuous and at times unpredictable—I was given a diagnosis. Finally, I had a name for my condition: a form of chronic sexual pain (or dyspareunia) called vulvodynia. The clinical definition, however, is unsatisfyingly vague: “Vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder.” In another definition, generalized vulvodynia “appears to be a form of complex regional pain syndrome […], a neurological condition resulting from dysfunctional nerve fibres that overreact to normal stimuli and don’t turn off when stimuli end.”
As the definitions suggest, vulvodynia is a catch-all term, a diagnosis before a diagnosis, and yet it gives a name to and acknowledges that sexual pain is real rather than purely psychological or even normal, as it would have been understood until recently. The list of potential causes is long and uncertain: there may be genetic factors or an immunological problem, or the condition may be provoked by an allergy, pelvic floor dysfunction, neurologic sensitization, chronic yeast infections, or prolonged use of hormonal contraception. In my case, it seems that at some point my pudendal nerve was injured—perhaps through a minor, slightly embarrassing, injury like falling on my butt—and a tightening of the muscles on my pelvic floor exacerbated my pain.
Having a name for the pain was initially reassuring. It gave me a sense of mastery and control. This sense of control quickly dissipated: over the past year my vagina has become an overarching presence in my life. Not only because there is seldom a moment where I am not physically aware of it, but because the routine of OBGYN, physiotherapist, and psychologist visits has filled my time and slowly drained my bank account.
Once every two weeks I go to physiotherapy. I lie with acupuncture needles in my legs where, on a good day, my physiotherapist can insert two fingers into my vagina and palpate my pelvic floor, trying to release the muscles pressuring my pudendal nerve. She likes to interpret my pain as a reaction to my research. In her eyes, my vulva, vagina, and pelvic floor have been traumatized by my daily study of rape narratives and their representation in print culture. According to her, in my day job I see the penis as a weapon, so it is inevitable that my pelvic floor clenches at the possibility of allowing an instrument of violence to enter my body, seizing my pudendal nerve and creating the extreme pain I experience. In contrast, my psychologist, when we first met, called me vaginally retentive. Apparently, I am too much of an A-Type, left-brained person, painfully retaining my fear of intimacy, my desire for control, in the muscles of my pelvic floor. My OBGYN avoids talk of cause or cure entirely, but encourages me toward ever more dramatic measures: valium suppositories, neuro-inhibiters.
I am uncomfortably situated either between the hopelessness presented by my doctor (“it is time to consider this the new normal”) and the inadvertent accusation from others that this is somehow my fault, that I am not in touch with my emotions, my research is too traumatic, I need to learn to relax. In fact, one doctor presented vulvodynia to me under the rubric of sexual dysphoria. This description enacts a rather predictable displacement, away from the body and toward the feminized world of emotions.
Dysphoria suggests a sense of unease, dissatisfaction, or anxiety. When used to describe sex, the word implies a discomfort in one’s body, a sense of depression or anxiety in relation to sex. Thus, although vulvodynia is experienced as physical, this formulation tacitly suggests that the root causes of chronic sexual pain are in fact psychological. Through the lexicon of sexual dysphoria, as well as other language that links sexual pain to emotional instability, the physical experience of pain is displaced onto the woman’s psychology, linking sexual pain to a kind of latter-day sexual neurosis or hysteria, wherein the woman’s physical symptoms are described by psychological causes.
My intention here is not to imply that women don’t often carry their stress in their pelvic floor, or that emotions cannot have corporeal effects. Rather, I want to note how this language that made overt and tacit links between sexual pain and emotional instability or bad feelings was alienating for me as a female patient, not only because it retrospectively pathologized my relationship to emotion and to sexuality, but because it involved an inadvertent discourse of blame that served to negate my own experience of my body.
Above all, what has been most alienating about these encounters with medical health practitioners, all of whom have been kind and genuinely concerned, has been a surprising absence of discussion of my own relationship to sex and my personal experiences of desire. In part, the tethering of sexual pain to emotion allowed health workers to project onto me a negative relationship to sex and my body without ever asking me how I feel about sex and desire—even though the wide range of women who experience this kind of vulval or vaginal pain includes women who have previously had healthy happy sex-lives as well as women for whom sex has always been impossible. In addition, the medical practitioners above all prioritized penetrative sex in their approach to my treatment; the best outcome of their ministrations was to make my body penetrable to a penis. As a result my encounters with medical health professionals inevitably defined both the vagina and female desire in relation to a penis.
The most common concern expressed by my doctors was not for my experience of myself as a sexual being, but for the impact sexual pain would have on my relationship: “Take this seriously,” one doctor said, “or you will lose your partner.” With the pressure to conform to the demands of heterosex, my vulval and vaginal pain seemed to be accompanied by an inevitable end to sex, the dissolution of my relationship, and an eventual future of sexlessness. For many of these practitioners, no matter how well intentioned, it seemed that the preservation of penetrative sex was also the preservation and reinforcement of my heteronormativity, whether I desired or felt connected to that normativity or not.
Yet there have been moments of relief, joy, and clarity. Nicola Gavey’s Just Sex? The Cultural Scaffolding of Rape analyzes the causes of unwanted sex through an analysis of the cultural scaffoldings of heterosex, considering why women have sex that is unwanted, semi-coercive, but which they are unwilling to define as rape. Once I began feeling sexual pain, but still wanted a vehicle for my desire for my partner, I felt trapped into the inevitability of heterosex. Although my experiences of sex with my partner and with previous partners have luckily always been kind, playful, intimate, and consensual, reading Gavey’s book had me consider why, as heterosexual women, we often think of penetrative sex as the only real sex. Opening myself to the understanding that sex did not have to mean penetration (an extremely obvious but surprisingly difficult realization) allowed me to find potential for real sexual pleasure again. While my encounters with medical health practitioners largely made me feel erased as a female subject, feminist discussions of sex helped me find a provisional way back to my own desire and my own body.
Many of these realizations are so obvious they seem negligible in retrospect but were essential in the moment. For example, a good friend reminded me that I needed to get used to having sex with myself in this new painful body before even thinking about sex with my partner. This allowed me both to accommodate pain and understand that, at least for me, this pain still allowed for pleasure. Where previously, shame, a sense of failure, and fear of pain had often gotten in the way of a quickening of desire, approaching sex through affirmative consent made it possible to return to having sex with my partner. Mapping my body and that of my partner though a constant conversation of consent helped us find a rhythm and discourse for a new way to navigate my pain and increasingly find pleasure.
“Does this feel good, and this … what about here … can I touch you here?”
Yes, Yes … Oh Yes.
More than a form of intimacy, I often find sex to be radically individuating. Toni Morrison once described the experience of sexual pleasure as iron fillings being drawn towards a magnet, a cluster of strength that breaks apart, giving way to a “hurricane rage of joy [and] sorrow.” At that brink, before I tumble into that beautiful moment of non-being, I meet myself briefly.
Helen Frost is a PhD candidate at the University of Alberta, her work focuses on the representation of rape in South African print culture and the manner in which emotion circulates public spheres.
Acknowledgement: Thank you to Zeina Tarraf and Shama Rangwala for reading and commenting on various iterations of this post, and for helping me think through a number of these questions.
Ahmed, Sara. The Cultural Politics of Emotion. Edinburgh and New York: Routledge, 2004.
Gavey, Nicola. Just Sex? The Cultural Scaffolding of Rape. East Sussex and New York: Routledge, 2005.
Goldstein, Andrew et al. When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain. Cambridge: Da Capo Press, 2001.
Haefner, H.K. “Report to the International Society for the Study of Vulvovaginal Disease Terminology and Classification of Vulvodynia,” J Low Genit Tract Dis 11.1. (2007): 48-49.
Morrison, Toni. Sula. New York: Vintage International, 1973.