Tonight was historic for sufferers of vulvodynia and their partners as ABC’s news show, 20/20 highlighted sexual pain.  Dr. Timothy Johnson interviewed my colleagues (urogynecologist Dr. Andrew Goldstein, physical therapist Amy Stein, and vulvodynia advocate Chris Veasley of the National Vulvodynia Association) plus 2 women who have experienced sexual pain disorders.  Those 2 women, plus Chris, were able to cure their vulvodynia and go on to have normal sexual intercourse with their partners.

I was, of course, very happy to see this common but misunderstood set of conditions covered on national television.  I was a bit disappointed, though, that the segment did not include the perspective of a health psychologist or sex therapist.  There are researchers and clinicians that work with women that have pelvic pain disorders and their partners.

Here’s why a sex therapist can be helpful.  The women in the program complained of psychological problems such as feeling inadequate as a female, lacking support from a partner, embarrassment about the condition, and fears about ever being able to have normal sex again.  All of these problems are things that a few sessions with a psychologist can help.  Not only that, but a sex therapist with a background in health psychology can help women with sexual pain to relax and cope better with discomfort.

The fact is, of course, that if women are steered in the right direction by organizations like the NVA, their gynecologist, or an online search, they can find medical help for the problem of sexual pain.  There are surgery, topical solutions, and medications available.  However, in my clinical experience, some women achieve partial relief.  They are able to have more comfortable sex, but not necessarily pain free.  They also are sometimes left with damaged self-esteem.

Also, a study just released in JAMA confirms that chronic pelvic pain is sometimes associated with past childhood sexual abuse.  It isn’t that the pain is in the woman’s head; it’s that past abuse makes her susceptible to this and other health problems.  Physicians and physical therapists, therefore, need to assess their patients in this regard.

Aside from myself, there are definitely other sex therapists that are willing and able to help women with sexual pain; the best resource I know of is AASECT.

Kind regards,

Dr. Stephanie Buehler

Over the past week, a number of articles on sexual abuse were drawn to my attention by various sexologists.  The first was about a TV special called “Hot for Teacher,” which features Mary Lou Letourneau, a married teacher who slept with her teenage student (whom she met when he was in second grade), for which she was imprisoned.  After she was released, and having been divorced by her first husband, she married the boy and had children with him.  The TV special suggests that since she married him, all must be fine, that there is nothing unique about her relationship with someone so young.

Next, my colleague and fellow sex therapist Stephen Braveman, MFT, was featured in an article in Rolling Stone on a teenage boy who was molested by his teacher.  Outwardly, the relationship may have appeared to be consensual and even condoned.  Deeper investigation, however, shows that the boy became extremely distressed over the relationship.  It affected his grades, his relationships with peers, and his mental health.

Finally, as I was casually researching topics today for both of my blogs, I happened across two more articles, one in the Star News and one on a NYC news website about female teachers molesting students.  Both the Rolling Stone article and this one have a similar theme, that there is a prevalent myth that boys are unaffected by sex with a woman in a position of authority.  In fact, it is because of this myth that many boys may not come forward if they have been bothered by a similar sexual experience.

Another myth is that boys cannot be coerced into sex.  But erection is an automatic response to stimulation; it doesn’t necessarily take consent (more…)

Today I met with one of my favorite colleagues, Dr. Michael Krychman.  Dr. Krychman is a Hoag Hospital physician who specializes in sexual medicine and cancer survivorship, and he is internationally known for his expertise.

As we spoke about the usefulness of sex therapy as an adjunct to medical treatment, Dr. Krychman mentioned how difficult it was for women that have sexual pain problems like vaginismus and that have been sexually abused to come to therapy.

I understand.  Most every woman who comes into my office who has been sexually abused–whether they’ve been diagnosed with a sexual pain problem or not–is not exactly thrilled to be there.  After all, talking about sexual abuse is very difficult.  It brings up feelings of shame, guilt, helplessness, and even disgust.

When women do come in, it is often because they cannot have sex with their partner, either because of sexual pain or because they are being “triggered” and cannot tolerate the physical sensations of lovemaking.

Here is what I know:  If I don’t go slowly, don’t go at the woman’s pace, I’ll lose her as a client.  And that’s the last thing I want to do.  And I have also learned that (more…)