Treating Dyspareunia and Vulvodynia
Like vaginismus, dyspareunia should be evaluated medically prior to treatment. Several physical and psychological issues can contribute to painful intercourse. If there is a physical problem, such as an infection, medical treatment will usually result in a lessening or total elimination of the pain. As we discussed earlier in this chapter, women suffering from dyspareunia should also be evaluated for vulvodynia prior to any treatment for their sexual dysfunction. Treatment for vulvar vestibulitis, including psychotherapy, biofeedback and surgery, have resulted in significant reduction in dyspareunia after treatment and in follow-up studies (Binik et al., 2002). Psychological causes of dyspareunia, such as performance anxieties or a fear of intimacy, must be treated through counseling or psychotherapy.
A controversy arose in 2005 over whether dyspareunia should be classified as a sexual pain disorder. Some researchers believe that it should be classified as a pain disorder, rather than a sexual dysfunction (Binik, 2005). This discussion will continue and may affect how dyspareunia is diagnosed and treated in the future.
Question: Why do women fake orgasms rather than honestly telling their partners what they are doing wrong?
Faking orgasms often occurs as a result of a dysfunction. To a man or woman who experiences orgasmic disorder or retarded ejaculation, faking an orgasm may seem the best way to end the sexual activity or to please the partner. However, such deceptions are not healthy in a committed relationship, and partners are generally advised to discuss any sexual problems they have instead of covering them up. A woman (or a man) may have a difficult time communicating sexual needs and desires. So, instead of talking to her partner about what sexually excites her, she hopes that he knows how to do it. She may feel too embarrassed or vulnerable to tell him what to do. In this society, we expect men to know exactly what turns a woman on. However, what feels best to one woman may not feel good to another, and what feels good may change over time. Many variables can also interfere with sexual pleasure, such as stress, fatigue, anxiety, or depression. It is important that couples communicate so that they can make their sex lives satisfying for both partners.
ILLNESS, DISABILITY, AND SEXUAL FUNCTIONING
We all need love, and we all need touching and contact with others. Yet somehow we have grown to think that sexuality is the privilege of the healthy. We tend to exclude ill or disabled people from our visions of the sexual, and so we deny them a basic human right (see the nearby Personal Voices, “I Want Sex—Just Like You”). If you were suddenly disabled or developed a chronic illness, would you lose your desire to be regarded by another as sexy and desirable?
Healthcare providers often rely on the International Classification of Diseases (ICD), an official system of identifying various illnesses. Several of these illnesses and their treatments can interfere with a person’s sexual desire, physiological functioning, or both. Sexual functioning involves a complex physiological process, which can be impaired by pain, immobility, changes in bodily functions, or medications (Levay et al., 1981). More often, though, the problems are psychological. Sudden illness causes shock,
SEX in Real Life