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I've always been an evidenced-based practitioner. And whenever I get geared up for community or professional events, I hit the literature hard for the most recent data I can find. I guess it had been a couple of years, but I recently underwent an extensive literature search for the prevalence of female sexual pain. The numbers are nothing short of astounding. It has made me wonder, if 34-45% (cite journal article) of the female population suffered from this, should it be a public health concern? What do you think?

Here's what I think...YES! ABSOLUTELY! And why? This next bit comes from over 12 years of experience with patients that fall in the category. 34-45% of their peers have painful sex, and yet, 99% of them wouldn't tell their best friend, sister, mother or other female confidant. Yet, they feel 100% alone and that there is something wrong with them because they have this pain. Here's who they did tell:

1) Their Husband/Partner--Well, obvious one, as if the wincing in pain wasn't a dead giveaway; although, sometimes this one gets skipped and women hide their pain from their partner and go straight to....

2) Their doctor--After the initial thought of "Why do I have pain?" it is logical that the next step would be to go visit their local gynecologist or primary care doctor. What the majority of my patients tell me followed these fateful visits saddens me to no end. Many were told, after the usual battery of testing for infections and a check of the anatomy that nothing is wrong with them. And yet, they are in the office stating they have pain, so since they are viewed as "having nothing wrong" are often dismissed, or referred to relationship counseling. Or, I have had patients tell me that the doctor will not even schedule an appointment as their case "seems too complicated".<---WHAT?! I have a whole host of "what healthcare providers have actually told my patients" aka "medical advice" in my book. And some of it will undoubtedly seem like deja vu to you, too, if you are a woman that experiences sexual pain.

Many women that experience painful sex also have to sort through feelings of shame, anxiety, depression, guilt and the like. It is my belief that many of the feelings start with the experience of their pain, and then becomes a positive feedback loop of

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increased shame/anxiety/depression-->increased expectation of pain-->increased pain due to muscle guarding-->increased shame/anxiety/depression etc. I am not discounting that perhaps some anxiety/depression/etc preceding the painful act couldn't have been the source, but it still inserts in the above the loop, producing the same end result.

I have some hopes for these women in the future. I hope that their complaints of pain will be taken seriously. I hope that healthcare providers will realize that muscles exist in the pelvic floor and can be a source of pain, just as muscles can be a source of pain in other areas of the body. I hope that providers will take 5 minutes to assess these muscles and see if they can reproduce their patients pain once a medical cause for their pain has been ruled out. I hope that these women will finally get the care they deserve and set on a healing path.

~Heather Jeffcoat, DPT