A fascinating paper was just published that challenges the notion that women who suffer from painful intercourse have a disorder. 

The paper, found here, makes some important assertions:

 “The professions of psychiatry and medicine potentially standardize coercion through invasive interventions that focus on further unwanted, painful, or distressing penetration”. 

This means that painful procedures, such as using dilators, physical therapy, botox, etc, contribute to the experience of women’s lack of autonomy over their own bodies.

“While there are some within the profession who offer alternative approaches, the predominant perspective of vaginal penetration as the ‘norm’ can close down avenues for other kinds of assistance, such as supporting couples as they adjust to sexual intercourse with a changed body (in the case of genital surgery) or alternative forms of sexual activity.”

and

“fear of penetration could include a fear of their partner’s reaction if they fail to live up to unreasonable or idealistic expectations of women’s sexual availability. This also brings into question women’s ability to refuse sex, and the risk of participation in “unwanted” sex (Walker, 1997) as a means of avoiding conflict or hostility.”

And my response is as follows: Many of the points in this paper are extremely relevant. I work with a traditional population, so I am heavily involved in introducing concepts of autonomy, alternatives to intercourse, consent, mutuality, etc. It is extremely important to normalize all sexuality types, including nonpenetrative. The points made, that women often have sex regardless of pain for mate guarding and without arousal, as a chore, are indeed the case and we, as feminists and sexual health professionals, have much work to do in this area. We absolutely do not want to collude with a coercive system and I have myself published on this PDF.

The point that “fear of penetration could include a fear of their partner’s reaction if they fail to live up to unreasonable or idealistic expectations of women’s sexual availability.” is very true, and this is why, as a couples therapist, looking at the relationship dynamic is crucial However, I think the authors lose their credibility when they paint the researchers with one brush. For example, the authors describes Sophie Bergeron’s work  as  “psychiatry promotes “facilitative responses, in which the partner encourages the patient’s efforts at coping with the pain” (Bergeron et al., 2011, p. 1224). Encouraging women to “cope” with pain for the duration of penetration while their partner experiences pleasure reads similar to accounts of rapists who are sympathetic to their victims during assault, who also describe how women’s predominant concern prior to an attack is a fear of pain (Lea & Auburn, 2001). Later studies by her team simply showed better outcomes with partners who displayed encouraging-facilitative responses rather than hostile or overly solicitous responses, and is important in that it encourages clinicians to examine couples dynamics. Bergeron and her team are amongst the leaders in research that validates and respects women’s experiences and to describe their approach as similar to rape, distresses me.  Finally, I have to wonder here about the boomerang effect. Yes, there are women who are oppressed, who feel coerced, engage in painful sex for mate guarding, etc. We must advocate for them. But there are women who really suffer, because they have pain with intercourse, and they really want to have intercourse, because they like it, they value it, they have pleasure from it and have orgasms with it. These women are out there and they could feel infantilized by an approach that appears to undervalue their desire to engage in painless, pleasurable and satisfying penile-vaginal intercourse.