Episode 3: A Broken Optimism
Sex hurts the first time, but then it gets better. Right? This is the message so many of us grew up with. We saw it in movies and heard it from friends. But what if sex isn’t supposed to hurt? How much pain is too much pain? When is pain “normal” and when does it require medical attention? These are questions that Maura, a teacher and dancer, has spent almost her whole life thinking about. In today's episode, we hear from Maura, and many others, about how and why they've spent years putting up with pain.
Resources:
Not Tonight: Migraine and the Politics of Gender and Health by Joanna Kempner
More about Professor Joanna Kempner
More about Barbara Gross
Studies included in this episode:
Transcript
Episode 3: A Broken Optimism
Episode
Voice Memo 1: Let me tell you a little bit about the first time I ever had sex. I was seventeen. Everyone tells you sex hurts the first time. And you just have to get used to it. And so we tried, and I remember feeling like somebody was ripping me open and stabbing my vagina with a knife. A huge kitchen knife that was also on fire.
Voice Memo 2: I decided that I wanted to have sex with him and literally every single time we tried it was the most painful thing that I'd ever gone through. It felt like I was being ripped open from the inside out.
Voice Memo 3 I would all of a sudden feel like this like sharp stabbing pain and wasn't really able to process it or stop. And it wasn't until after we were done having sex that I was like, huh that was really painful. And then I would do it again.
Voice Memo 4: So he would penetrate me up to a certain point. And during it I would think, is this too painful? This has gotta be too painful. Should we stop? This is just so so horrible, but I don't want to have to stop. I don't want to fail.
Noa: Sex is supposed to hurt.
This is the message so many of us grew up hearing. Our whole lives we learned that penetrative sex is supposed to be painful, at least at first. That's what our friends said, it's what we read in books - it's what we saw in the movies. Take this scene from American Pie - a movie entirely about losing your virginity before college.
[Clip from American Pie movie]
So, does it hurt ?\ What ?\ You know-- sex.\ Does it hurt ?\ Yeah. I mean, the first time you do it, you know, it hurts. But then you, you do it again and again and again--it just starts to feel good. Really good.
Noa: In general, our society has decided that vaginal pain during sex is acceptable. It goes in the same file as growing pains, a loose tooth - or sore muscles from a good workout. Overall, we understand and label this kind of pain as common, normal and expected -- something you just have to get through.
Voice Memo 5: There were so many times where I shrunk myself or my needs or my pain to accommodate for someone else's experience and pleasure.
Voice Memo 6: I'm sure there are some people out there who would say well that's your problem for not feeling like you can speak up. It just feels so much easier in the moment just to shut up and wait for it to be done. It's like, ok he's gonna come at any second so just like five more seconds and you can do it.
Voice Memo 7: I think it's hard to stop because you just want it to be true, you know. You just want to be somebody who can have sex. Like everyone else. It feels like a huge failure to not be able to.
Voice Memo 8: I remember the next day getting ice cream with two very close friends and telling them about this and them saying that's normal, like you just have to get used to it you're probably just like really nervous. You'll stretch like you'll get used to it.
Noa: This is the reason it took me until I was 25 to seek medical treatment for the pain I experienced trying to have penetrative sex. I'd learned from friends and tv shows that this was just a normal part of the process - it was okay to be in pain.
But here's the thing our society somehow overlooked or forgot to mention: pain exists on a spectrum. And while maybe a little mild discomfort during sex is sometimes acceptable, experiencing consistent pain, or extreme pain is just not.
Noa: This is Tight Lipped, a public conversation about a private type of pain. I'm Noa.
Hannah: And I'm Hannah. On this show we ask big questions about chronic vaginal and vulvar pain -- and pelvic floor dysfunction. We talk about painful sex. And shame. And the politics surrounding these conditions that we often keep secret.
Noa: In our last episode, we followed Shelby from doctor's office to doctor's office - in her search for a diagnosis. We learned why not one of the twelve different medical professions she saw could accurately diagnose her with vaginismus, despite how common it is.
When someone is suffering from a rare disease, we expect that that person will need to seek multiple opinions and search high and low for a doctor who can diagnose their unusual disorder. But, in the US, up to 1 in 4 people with vaginas will have chronic pain with intercourse at some point in their lives -- that's about 40 million people. So it's not rare at all. It's common. Still, Shelby's doctors attributed her condition to nerves or something emotional, they dismissed her pain as imaginary.
Hannah: On today's episode we're talking about the nature of pain. How do we learn which kinds of pain to pay attention to? We'll look at how pain is normalized by popular culture - and how that normalization is often reinforced by medical professionals.
Up to 50% of people who have chronic vaginal pain with sex never talk to a doctor about their symptoms. This could be for a number of reasons. Historic racism in the medical industry leads many people of color to distrust doctors. Lots of people can't afford the costs associated with seeing multiple physicians in search of a diagnosis. And so many people are just trying to get by, working multiple jobs, and don't have the time.
All of these factors are compounded by the fact that so many of us are taught to accept our pain as inevitable, unavoidable, and, well, normal. So, how are we supposed to know when to prioritize pain? Or if something is or isn't supposed to hurt?
Noa: Barbara Gross is a psychotherapist who treats individuals and couples who struggle with pelvic pain - and conditions that cause painful sex. Her message to patients is simple. If it hurts, stop.
Barbara Gross: I mean I always tell women this, why on earth would you want to do it if it's gonna cause pain, it doesn't make sense. Like if someone was poking you in such a way that it was painful, you would pull away from them and that's a normal reaction to pain.
Noa: But what if your whole life you were told that "the poking" would hurt at first, but eventually, if you endured, it would feel really good? And what if you were taught that "the poking" played an important and central role in your most intimate relationships - in your identity and your sexuality?
Hannah: Many of the romantic comedies and TV shows we watched growing up, inevitably included an awkward "losing your virginity" scene. I saw this in the OC, Gilmore Girls, Clueless, Sisterhood of the Traveling Pants, and Juno. And more recently, I saw it in Jane the Virgin, How I Met Your Mother, and Chewing Gum - a British comedy where the character's entire goal is to lose her virginity.
Noa: As I learned about sexuality and sex, somewhere along the way, I internalized the belief that penetrative sex was supposed to hurt, but that eventually it would stop. Then again, how long is eventually? After a couple weeks? Months? Years?
Noa: Barbara Gross has seen this in many of her patients who have a kind of broken optimism. Despite experiencing so much pain, they say to themselves: well maybe this time it'll be different. Maybe tonight it won't hurt.
Barbara Gross: Part of you I think just thinks I'm just gonna endure. And I always say: please don't. Please don't do that. Like let us figure this out, let us slow it down and figure out what's going on so that you can be pain-free.
Noa: So many people we've talked to for the show have told us that for a while they thought pain was just part of sex. One of those people is Maura Sternberg. For Maura anticipating and accepting pain as normal is the story of her whole life.
Maura: and how it's operated in my pelvis.
Noa: Maura is 27. She's a teacher and a dancer. And she and I have a lot in common - we both grew up in the suburbs of Chicago. We met as students at Oberlin College, where we were both dancers. Even though we spent hours stretching, rehearsing, and talking about our bodies, I don't remember ever talking about pain.
For Maura, her pain began when she was a young girl. She said her first memory of it was at age five, watching Aladdin.
Maura: And they were doing the scene where they're on the magic carpet and they float down, on the magic carpet and then land seated, I was like that's beautiful and so romantic and I'm a dancer so I can make my body do what anyone else's body does so I just jumped off the couch as many times as I possibly could.
Noa: She kept jumping until she finally landed like they did in the movie, which was directly on her tailbone.
Maura: and I was like wait but where is my magic carpet, this hurts so bad.
Noa: Then, she exacerbated the injury when she slipped and landed hard on some monkey bars. Her legs on either side of one of the bars.
Maura: From then on I remember always having like pelvis pain. I remember sitting in school and being in pain, like second grade.
Noa: Being in pain became normal for Maura.
Maura: I started training as a competitive Irish dancer so having hip pain and knee pain and back pain that was all just a part of my identity as a dancer, like part of the story of me making art.
Noa: Maura would take advil and push through the pain, just like the other dancers. But, there were limits. When Maura was seventeen, she wanted to have penetrative sex. So her Mom suggested that first she should try putting in a tampon. Much like Shelby from the last episode, Maura had never been able to use tampons.
Maura: Up until this point I had kind of thought that everyone who was like just put a tampon in and then we'll go in the pool, I was like they're lying, they must be lying, I couldn't fathom it.
Noa: So Maura tried, but it didn't work. So she tried harder. Finally, she forced the tampon inside of herself - and immediately felt really dizzy, like she was going to pass out. She stumbled into her bedroom and sat with her head between her knees - until the room stopped spinning.
Noa: That's when Maura's mom took her to see a gynecologist who tried to do an exam with a speculum.
Maura: We'll try a smaller one okay a smaller speculum, and no, maybe just a finger all the way down to a q-tip and I remember like choking back my tears and screams in pain.
Noa: The gynecologist told Maura that she had a semi-imperforate hymen, that's when the thin tissue of the hymen partially covers the vaginal opening - making any kind of penetration difficult and painful. The doctor suggested that Maura get a hymenectomy - a minor procedure where the doctor opens or stretches the hymen. So, she did. And after she healed from the surgery, she felt ready.
Maura: I was like great, now is the time, let's have sex boyfriend. And he was like let's do it, and it didn't go very well. I was like, this hurts so bad, I could like kind of do it but kind of not.
Noa: Maura moved away for college. She and her boyfriend stayed together, long-distance.
Maura: We'd like you know come be together for a weekend and fuck, fuck, fuck, fuck and go away for a month and then do it again so I kept having painful sex that maybe got slightly less painful but not by a large margin.
Noa: It went on like this for years - all through college.
Maura: So by the end of college I'm just like perfect, I have a tailbone that is perpetually a little bit injured which means that I can't do certain yoga positions and it takes me a while to be able to enjoy penetration.
Noa: Maura had a justification for her pain - her injured tailbone. She was able to minimize and accept it. It wasn't that big of a deal. She could handle it. But what does that even mean, acceptable pain?
Noa: If we're taught that painful sex is normal and to be expected, how are you supposed to know when pain or extreme discomfort is not ok? And when does the pain cross the line to something that requires medical care?
Joanna Kempner: And that itself is a really social question.
Noa: Professor Joanna Kempner is a sociologist at Rutgers University. She wrote a book called Not Tonight: Migraine and the Politics of Gender and Health. Her research is on migraines, not vaginas. But what she looks at is how and who decides what pain is serious and what pain is not. She found: It's actually societal or cultural norms that determine what pain we think is okay and what pain is not -- no matter how extreme the pain actually is.
Joanna Kempner: You know, I have this funny little comic in my office, it's somebody googling: "am I tired or am I dying?" Is what we're feeling normal? Or is it something that we actually have to see a doctor about.
Noa: So, whether or not we decide to see a doctor isn't just about the amount of pain we experience. It's influenced by our social circles, our community, our upbringing, and our internalized beliefs about pain.
Joanna Kempner: And whether or not we go and find expert help is something that would change over time and across cultures. And then what happens when we go see a doctor? What kind of expert do we go see. Is really social. And what does that expert, whether it's a doctor or nurse or a shaman, how do they treat you?
Noa: Professor Kempner experienced this personally. For her, pain was just a normal part of life growing up.
Joanna Kempner: I'm actually a person that has pain all over my body. And I come from a family where almost everybody is in pain all the time. It's really kind of a quite normal thing to come home and say, hey Mom how are you? And she goes ughhhh, this hurts, that hurts, my head hurts.
Noa: When she was little, she would get really bad headaches. Eventually they got so bad her mom took her to see a doctor.
Joanna Kempner: He tells her, well there's nothing you can do. She just has a type A personality, you know Type A personality kids get migraine.
Noa: She was a five year old! I was shocked when I heard this - that a doctor would categorize a young child as too Type A - and then attribute her chronic pain to her personality!
Professor Kempner lived with chronic migraines for decades before she learned her pain is actually a real condition. About twenty years ago, she was at home doing laundry and listening to a call-in radio show. There was a well-known headache specialist on the program.
Joanna Kempner: He said, we used to believe that migraine was a disorder of neurotic women whose blood vessels dilated and they couldn't face up to life. I was like, oh yeah okay that sounds familiar. I've been called a neurotic woman before.
Noa: But then he explained that this is no longer the scientific understanding of migraine. He started to say:
Joanna Kempner: We now know that migraine is a disorder of the brain. I was like, wow! Really? We know that? I'd never heard a doctor say that what I was experiencing was a real disease. Like something that was wrong with my brain. It was really thrilling to hear that I had a brain disease. That's pretty messed up.
Noa: She'd spent her entire life dealing with doctors who said she was crazy, even neurotic. Naturally, she internalized this message. Like Maura, she'd minimized her pain, and learned to put up with it. When society, popular culture, and especially medical professionals normalize your pain, it makes sense you don't seek treatment. And most people with migraine don't.
Joanna Kempner: Fewer than half of people with episodic migraine ever even go seek help from their doctor of those who do, only about half get the right diagnosis. And fewer than that who are getting the correct diagnosis are getting recommended treatment.
Noa: We see the same thing happening with chronic vaginal and vulvar pain conditions. According to a study, published in 2014, only about 50% of women who suffer from vaginal and vulvar pain seek treatment. Half don't. Women in the study described either a chronic burning or knife- like pain, but still they didn't ask for medical advice.
And for the people with vaginal pain who do seek treatment -- if they don't find answers, many continue to grit their teeth and try to push through the pain: just like Maura.
Noa: One day, Maura was in a yoga class. She tried to do what's called a V sit, where you balance on your tailbone.
Maura: And I send my coccyx out into oblivion, like hurts to drive, hurts to sit in class, hurts all the time basically.
Noa: Maura's chiropractor said she needed to see a pelvic floor physical therapist. But Maura was terrified of what's called "internal work." That's when a physical therapist uses their fingers to massage inside the vaginal walls. So for years Maura wouldn't go to physical therapy -- even after multiple bad flare ups.
But eventually, when she was 26, she realized she wanted to get pregnant and give birth. So she got up the courage to go to physical therapy. Her physical therapist asked really probing questions and wanted to know about how the pain impacted Maura.
Maura: And she started asking about how I pooped, how I fucked, and like all that stuff because she doesn't see our systems as isolated and that really drove that point home and I was like oh my gosh, of course the fact that I use a squatty potty matters when I want to put something in my vagina and it also matters when I want to sit for long periods of time.
Noa: Then, she asked Maura about penetrative sex.
Maura: And I'm like yeah great, pretty par for the course and I maybe said something flippant like you know but it does hurt a little bit at the beginning every time. And she was like, what? And I was like yeah but I mean, you know, that's just what, that's just like sex you know, at first it just hurts and then usually it doesn't hurt eventually.
Maura: And she was like "ohh." She was nice but she was like very very gentle and kind about it but the vibe was "oh no Maura, that's not what this is."
Noa: It wasn't until this moment that Maura even considered the possibility that she shouldn't be experiencing this level of pain during penetrative sex. She realized that all this time she'd been forcing herself to push through the pain, telling herself it was fine. But why had no one told her IT WASN'T?
Noa: It's not just popular culture that taught Maura that pain with sex is not a big deal. This idea had been reinforced by her doctors.She remembered this one time - when she was 18 years old. She'd been having penetrative sex with her boyfriend for some time, and it still hurt. So she decided to go see a gynecologist.
Maura: So I go to the gyny, I'm like okay you know, like I love my guy we have a lot of fun, but this is not working and she's like okay well I bet you're probably pretty nervous. This sounds a lot like you're probably anxious about it. She says if I were you, I'd just make sure you got a glass or two of wine in you before you try again.
Noa: You probably remember that's the same advice that Shelby, from our last episode, got from her doctor. Go home, drink a glass of wine, try to relax. This didn't sound right to Maura.
Maura: And I was like I'm so sorry but I don't think you're legally allowed to say that and also I don't drink.
Noa: Maura didn't feel like she was anxious. She was enjoying sex - that is, for the most part.
Maura: Our conversation left off with her being like well I could prescribe you an anti-anxiety if you need and I was like here's the thing though, I orgasm every time like I'm not that nervous, I'm like excited, this is not anxiety. It's not anxiety.
Noa: So after being told by a medical professional that this was nothing to worry about - it's not that surprising that Maura minimized her pain.
Dr. Bat Sheva Marcus, who's the Clinical Director at Maze Women's Sexual Health, says she hears this type of thing all the time.
Bat Sheva Marcus: So I think women go, finally kind of get up their courage to talk to either a primary care doctor or their OBGYN and if they get cold water thrown on them, like there's nothing wrong with you, then they go back and curl up in a ball and just say ok, I'm crazy...it is very disheartening to be told, you're crazy.
Noa: This happened with another patient Marcus talked to - who went to see a therapist.
Bat Sheva Marcus: The therapist says something like "maybe that's you way of your vagina telling you that you're not ready to have sex." And I, at one point I turned to a patient and said, well maybe it was your vagina's way of saying to you: you need to find a new therapist.
Noa: We look up to doctors - we respect them. So if a doctor tells you your pain isn't anything out of the ordinary - you believe it. Maura's one of many many people with chronic vaginal or pelvic pain - and pain with sex - to have this experience.
Voice Memo 9: I remember the first time I brought it up with a doctor was in 2017 with my OBGYN and she basically was like, I just did a pap smear on you and everything looked fine, like there's no problem. And this was a really well-renowned doctor, very high up in Washington, DC society and so I didn't really know what to do about it so I just kind of accepted it.
Voice Memo 10: I went to my gynecologist and I told her and she said to me: are you sure that you're not just petite and your boyfriend well-endowed.
Voice Memo 11: And they're like try lube. And I'm like, great so what else can you tell me. Obviously I have tried this, I'm trying to tell you that something hurts. You're like it's not my job as a doctor to care about whether or not you're enjoying sex, all I can do is test you for this yeast infection.
Noa: If we grow up expecting to feel pain during sex, if we're taught to tolerate and accept this as inevitable, how are we supposed to think any differently? To contradict the medical professionals whose job it is to tell us what's going on in our bodies?
But Maura's physical therapist taught her to take her pain seriously and to treat it.
Maura: I'm starting to actually experience what painless penetration feels like, I think it happened maybe for the first time in my entire life maybe three months ago, and you betcha I did cry a lot. I was like oh my god, babe, like if this is what this is, then 24:30 what was all of that other stuff?
Noa: Maura regularly sees a pelvic floor physical therapist, chiropractor, and acupuncturist. Her experiences in the doctor's office led her to be skeptical and have a hard time trusting western medicine. To the extent that she can, Maura's seeks care elsewhere. She looks to herbal-intuitive medicine, which draws on spiritual and healing practices from her Celtic ancestry. But, at the same time, she has found a primary care doctor who works for her.
Maura: I took a long time to find a doctor who does like integrative stuff. So she's like yep good luck with the period cramp thing that you're trying to figure out, also I think you should try eating more cruciferous vegetables before you bleed.
Noa: Maura's now in the process of learning more about her body, and what kinds of pain she shouldn't have to accept as part of her daily life. Unfortunately, many people with vaginas feel like they just have to put up with it and keep having painful sex. I used to be one of them.
I convinced myself that it would just go away.
Like many others, somehow somewhere I learned that vaginal pain doesn't matter. It isn't worth looking into. It really is not a big deal.
But what if we were told a different story - that our pain does matter, that we deserve attention and care. Like psychotherapist Barbara Gross says:
Barbara Gross: There's something serious going on and it needs to be treated
Noa: What if all healthcare professionals reinforced this idea - that vaginal pain isn't something you should have to put up with. Sometimes I think about what my trajectory would have been like if I'd been taught to take my pain seriously. What would've happened if the first gynecologist I went to said, let's look into this. Instead of telling me nothing was wrong - and later, telling me to take sedatives and relax.
What would've been different if I had known that over 40 million women in the US struggle with vaginal pain. And if the communities, and larger society, that I grew up in had made clear to me that just because this pain is common, doesn't mean we can write it off and treat it as just a part of daily life. Maybe then I would've gotten help sooner. And the years of struggling with pain and shame would already be behind me.
Hannah: In order for people with vaginal pain to be believed, diagnosed and treated it's not just a matter of changing the story - and taking women's pain seriously. We also need more research, we need better medical training, we need all sorts of resources. But this is a vital first step.
Our next episode will be the last in our exploration of "being believed" - how vaginal and pelvic pain are interpreted by doctors and broader society. After that we'll move on to talk about other aspects of healthcare and these conditions. We'll hear from author Lara Parker...
Lara: there was like a distinct moment that I remember just laying on my dorm twin bed, bawling my eyes out and saying to myself, am I really that fucked up in the head that I am imagining all of this pain and everything that's gone wrong. I really thought that I was losing it. It got to the point where, and I still to this day am like this where I don't trust my own 44:01 thoughts and feelings.
Noa: Thanks for listening. We really value your reviews and comments and love hearing from you! So, if you haven't done so already, we hope you'll take a minute to rate and review us on iTunes - it's a short and easy way to support the podcast and spread the word.
Hannah: We know many of you listening have countless stories of your own. And that's why we're putting together a Zine! It'll be a written compilation of stories and resources about chronic vulvar pain and pelvic floor dysfunction. Submit any personal essay, poem, illustration, comic or other form of writing or art to . And for more info, check out our website - tightlippedpod.squarespace.com!
Hannah: This episode was produced by me, Hannah Barg, with Noa Fleischacker. The editor is Arianna Skibell. Our episode art this season is designed by Arielle Stein. We also received editorial support from Judah Kauffman, Laura Garbes, Shannon Boerner, and Yochai Maital. Thank you to Louise Fix, Zoe Goldstein, Sarah Minion, Caitlyn Ruen, Jocie Sobieraj, Daniela Tolchinsky, Melissa Guller and Sela Waisblum.
We're also incredibly appreciative of the professionals who gave their time and expertise to this episode: Barbara Gross, Joanna Kempner, and Bat Sheva Marcus. Thank you again to Gaby Escovar for our logo and Marty Kezon for our website. This season is supported by the Dorot Fellowship Alumni Leadership award, which has enabled us to continue to do this important project. All scoring you hear is from Blue Dot Sessions.
Thank you so much and we'll be back soon.