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Monday Reviews: Healing Painful Sex

October 08, 2012
The CSPH

Every Monday, The CSPH takes a look at a book or film focusing on an aspect of sexuality. This week we are featuring Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain by Deborah Coady, MD and Nancy Fish, MSW, MPH.

Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain is a comprehensive guide in which two women join forces to help other people suffering from sexual pain understand their individual conditions, take control of their healthcare and find treatment, and manage their personal and professional relationships. Nancy Fish and Deborah Coady both make careers out of helping others; Fish, a social worker with a master’s in public health, went through many doctors for her chronic sexual pain before arriving at Dr. Coady, a gynecologist with a practice devoted to treating sexual pain.  “Painful sex” is an umbrella term that encompasses all types of sexual pain experienced by those with vaginas, from Clitorodyna, to pelvic floor or vestibular pain, to complications from IBS and hormonal changes.  Sexual contact—or, in some cases, any type of contact—is excruciatingly painful for people with any of the conditions described in the book, leading to unfulfilling sex lives and possibly upsetting personal relationships.

The authors address the current medical system in the United States, which they say is not educated about sexual pain and ill-equipped for its treatment in general: doctors often have time for only 15-minute appointments with each patient, which is not enough time for adequate examination or questioning.   Women suffering from sexual pain are often told that their problems are psychological, that they just need to relax and deal with it, and that their pain can’t possibly be as debilitating as they claim.  This isn’t an anti-doctor or home remedy/holistic medicine book, though:  Dr. Coady and Fish acknowledge the limits of Western medicine while teaching their readers how to navigate within these limits to achieve freedom from pain.  It might take many visits to many doctors, it might take the cooperation of several specialists and physical therapists, and won’t be quick, but individuals who suffer from sexual pain can reclaim their bodies and their sexualities; they can heal.

However, the authors make it clear that this isn’t a diagnostic book, as diagnosing and treating sexual pain isn’t easy.  The pain sufferer (often addressed as “you”) is brought first to a place where the sufferer can articulate the types of pain they are feeling, and then the book describes a litany of different types of sexual pain in subsequent chapters.  In these chapters, the types of pain and typical reasons for the genesis of the pain are listed and discussed with the purpose of educating the sufferer and providing them with articulate information to bring to a healthcare provider.

Perhaps the most useful and original part of this book is how the authors arm pain sufferers for their meetings with doctors.  Urging the patients to be their own best advocates, the authors provide pain sufferer with scripts and suggestions for having a conversation with a doctor to determine whether or not the doctor will be able to treat their condition.  Dr. Coady knows, as a practicing gynecologist, that many doctors are overtaxed as is and don’t have the time or funds to help sufferers of chronic pain, and that, crucially, this isn’t their fault.  Pain sufferers are coached to be choosy about their doctors but not to see them as adversaries or obstacles to healing.  Ultimately, the chosen doctor or doctors should believe that sexual pain is not psychological, should understand that many visits and perhaps more than one doctor will be needed, and be willing to either do research into specific types of sexual pain or accept the patient’s own research (from scientific journals, and other legitimate non-internet sources, of course).

There can be no telling how long pain will last in many cases, or how long it will take to heal.  Fish and Dr. Coady make sure to talk about the psychological toll that sexual pain can have not only on pain sufferers, but also on sex partners and family members of those suffering.  Those without partners are not left out of the “relationships” conversation, as the authors give advice for those who have begun to heal and are interested in dating.  Additionally, the authors discuss navigating the workplace with a condition that most sufferers don’t wish to make openly known.   Suicidal thoughts are common in sufferers of sexual pain, and Dr. Coady and Fish address this often, stressing that if any pain sufferer finds that their thoughts are turning into suicidal plans that they need to go immediately to an emergency room.

Healing Painful Sex is a must-read guide for any female-bodied individual suffering from sexual pain who has been unable to get adequate care, as well as anyone in a sexuality profession that could encounter someone asking them for advice about sexual pain.  It’s truly comprehensive in scope and compassionate in tone, while offering practical advice for how sufferers can learn to work with medical providers to get better.  Deborah Coady and Nancy Fish aren’t offering any sort of cure-all or product, they simply want sufferers of sexual pain to know that treatment is available, and how to advocate for that treatment in a cooperative and effective manner.

More information about the book and the authors’ contact information can be found at http://healingpainfulsex.com/.

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