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“If Sex Hurts, Am I Still a Woman?” The Subjective Experience of Vulvodynia in Hetero-Sexual Women

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Abstract

Vulvodynia has recently been recognized as a significant health problem among women, with a considerable proportion experiencing psychological distress and sexual dysfunction for many years. This study used a material-discursive framework and a qualitative methodology to investigate women’s subjective experience of vulvodynia within the context of a hetero-sexual relationship, and their negotiation of coitus, commonly associated with vulvar pain. Seven women, who had experienced vulvodynia between 2 and 10 years, took part in in-depth interviews. Thematic decomposition drawing on a Foucauldian framework for interpretation identified that six of the seven women took up subject positions of “inadequate woman” and “inadequate partner,” positioning themselves as failures for experiencing pain during coitus, which they interpreted as affecting their ability to satisfy their partners sexually, resulting in feelings of shame, guilt, and a decreased desire for sexual contact. This was interpreted in relation to dominant discourses of femininity and hetero-sexuality, which conflate a woman’s sexuality with her need to be romantically attached to a man, position men as having a driven need for sex, and uphold coitus as the organizing feature of hetero-sex. Only one woman positioned herself as an “adequate woman/partner,” associated with having renegotiated the coital imperative and the male sex drive discourse within her relationship. These positions, along with women’s agentic attempts to resist them, were discussed in relation to their impact on hetero-sexual women’s negotiation of vulvodynia. Implications for future research and vulvodynia treatment regimes are also raised.

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References

  • Bergeron, S., Binik, Y. M., Khalife, S., & Pagidas, K. (1997). Vulvar vestibulitis syndrome: A critical review. The Clinical Journal of Pain, 13, 27–42.

    Article  PubMed  CAS  Google Scholar 

  • Bhaskar, R. (1989). Reclaiming reality: A critical introduction to contemporary philosophy. London: Verso.

    Google Scholar 

  • Binik, Y. M. (2003). Dyspareunia resulting from vulvar vestibulitis syndrome: A neglected health problem. Psychiatric Times, 1, 69–73.

    Google Scholar 

  • Binik, Y. M. (2005). Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision. Archives of Sexual Behavior, 34, 11–21.

    Article  PubMed  Google Scholar 

  • Binik, Y. M., Meana, M., Berkley, K., & Khalife, S. (1999). The sexual pain disorders: Is the pain sexual or is the sex painful? Annual Review of Sex Research, 10, 210–235.

    PubMed  CAS  Google Scholar 

  • Davies, B., & Harre, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behavior, 20, 43–63.

    Article  Google Scholar 

  • Davies, B., & Harre, R. (1999). Positioning and personhood. In R. Harre & L. van Langenhove (Eds.), Positioning theory: Moral contexts of international action (pp. 32–52). Oxford: Blackwell.

    Google Scholar 

  • Edwards, L. (2003). New concepts in vulvodynia. American Journal of Obstetrics & Gynecology, 189, 24–30.

    Article  Google Scholar 

  • Foucault, M. (1972). The archeology of knowledge. London: Tavistock.

    Google Scholar 

  • Foucault, M. (1977). Discipline and punish: The birth of the prison. Harmondsworth: Penguin.

  • Gates, E. A. (2000). Sexual behaviours and sexual self-schema in women with vulvar vestibulitis. Dissertation Abstracts International: Section B: The Sciences and Engineering, 6, 6119.

  • Gavey, N. (1989). Feminist poststructuralism and discourse analysis. Psychology of Women Quarterly, 13, 459–475.

    Article  Google Scholar 

  • Gavey, N. (2005). Just sex? The cultural scaffolding of rape. East Sussex: Routledge.

    Google Scholar 

  • Gavey, N., & McPhillips, K. (1999). Subject to romance: Heterosexual passivity as an obstacle to women initiating condom use. Psychology of Women Quarterly, 23, 349–367.

    Article  Google Scholar 

  • Gavey, N., McPhillips, K., & Braun, V. (1999). Interruptus coitus: Heterosexuals account for intercourse. Sexualities, 2, 35–68.

    Article  Google Scholar 

  • Graziottin, A. (2005). Why deny dyspareunia its sexual meaning? Archives of Sexual Behavior, 34, 32–34.

    Article  PubMed  Google Scholar 

  • Graziottin, A., & Brotto, L. A. (2004). Vulvar vestibulitis syndrome: A clinical approach. Journal of Sex & Marital Therapy, 30, 125–139.

    Article  Google Scholar 

  • Green, J., Christmas, P., Goldmeier, D., Byrne, M., & Kocsis, A. (2001). A review of physical and psychological factors in vulvar vestibulitis syndrome. International Journal of STD & AIDS, 12, 705–709.

    Article  CAS  Google Scholar 

  • Haefner, H., Collins, M. E., Davis, G. D., Edwards, L., Kaufman, R. H., Lynch, P. J., et al. (2005). The vulvodynia guide. Journal of Lower Genital Tract Disease, 9, 40–51.

    Article  PubMed  Google Scholar 

  • Harlow, B. L., & Stewart, E. G. (2003). A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia?. Journal of the American Medical Women’s Association, 58, 82–88.

    PubMed  Google Scholar 

  • Haug, F. (1999). Female sexualization: A collective work of memory (E. Carter, Trans.). London: Verso.

  • Hollway, W. (1989). Subjectivity and method in psychology: Gender, meaning and science. London: Sage.

    Google Scholar 

  • Humphreys, M. (2005). Getting personal: Reflexivity and autoethnographic vignettes. Qualitative Inquiry, 11, 840–860.

    Article  Google Scholar 

  • Hunter, M. S., & O’Dea, I. (1997). Menopause: Body changes and multiple meanings. In J. M. Ussher (Ed.), Body talk: The material and discursive construction of sexuality, madness and reproduction (pp. 199–222). London: Routledge.

  • Jack, D. C. (1991). Silencing the self: Women and depression. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Jantos, M., & White, G. (1997). The vestibulitis syndrome: Medical and psychosexual assessment of a cohort of patients. Journal of Reproductive Medicine, 42, 145–152.

    PubMed  CAS  Google Scholar 

  • Jones, R. W. (2000). Vulval pain. Pain Reviews, 7, 15–24.

    Google Scholar 

  • Jones, D. W. (2004). Shame and loss: Narrative and identity in families with a member suffering from mental illness. In W. Hollway (Ed.), Psycho-social research (Vol. 10, pp. 69–93). London: Lawrence-Wishart.

    Google Scholar 

  • Kaler, N. (2006). Unreal women: Sex, gender identity and the lived experience of vulvar pain. Feminist Review, 82, 50–75.

    Article  Google Scholar 

  • Kaschak, E. (1992). Engendered lives: A new psychology of women’s experience. New York: BasicBooks.

    Google Scholar 

  • Katz, S. R. (1996). The experience of chronic vulvar pain: Psychosocial dimensions and the sense of self. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56, 704B.

  • Kaufman, G. (1993). The psychology of shame: Theory and treatment of shame-based syndromes. London: Routledge.

    Google Scholar 

  • Masheb, R. M., Brondolo, E., & Kerns, R. D. (2002). A multidimensional, case-control study of women with self-identified chronic vulvar pain. Pain Medicine, 3, 253–259.

    Article  PubMed  Google Scholar 

  • Mauthner, N. A. (1999). “Feeling low and feeling really bad about feeling low”: Women’s experiences of motherhood and postpartum depression. Canadian Psychology, 40, 143–161.

    Article  Google Scholar 

  • McKay, E., Ryan, S., & Sumsion, T. (2003). Three journeys towards reflexivity. In L. Finaly & B. Gough (Eds.), Reflexivity: A practical guide for researchers in health and social sciences (pp. 93–114). Oxford: Blackwell Science.

  • McPhillips, K., Braun, V., & Gavey, N. (2001). Defining (hetero)sex: How imperative is the “coital imperative”? Women’s Studies International Forum, 24, 229–240.

    Article  Google Scholar 

  • Meana, M., Binik, Y. M., Khalife, S., & Cohen, D. (1997a). Biopsychosocial profile of women with dyspareunia. Obstetrics & Gynecology, 90, 583–589.

    Article  CAS  Google Scholar 

  • Meana, M., Binik, Y. M., Khalife, S., & Cohen, D. (1997b). Dyspareunia: Sexual dysfunction or pain syndrome?. Journal of Nervous and Mental Disease, 185, 561–569.

    Article  PubMed  CAS  Google Scholar 

  • Meana, M., Binik, I., Khalife, S., & Cohen, D. (1998). Affect and marital adjustment in women’s rating of dyspareunic pain. Canadian Journal of Psychiatry, 43, 381–385.

    CAS  Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Moghaddam, F. M. (1999). Reflexive positioning: Culture and private discourse. In R. Harre & L. van Langenhove (Eds.), Positioning theory: Moral contexts of intentional action (pp. 74–86). Oxford: Blackwell.

  • Mooney Somers, J. (2005). The construction and negotiation of hegemonic discourses of heterosexual male sexuality. Unpublished doctoral dissertation, University of Western Sydney.

  • Nicolson, P. (1993). Deconstructing sexology: Understanding the pathologisation of female sexuality. Journal of Reproductive and Infant Psychology, 11, 191–201.

    Article  Google Scholar 

  • Nicolson, P. (1998). Post-natal depression: Psychology, science, and the transition to motherhood. New York: Routledge.

    Google Scholar 

  • Nicolson, P., & Burr, J. (2003). What is normal about women’s (hetero)sexual desire and orgasm? A report of an in-depth interview study. Social Science & Medicine, 57, 1735–1745.

    Article  Google Scholar 

  • O’Grady, H. (2005). Woman’s relationship with herself: Gender, Foucault and therapy. London: Routledge.

    Google Scholar 

  • Pagano, R. (1999). Vulvar vestibulitis syndrome: An often unrecognised cause of dyspareunia. Australian New Zealand Journal of Obstetrics & Gynaecology, 39, 79–83.

    Article  CAS  Google Scholar 

  • Potts, A. (2002). The science/fiction of sex: Feminist deconstruction and the vocabularies of heterosex. London: Routledge.

    Google Scholar 

  • Pukall, C., Payne, K. A., Binik, Y. M., & Khalife, S. (2003). Pain measurement in vulvodynia. Journal of Sex & Marital Therapy, 29(s), 111–120.

    Article  Google Scholar 

  • Reed, B. D. (2004). Vulvodynia: Study finds genital pain more common than believed. Obgyn & Reproduction Week Atlanta, pp. 30–31.

  • Reed, B. D., Advincula, A. P., Fonde, K. R., Gorenflo, D. W., & Haefner, H. K. (2003). Sexual activities and attitudes of women with vulvar dysesthesia. Obstetrics & Gynecology, 102, 325–331.

    Article  Google Scholar 

  • Reed, B. D., Haefner, H. K., Punch, M. R., Roth, R. S., Gorenflo, D. W., & Gillespie, B. W. (2000). Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain: A comparative evaluation. Journal of Reproductive Medicine, 45, 624–632.

    PubMed  CAS  Google Scholar 

  • Reid, R. (2003). Update: Vulvodynia. Medical Observer, 36–37.

  • Ridley, C. M. (1996). Vulvodynia: Evolution of classification and management. Journal of the European Academy of Dermatology and Venereology, 7, 129–134.

    Article  Google Scholar 

  • Sackett, S., Gates, E., Heckman-Stone, C., Kobus, A. M., & Galask, R. (2001). Psychosexual aspects of vulvar vestibulitis. Journal of Reproductive Medicine, 46, 593–598.

    PubMed  CAS  Google Scholar 

  • Sayer, A. (2000). Realism and social science. London: Sage.

    Google Scholar 

  • Seu, I. B. (1995). A psychoanalytic feminist inquiry into shame. Unpublished doctoral dissertation, University of London.

  • Stewart, D., Reicher, A. E., Gerulath, A. H., & Boydell, K. M. (1994). Vulvodynia and psychological distress. Obstetrics & Gynecology, 84, 587–590.

    CAS  Google Scholar 

  • Stewart, E. G. (2003). Treatment options for vulvar vestibulitis: Considering how successful surgery is, how do you tell a young woman who’s unable to have intercourse that she needs to learn to live with her pain? Even so, a surgical approach is only for carefully selected women—Usually those with primary vestibulitis who has exhausted other treatment options. Contemporary Obstetrics/Gynecology, 48, 47–54.

    Google Scholar 

  • Stoppard, J. M. (1998). Dis-ordering depression in women: Toward a materialist-discursive account. Theory and Psychology, 8, 79–99.

    Article  Google Scholar 

  • Tiefer, L. (1994). The medicalization of impotence: Normalizing phallocentrism. Gender and Society, 8, 363–377.

    Article  Google Scholar 

  • Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70, 678–690.

    Article  PubMed  Google Scholar 

  • Ussher, J. (1997). Fantasies of femininity: Reframing the boundaries of sex. London: Penguin.

    Google Scholar 

  • Ussher, J. (2004). Premenstrual syndrome and self-policing: Ruptures in self-silencing leading to increased self-surveillance and blaming of the body. Social Theory & Health, 2, 254–272.

    Article  Google Scholar 

  • Williams, S. J. (2003). Beyond meaning, discourse and the empirical world: Critical realist reflections on health. Social Theory & Health, 1, 42–71.

    Article  Google Scholar 

  • Willig, C. (2004). Discourse analysis and health psychology. In M. Murray (Ed.), Critical health psychology (pp. 155–169). London: MacMillan.

    Google Scholar 

  • Wojnarowska, F., Mayor, R., Simkin, S., & Day, A. (1997). Psychological characteristics and outcome of patients attending a clinic for vulval disease. Journal of the European Academy of Dermatology and Venereology, 8, 121–129.

    Article  Google Scholar 

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Acknowledgments

Thanks are extended to Julie Mooney Somers and Emilee Gilbert, who commented on an earlier draft of this article, and to other members of the Gender Culture and Health Research Unit, Janette Perz, Georgia Ovenden, Mirjana Sandoval, Beverly Johnson and Megan Brock, who commented on the ongoing research.

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  1. Gender, Culture and Health Research Unit: PsyHealth, School of Psychology, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, 1797, Australia

    Kathryn Ayling & Jane M. Ussher

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  1. Kathryn Ayling
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  2. Jane M. Ussher
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Correspondence to Jane M. Ussher.

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Ayling, K., Ussher, J.M. “If Sex Hurts, Am I Still a Woman?” The Subjective Experience of Vulvodynia in Hetero-Sexual Women. Arch Sex Behav 37, 294–304 (2008). https://doi.org/10.1007/s10508-007-9204-1

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