Let's Talk About Painful Orgasms

Photo: Natalia Mantini
If you’ve ever experienced pain during orgasm, don’t panic, you’re not alone.

While a quick internet search pulls up only a few scholarly articles on the subject, you'll realise that there are, however, plenty of community posts from women seeking help for what is often described as "cramping pain" during orgasm.

The bad news is that very little is known about this problem and its underlying causes. In the past, pelvic experts have listed it as a possible sign of pelvic floor disorders, and it is reportedly common among patients with endometriosis.

But how does it happen? Is there any treatment available? And is there a need for more awareness?

“[Painful female orgasm] does exist, [although] it is rare,” says Krystal Woodbridge, psychosexual therapist and trustee of the College of Sexual and Relationship Therapists. “It’s described like a cramping sensation in the lower abdomen, or sometimes in the rectal area. It can be really painful.” It can develop quite suddenly, without a gradual build-up, causing sufferers a great deal of worry and distress.

Because there is so little information out there, Krystal’s primary advice to anyone experiencing gynaecological pain is to consult a doctor. In the specific case of pain at orgasm, she warns that it is really important to rule out conditions like ovarian cysts, fibroids and endometriosis.

It is hard to estimate how many women actually are or have been affected by orgasmic pain but, in an article from 2015, GP and family planning specialist Dr. David Delvin writes that the problem may be more common than we think. He posits the fall in female hormone levels that typically occurs during menopause as a possible cause, since the majority of the women reporting pain at orgasm were approaching or already around this age.

Delvin also references a book by Penn State University professor Jennifer Hillman in which 'dysorgasmia' – the term he uses to describe painful orgasms – is linked to a range of medications including antidepressants, psychoactive drugs and the popular natural remedy, St John’s wort.

Other experts are less convinced. “It’s certainly not regarded as a sexual dysfunction. I worked on the [latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)] for the sexual and gender identity disorder group and this issue wasn’t even discussed,” says Cynthia Graham, professor in sexual and reproductive health at the University of Southampton.

People think that everybody else is having 'normal sex' – whatever that means – and not having problems

Graham says that if pain during orgasm occurs, it is likely to be linked to physiological causes.

“I think it probably isn’t very common and if it does occur, from what I understand from the literature too, when I read about it, it’s not something that lasts very long,” she adds. “Pain during sex is a whole other thing, generally [it] can be very common and very distressing, and it affects sexuality a lot. That might include, specifically, pain when orgasm occurs. I think it would be more common if pain during sex occurs anyway, that women have pain during orgasm.”

With 25 years of experience as a clinician, working mostly with women and couples, she doesn’t remember encountering a female patient with the problem. But she clarifies: “The bottom line is, I think it is very likely that although it does occur, it would be linked to different kinds of gynaecological problems and maybe other disorders, that are non-gynaecological ones but associated with pain, too.”

Dr. David Goldmeier, a consultant in sexual medicine at Imperial College London, says that women who experience painful orgasms may be displaying symptoms of uterine problems (such as fibroids or endometriosis) or neuropathy: “They have some sort of nerve problem in and around the genital area, so the nerve impulses that come up are altered.”

Looking back at his clinical experience, he recalls treating one woman who had never had an orgasm. “After sex therapy with us, she could orgasm but it was painful,” he explains. Prescribing an antispasmodic – a medication that prevents or relieves muscle spasms – seemed to help.

Whether painful orgasm is physiological, psychological or related to other bodily issues remains to be seen but, as with all things sexuality-related, open conversation is the only way to progress.

“People don’t talk about problems with sex, they only talk about sex,” Woodbridge says. “People think that there are certain expectations of them, that everybody else out there is having ‘normal sex’ – whatever that means – and not having problems. So, when [they] are experiencing problems they think they should not have, they feel very isolated and that they are the only ones [experiencing them] and that it is not socially acceptable to really talk about it.”

Painful orgasms or not, it looks like one crucial step towards helping women to enjoy a healthier and more satisfying sex life would be to spark a frank conversation about pleasure – problems and difficulties included. Sex isn’t always great, it isn't always effortless – we know that – and it’s past time we talked about it.

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