If you search for "painful orgasms" around the internet, you pull up a lot of results that are mostly testimonials from women who experience them, and a couple of news articles asserting that they're real. But if you're looking for hard, medical data on painful orgasms—or the condition called dysorgasmia—you'll run into the same wall a lot of the people who treat them run into: There's really not much out there. Even The American Congress of Obstetricians and Gynecologists' information is limited to painful sex more broadly, without specifics regarding painful orgasms.
It's not unusual for a health problem that: 1. Affects women, 2. Affects women's sexuality, specifically, and 3. Affects women's sexual pleasure, even more specifically, to have precious little research data available. But, as Dr. Katherine McHugh—an ob-gyn at Indiana University Health and a pelvic pain specialist—said, that doesn't mean it isn't very much real, and important to acknowledge and treat.
All that said, there aren't concrete numbers on how many women in the population experience painful orgasms, but in her own pelvic pain practice, McHugh sees dysorgasmia quite often. It's a separate condition from generalized pain during sex, called dyspareunia, but the two issues often accompany one another. McHugh said it's still important to acknowledge the distinction. "Part of the reason dyspareunia is treated more aggressively than dysorgasmia is that dyspareunia affects both the male and the female, or the partner who is having pain and the partner who is not having pain," McHugh said. She takes issue with the idea that one partner might be able to have enjoyable sex with an orgasm, while the other (especially a woman) is incapable of doing so.
The spoiler here is that no, painful orgasms aren't normal. Which just means that if this is something you're experiencing, you don't have to. "Sex is a normal part of a woman's life, and it should not be painful, it should not hurt," McHugh said. "And if it does, there's something wrong that can be fixed."
Here's everything you need to know about how to start getting it fixed, and get your orgasms back to being the purely pleasurable events they're meant to be.
What physical factors cause an orgasm to hurt?
One of the trickiest parts of McHugh's job in diagnosing and treating dysorgasmia is figuring out where the pain is coming from, and from there she can start to figure out what's causing it. McHugh said the physical exam is super important in helping her find a starting point. "It's not that I'm going to necessarily replicate the pain, but when I examine, I sometimes touch areas and the woman will say, that is where I feel the pain, I don't feel it now, but that's exactly where it is," she said. "That is so useful, because I can then target the therapy to address the actual cause of the pain."
Think of dysorgasmia like a headache. Some headaches are concentrated in one spot—like a sinus headache behind your eyes, or a dehydration headache behind your temples—and those are typically easier to treat, because the area the pain is coming from gives you an idea of what's going on. If McHugh can locate a precise spot that's causing pain, she can localize treatment to that area. Some examples are pain in the bladder, which could be a result of flare up or side effect of painful bladder syndrome, or pain in the muscles near the rectum, which can indicate a spasms in those muscles.
But then, sticking with the headache metaphor, sometimes you get a migraine, and it's not so much that this one spot on your head hurts, but the whole thing is throbbing. The most common presentation of dysorgasmia McHugh says she sees is a deep ache women feel in their abdomen, which typically indicates a problem with the uterus — the biggest muscle that's contracting and releasing when an orgasm happens. That pain can come along with uterine fibroids or endometriosis (and for some women with endometriosis, sex can be comfortable and pain-free up until the point of orgasm). Or it can also indicate something the uterus is pulling on, like adhesions—scar tissue that builds between the inner walls of the uterus. McHugh said pain stemming from the uterus can also last for hours or even days after an orgasm.
What mental factors cause an orgasm to hurt?
McHugh said a huge factor in treating any kind of pain in women—particularly pelvic pain—is screening for and addressing any history of sexual assault or trauma. "Women tend to internalize things and have a very mental and emotional response," she said. "Even if sex is enjoyable and they're with a partner they trust and everything is going well, it can be difficult to let go enough to have an orgasm, and when it is allowed t happen, it may come with both physical and emotional pain." She added that it can be incredibly hard for someone to separate those two things—the physical and emotional components of pain during sex.
To be clear, suggesting that the pain is coming from an emotional response isn't the same as saying the pain is all in a person's head. McHugh made it clear that the emotional pain someone may carry after some sort of trauma can very much result in real, physical pain. "I commonly refer people to mental health counseling for the purpose of talking about how the pain has impacted her life," McHugh said. "Also sex therapists—I refer people to sex therapists all the time. All of those people are useful to get this woman back to normal function."
Kimberly Anderson, a sex therapist and clinical instructor of psychiatry at UCLA, said she treats hundreds of women with pelvic pain a year, and among those are women with dysorgasmia. Like McHugh was saying, Anderson works typically as a team with other physicians—an ob-gyn who can diagnose dysorgasmia and treat with medicine, as well as a pelvic floor physical therapist who can help a woman re-train, stretch, or strengthen her pelvic floor muscles.
Anderson focuses on the mental aspects of pain. "If you have endometriosis or are a survivor or sexual abuse, you sort of feel betrayed by your body," she said. "Orgasm is supposed to be the icing on the cake, and if every time you're supposed to have pleasure you have pain, that's traumatic."
Focusing on mental components doesn't just mean treating a preexisting history of pain — it also means focusing on how the new pain, the painful orgasms the woman is currently experiencing, and how it are affects her mental health. "A phrase I use a lot with these women is don't throw the baby out with the bath water," she said. "For them it's all or nothing. They avoid all sexual contact and intimacy. Because they feel like they can't engage in their sexual life, they tend to feel less feminine, less sexy. It affects how women walk, how they speak, their posture. It's a very basic, fundamental thing."
Anderson also commonly asks a woman she's treating to bring her partner in so she can help facilitate a conversation about the pain between the two of them. She said her primary role in those conversations is just identifying the elephant in the room, and giving them permission to talk about it openly.
Aside from a history of trauma or assault, other mental factors can be something as simple as stress. McHugh said, similar to the way some people carry stress in their shoulders or lower back, a lot of people (women in particular) carry stress in their pelvis. "Many women have pelvic pain or pain right in their vagina, or pain they only feel with orgasm, when they're stressed," she said.
Ok, so how does this get better?
It all depends on where the pain is coming from. Like McHugh and Anderson said, treating painful orgasms usually involves a small team of doctors, or a multidisciplinary approach. If it's caused by something like an occasional muscle spasm or cramp, McHugh said the solution could be as simple as taking an ibuprofen before sex. If it's an issue with muscles releasing and contracting out of sync or muscles that are too tight, she may prescribe a muscle relaxer the same way she would for any other part of the body. And then there are the referrals to a mental counselor and a pelvic floor physical therapist.
Anderson said this is a dysfunction that really requires a well-rounded treatment plan. With mental counseling but no pelvic floor therapy, a woman might feel better about sex but still have issues with tight muscles or nerves in the area. And without mental counseling, a woman may retrain the muscles but never re-develop a healthy approach to sex and pleasure. The best approach for returning to pain-free orgasms is to treat the whole body and mind all at the same time.
Both Andersen and McHugh also gave the caveat that, while it's highly likely you'll be able to return to a thriving sex life with pleasurable orgasms aplenty, they try to be realistic with patients: This isn't something that's 100 percent treatable, 100 percent of the time. But there are things you can do to help yourself, whether this is something you experience all the time or even once in every dozen orgasms. The best thing is to see a doctor as soon as you can. It's much easier to treat dysorgasmia earlier rather than later. And it's also crucial to find a doctor who will actually listen to and believe you, something Anderson said can be difficult for a lot of women.
"It's not like a blood test," Andersen said. "A lot of doctors don’t know how to treat it and don’t believe it exists. I would encourage women to be assertive in advocating for themselves. If your doctor is dismissive, I would find another doctor, and not rest until you find a good one." If you're having a hard time locating a good doctor for dysorgasmia (or any type of pelvic pain issue) in your area, McHugh suggested the website for the International Pelvic Pain Society, which has a list of doctors based on region.
The most important step, and often the hardest for women to make, because the experience of being a woman is often invalidating especially when it involves matters of pain and sex, is to acknowledge that painful orgasms don't have to be "normal" for you, or for anyone. From there, a team of physicians should be able to help you get back on track.
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This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.