Sex Hurts full transcript
ALLISON BEHRINGER: Hey mom, you did a great job. But why didn’t we ever talk about how sex is supposed to be just as good for me as it is for my partner? Why did I think it was OK to always put myself second?
I’m Allison Behringer and this is Bodies, a new podcast in collaboration with KCRW’s Independent Producer Project.
I think often we see our bodies as this independent system. But actually, I think what happens to our bodies is woven into our relationships--with ourselves, with friends and family, with partners. Each episode of Bodies begins with one person and a question or mystery they have about their body. The story is their journey to figure out what’s going on. And the first episode? It’s what inspired this whole show. It’s about my body.
I meet Luke in the spring, in the basement of a bar in Harlem. I’m 24. He shows me a new way to exist in a city that I’ve written off. One time, after a dinner out, he has his bike with him. So I sit on the seat and hold on to his waist and he pedals us back to his apartment. He wants to touch me and kiss me and take my clothes off at every opportunity. He creates these opportunities. I am the one to say I love you, first.
The first time I feel the pain, we’re in Paris after the summer apart. He meets me at the airport, with flowers and a chocolate croissant. We’ve been practicing our French together all summer. That first night back together, we’re both having a hard time taking it slow. It’s going exactly as I imagined.
But then. He enters me, I feel a little pain, and some burning. But it also feels so good to have him inside of me again, so I don’t say anything. He comes.
I’ve been on the pill since I was 18, but Luke’s the first guy I let come inside me without a condom. We hold each other for a minute. The pain goes away. And besides that, and besides the late summer air being too chilly for my sleeveless dresses, the weekend is perfect and romantic in all the ways Paris with a lover should be.
It’s winter now and we’re moving in together. Luke’s driving the rental car and we’re on our way to a tiny one month sublet in Brooklyn.
As we get closer to the city, I pray that Google Maps will route us over the Brooklyn Bridge. It does. I look up at the steel wires crisscrossing the skyline and Luke gives my leg a squeeze.
We start to settle into life together. But painful sex is getting worse.
Foreplay: enough to get him hard, but I’m barely wet. He enters me slowly – at this point he at least by now knows to do this. And I feel a burn. I close my eyes, try to relax, try to enjoy it. Ok, it’s not so bad now. But then burning again, now pain deeper in my insides. He’s really into it. It’s hurting, I say in a small voice. Another thrust. It’s hurting, I say again. He pulls out. I help him finish. He goes to sleep. I stare at the ceiling.
I’m broken, I’m wired wrong, I have an STD, I have cancer! It’s all my head. What is wrong with me? Did I do this to myself? What are we doing wrong? Maybe we should take a break from sex for a while.
I’ve always thought of myself as a good communicator. But I keep these thoughts to myself. Luke knows that sometimes it hurts me, but I haven’t let on how often and how much. I don’t want to make a big deal about it. So I try to ignore it. Hope it’s just a phase.
I fall asleep, and in the morning, things are ok. I wake up in Luke’s arms. He’s holding me tight.
Besides Luke, I haven’t told anyone about what’s going on. I’ve just spent a lot of time googling “painful sex” and getting more and more scared. I find one condition called vulvodynia. No cause. No cure. Chronic pain. We try more lube, more foreplay. We try everything. Everything that is, that will get us to penetrative sex. And a lot of the time, sex is so painful that I just have to tell him to stop in the middle of it. He doesn’t really hide his disappointment.
Finally, I make an appointment with my gynecologist back home in Maryland. I tell my mom only the essentials.
I’m on my back, in the exam chair, and I tell the doctor that it’s been over 5 months of on and off painful sex. She does a quick exam. And then she’s just like, “Well, nothing’s wrong.” And I’m kinda like, “Wait, what? What could it be?” And all she really says is, “Eh, lots of women have pain during sex. It’ll probably go away. Try using more lube.”
When I get home, my mom is sitting at the kitchen table. How’d it go? She asks. I curl up her lap and cry. On the bus ride back to New York City, I stare out the window, watch the bare trees on I-95. I guess this is just how it’s gonna be. I’m not a person who’s ever going to have amazing, mind blowing sex.
I’ve played sports all my life. I run, I bike. I’m always telling my body what to do, and it listens. I know the ecstasy of finishing a twelve mile run, scoring an overtime goal. But with sex, it’s different. My body is not cooperating.
And, so, when I hear my friends talk about sex, about the three orgasms they had the night before. I feel so left out. Like I’m missing out on this grand human experience. And even Luke. Sex is so central to him. And I love having sex with him, the intimacy, the closeness. But I envy him – the pure pleasure that he feels.
About a month later after the doctor’s appointment, I’m chatting with a friend. I tell her how I’m thinking about getting an IUD and we get on the topic of birth control. And then, she starts telling me what happened to her. She’d had painful sex too – for 7 years. And she’d been to over 20 doctors and had tried everything. Finally, she found one more specialist, Dr. Goldstein, and he was able to tell her, pretty much right away: It’s your birth control pill.
So I’m like, “Oh my god, could this be my problem? I’m on the pill, one of those standard ones, ortho tri-cyclen.” My friend thinks it’s possible it might be the pill. So she connects me with Dr. Goldstein.
It’s a beautiful spring day. The windows are open in the waiting room and the breeze is tapping the blinds. I get shown into his office.
ANDREW GOLDSTEIN: Hi, I’m Andrew Goldstein, please take a seat.
ALLISON: Dr. Goldstein asks me everything.GOLDSTEIN: OK, and you started having periods at what age? Pain with tampon insertion? First time intercourse? Back Pain, hip pain? Anxiety or depression? History of trauma? What did you do for contraception starting at age 18? So when did you first notice pain with sex?
ALLISON: It was this past summer…
ALLISON: I tell him the whole saga.
GOLDSTEIN: And so intercourse was painful, was it enough to prevent you from having sex or make you stop during sex?
ALLISON: A lot of times, it was more like stop during.
GOLDSTEIN: That must have sucked. Is the relationship holding up ok though?
ALLISON: Yeah.
GOLDSTEIN: Okay, your boyfriend is pretty supportive?
ALLISON: Yeah.
GOLDSTEIN: Fabulous, that’s good. Were you getting more frustrated? Or feel like you can figure it out?
ALLISON: No, it was def really frustrating, especially ‘cause…
ALLISON: *crying*
GOLDSTEIN: I know, it’s tough. This is – this is – look, I have to tell you, this is something that’s really upsetting. Honestly, I hear this story again and again. It’s sort of doubly frustrating because the problem is very frustrating…
ALLISON: I know I just told him the relationship is fine, but it’s not. I’ve been feeling so isolated. I don’t have the language to explain the complexity of what is going on with Luke.
GOLDSTEIN: But sort of being dismissed by another doctor, to say there’s nothing wrong, there’s nothing we can do. Or even worse by someone saying, you know, a lot of women have this deal with it, is super frustrating.
ALLISON: Yeah, it’s kinda ruining my relationship.
GOLDSTEIN: Don’t blame yourself. Honestly, we’ll figure out what the cause is and we’ll figure it out.
GOLDSTEIN: So come with me. Go this way.
ALLISON: Dr. Goldstein leads me to the exam room. The exam is meticulous, 15 minutes long. Does this hurt? What about this? What if I press here? He gives me a mirror so I can look at myself and see exactly what’s happening and where. Then back to his office.
He shows me a diagram of the vulva and then points to the vulvar vestibule--it’s the area inside the lips, right around the opening of the vagina.
GOLDSTEIN: Now what’s interesting about the vestibule is that the tissue is very very hormonally sensitive. It needs hormones to work.
ALLISON: What he says next surprises me: The hormone these glands need isn’t estrogen, it’s actually testosterone. And when there’s not enough testosterone, the glands don’t work and the tissue thins out.
GOLDSTEIN: When I did an exam today and I showed you those gland openings, I think you’ll remember they were really really red. So the pill has essentially thinned out the skin and tissue. So it causes burning actually in the skin of the vestibule.
ALLISON: He walks me through the science: The pill prevents pregnancy by shutting down the ovaries. This shutdown decreases the amount of testosterone and estrogen that the ovary naturally makes. The second key thing that happens is that the pill increases a protein in the body called sex hormone binding globulin – just remember that it’s a protein. This protein is really important to the painful sex puzzle. What it does, is it binds on to testosterone, and prevents the body from using it. So, it decreases the amount of testosterone that’s available for the body to use. And then he explains where the other pain – that deeper pain – is coming from.
GOLDETEIN: When you have pain because of hormonal reasons, the natural inclination – because you’re guarding – is to tighten up muscles.
ALLISON: These muscles are called the pelvic floor, basically this basket of muscles that holds your bladder and reproductive organs. And from constantly bracing against the pain, my muscles here are really really tight.
So basically, he tells me, I have pain for two reasons: Hormonal imbalance from the birth control pill and tight pelvic floor muscles from bracing against the pain.
GOLDSTEIN: And that combination is very common.
ALLISON: He gives me my treatment plan: One: Stop the pill. Two: use a topical hormonal gel with estrogen and testosterone. Three: pelvic floor physical therapy – which I’ve never heard of.
GOLDSTEIN: So this all can be accomplished probably within about 6 months. Any questions about all this stuff?
ALLISON: Um, so, and what about sex during those 6 months?
GOLDSTEIN: So there are a couple things. Painful sex is bad, OK. So the more painful sex you have, the more you’re gonna be conditioned to tighten up, ok. So I strongly discourage painful sex. On the other hand, I strongly encourage non-painful sexual activity. Really embrace intimacy, really do things that feel good. Really focus on your sexuality as a couple. During the next at least 3-4 months, really I suggest not have penetrative sex.
ALLISON: Overall I’m so relieved just to know what’s wrong with me. I throw away the rest of my pill pack, fill the prescription for the gel. But when I get home that night and tell Luke about the appointment and I get to the not having sex part, his shoulders slump.
The next day, I draft an email to him:
“When the doctor told me that I shouldn't have sex for 2-3 months, the first thing that came to mind was your reaction and how it wouldn't be good. You haven't seemed to want to understand what it’s been like. When you told me you wanted to move in together, the idea really scared me. I wish you cared to get to know my friends and their names. I wish you wanted to spend time with my family. I haven't felt like myself lately. I love my independence. Maybe those two are related.”
I don’t finish the email. I don’t send it. I copy and paste it into my journal instead.
I start going to a pelvic floor physical therapist. My insurance doesn’t cover it, and so I pay over 1,000 dollars for my four visits.
So, something interesting about the pelvic floor – that basket of muscle that cradles up your pelvic area organs – in men, the pelvic floor is difficult to reach, but with women, the vagina provides an access tunnel, if you will. So my physical therapy sessions consist of the PT essentially fingering me and giving me a pelvic floor massage. Yes, it’s a little weird. And yes, it does feel kinda good.
But in the first weeks, like Dr. Goldstein said, I’m not seeing much change. I’m hopeful though that this’ll be a time to explore my sexuality, and I’m excited to try new things, all the other parts of sex besides the P in the V.
But here’s how it goes: We start messing around, Luke is trying to listen, trying to focus on me, I know he’s really trying. But then he gets all excited and tries to stick his P in my V, so we do other things so that he can finish. And then it ends. No pain, but not much pleasure for me either. I wonder if I ever really WILL get back to normal. But I guess I don’t even really know what normal is… I’d been on the pill since I was 18 when my mom found out I was having sex.
I start getting more and more angry. At Luke for not being more understanding. At the first doctor I saw. Angry about all the things I didn’t know and all the things I still don’t understand. I think my biggest question is like, now that I know..taking synthetic hormones every day for years seems like an obvious suspect for a sex-related problem.
And so how is it that I never ever suspected that the pill could be the culprit?
I’ve always thought of the birth control pill as the foundation of modern feminism, of sexual liberation. But have there always been side effects like this? I start digging. Here’s what I find out.
In the 1950s, when Margaret Sanger and her team were developing the pill, contraception was still illegal in most states, so they couldn’t run the clinical trials in the US. So they did the tests instead on Puerto Rican women, without telling them it was an experiment, and without telling them it was a contraceptive drug.
During the 9 months of the study, it was 100% effective in preventing pregnancy, but the doctor who was actually running the trials said that it caused too many side reactions to be acceptable. But Sanger’s team pushed ahead. They were SO close. This pill was gonna change women’s lives.
And in 1960, the FDA approved Enovid as the very first contraceptive pill...initially, by the way, only available to married women. Within 5 years, 6 million women reported using the pill.
But the estrogen levels were like 10 times the amount that today’s pill has, so there were TONS of side effects: heart attacks, strokes, blood clots, cancer, depression and loss of sex drive. But when they went into their doctors with these side effects, they were told to continue using the pill.
Then this journalist Barbara Seaman wrote a book exposing these side effects, and as result a Congressional hearing was set up. At the hearing, pharmaceutical companies were called to testify. Doctors – all of whom, male – were called to testify. But no women were called to testify. Not one who was actually affected.
A group of women showed up though. And at one point, one woman stands, shouting from the back of the room.
WOMEN: Why have you assured drug companies that they can testify? Why have you told them they will get top priority? They’re not taking the pills, we are!
MAN: Uh huh.
WOMEN: We are not going to sit quietly any longer. You are murdering us, for your profit and convenience.
MAN: We’re not going to permit proceedings to be interrupted in this way, if you ladies would uh, sit down.
WOMEN: Our lives have been interrupted by taking this pill.
MAN: We’re conducting–
WOMAN: I don’t think the hearings are any more important than our lives...
OFFICER: Miss...
WOMAN: Take your hands off me.
ALLISON: After the hearing, the estrogen levels in the pill were slashed. And it was mandated all prescription drugs, not just the birth control pill – had to have a label for patients that described the side effects.
By this time, seven other pharmaceutical companies had created contraceptive pills. I mean, think about it: A medication taken by a healthy person, by half the population? Everyday, potentially for decades?
So if there is this history of side effects, what’s the consensus on side effects of the pill today? I start researching and talking to doctors. Everyone’s kind of saying different things.
On the one hand, some studies suggest that today’s pill can negatively affect a woman’s ability to orgasm, decrease her sex drive and cause vaginal dryness. And there are peer-reviewed studies which suggests that the pill may cause painful sex.
But many of the doctors I talked to said that painful sex is not a side effect of the pill.
IRWIN GOLDSTEIN: The fact that individuals don't appreciate the link is largely based on the fact that individuals don't see patients so they don't have suspicion for the link.
ALLISON: This is Dr. Goldstein – No, not the same one I saw for my appointment, a different Goldstein, this one’s Irwin.
IRWIN GOLDSTEIN: But to sit in my office. You see the link almost on a daily basis. It still goes back to health care providers don't view women as sexual beings. They don't understand the role of women's sexuality in their life quality. They’re more interested in stats on teen pregnancy.
ALLISON: So something that doesn't make sense to me, if there are some accepted side effects of the hormonal birth control pill, like dryness or lower desire then why is it so surprising that hormonal birth control could also cause painful sex if it's causing these other sexual side effects?
IRWIN GOLDSTEIN: I I don't know how you can avoid going back to the argument that they say, “OK, who cares.” I don't mean that facetiously. From my point of view, I care very passionately. But to colleagues, it's not – it's not important.
I'll give a lecture to a group and I'll say, OK every man in the room stand up. so 250 people stand. I say remain standing up. If you would volunteer to take a medication that would, 100 percent of times, lower your testosterone value in your blood. Probably of the 250, 247 sit down.
So I asked the next group, all you women stand, okay, all 250 women stand. I say if I tell you there's a medication out there which guarantees to take a very critical sex hormone right on the lower it's a very significant low values, 100 percent of the time. Would you take them?
And the vast majority of women sit down. Very few of them would volunteer to take it. I said you have just shown me that if you actually knew what happens to your body with the birth control pill – it's essentially 100 percent of the time your testosterone would fall – then why is it that women are prescribed this and take it? So if the pill always increases the protein, then why aren’t all women on the pill experiencing painful sex?
Irwin Goldstein along with a group of doctors--including Andrew Goldstein--did this peer-reviewed paper. In the study, they took women who had painful sex because of the pill. And then compared them to women who were on the same kind of pill who didn’t have the problem. And the study found that there was a big difference in the genetics of their testosterone receptor gene. So, in other words, some women are pre-disposed to react this way to the pill. And I’m clearly one of them.
And of course, all medications have side effects. But if we don’t know about the side effects, how can we look out for them? So it turns out – and I can’t believe I didn’t already know this – but when the FDA is deciding on the safety of a drug, the FDA is not actually conducting the study themselves. The drug company is. And the FDA doesn’t require that companies ask about sexual side effects in their studies.
When the painful sex started for me, I was taking Ortho-Tri-Cyclen. So I call up the pharmaceutical company that makes this pill.
REPRESENTATIVE: Thank you for calling Janssen.
ALLISON: I wanna report the painful sex and see what side effects are listed in the prescribing information. Janssen, by the way, is a Johnson & Johnson company.
ALLISON: Yeah, and if it’s alright, I’m gonna record this conversation? No? Why is that?
She just repeats that she can’t give permission.
I report my side effect. And ask if I can talk to anyone on the record, how often this side effect gets reported. I don’t get anywhere. But she does offer to send me the full prescribing information.
I search the document for “pain” and “intercourse”, nothing. “Dryness” only comes in an “outside reports” section. But there is one thing. Sex hormone binding globulin--that protein that decreases the amount of testosterone available. The document says that the pill, quote, “may raise the concentrations of globulin.” But that’s it – it doesn’t go on to say how that affects testosterone or any other functioning.
And why not? Well, it’s not generally accepted that testosterone affects sexual functioning in women. And why isn’t there more research on that? Well, that just takes us back to what Dr. Goldstein said: We don't understand the role of women's sexuality in their life quality.
ALLISON: And as for my life quality? My body is healing, but the relationship is continuing to break down. It’s been 2 months since I first saw Dr. Goldstein. Luke and I have started having sex again, and the pain has mostly gone away. But we’re still struggling to communicate. And our differing values on money, family, friends – getting some semblance of a sex life back didn’t solve those things like I think we both had hoped.
And so, in the kitchen of our 4th sublet in 6 months, I break up with him. After being so passive, so unable to tell him what I want, my assertiveness surprises me. The next morning, I pack a bag of clothes and I leave.
In the inevitable post-relationship “what went wrong” analysis that we all torture ourselves with, I’ve wondered SO many times how things would have turned out if it weren’t for the pain.
But I’m not sure that an absence of pain would have meant pleasure. I think it still would have been all about him. And to be fair, I wasn’t firmly advocating for what I wanted. I was still trying to figure out what I wanted. I never expected it to be about me.
A study of college aged men and women found that college aged women are more likely to use their partner’s pleasure as yardstick for own satisfaction. Whereas college aged men are more likely to use their own satisfaction as a yardstick for their satisfaction.
There was one last person I wanted to talk to about all this.
ALLISON: You know, I feel like you did a really good job raising me. I think you're a great mom. But – like i just feel like we never had a discussion about, when you have sex, make sure that you can advocate for your own pleasure, like, this should feel good for you too, or like, make sure you put yourself first. We never had that conversation and I feel like it's taken me until my mid-twenties to start thinking in that way. Why didn't you ever tell me that?
MOM: That's an easy answer, ‘cause one is you only know what you know. And I didn't have any information to give you. My mother never talked to me about it. And I grew up in a very strict Catholic family. And you didn’t – you didn't advocate for yourself. I didn't know that you were supposed to advocate for yourself. And as a mother of a teenager, the goal was to make sure you didn't get pregnant. You're lucky. You learned in your 20s. It took me to my 50s.
ALLISON: We talk for almost thirty minutes. Trying to think if I have any more questions. I think that’s it. Thanks mom.
Then I put the microphone down.
MOM: Like I said, I only knew what I knew.
ALLISON: Mom! Why are you getting emotional? Why are you getting upset Mama?
MOM: Because sometimes I feel like I failed you in that department.
ALLISON: Mom! It’s ok. You didn’t fail me, that’s silly!
MOM: Yeah, but you – why didn’t you tell me? Why didn’t you? Well, I didn’t know any better. I mean, Aunt Kathy was the one who told me that, you know, you could rub your clitoris while you're having sex. Like what, I dunno!
ALLISON When did she tell you that?
MOM I don't remember, I had to be married. 20s or 30s or something like that.
ALLISON: You did a really good job. I’m serious. OK?
MOM: OK.
ALLISON: I love you.
MOM I know you do.
MOM: Mmm, mmm, mmm. [kiss kiss] Did you know a six second hug decreases your blood pressure?
ALLISON: 1, 2, 3… feels good.
CONCLUSION
When I was little, my mom was always the first person I went to when I had a question. But slowly, over time – as my worldview expanded and I’ll admit, my arrogance grew – my mom became the last person I went to with certain questions. This whole time, I think my question has been why didn’t I know my body better? And my mom had the answer: It’s because of silence. It’s because women haven’t been the ones writing the stories about our bodies.
And so, I don’t think it was fair of me to pin the blame on her. But I’m glad I asked, and I’m glad I pushed because we actually had a conversation about it.
And my mom reminded me that I do have the pill – and her – to thank for not getting pregnant in my teens and early twenties. And so I just feel like there has to be more awareness about the side effects.
We should know what we’re putting in our bodies and never settle for the idea that pain is just part of the deal, part of being a woman.
I never went back on hormonal birth control. And a few months after Luke and I broke up – Luke is not his real name by the way – I was able to have completely pain-free sex. As for the pleasure side and communicating what I want? Honestly, it’s still a work in progress. But I’m getting a lot better.
This podcast is about journeys like mine, that begin when a person doesn’t get a satisfactory answer about their body. It’s about thinking for yourself, but also thinking as a community, gathering knowledge from personal stories. Investigating different kinds of medicine, different perspectives.
It’s a chance to write our own story. I’m Allison Behringer. And this is Bodies.
An important note: Birth control is not the only cause for painful sex. I’ve talked to a LOT of people who’ve had this problem. So if sex is painful for you, check out Dr. Andrew Goldstein’s website--it has an extensive list of specific issues and treatments. You can find a link to this on the Bodies Facebook group.
The Bodies Facebook group has a lot of information that couldn’t fit in this episode. Like other common side effects of the pill. Non-hormonal birth control methods, like fertility awareness. More about the history of the pill. The Bodies Facebook group is ALSO a place to share questions or experiences about your body. Nothing is off the table, and everyone is welcome. You can find a link to the Bodies facebook group in the show notes or by going to kcrw.com/bodies. You can also follow the show on Twitter at @bodiespodcast and me at @albtweetin. Would love to hear your thoughts. Finally, if you got something out of this episode – please leave a review for Bodies on Apple Podcasts – it really really helps other people find the show.
This episode was produced by me, Allison Behringer. Editorial Advising by Kaitlin Prest. Additional editorial support by Abigail Keel. Original score and sound design by Dara Hirsch. Archival footage thanks to ABC News VideoSource. Special thanks to Rachel Schnipper – this episode includes footage from her forthcoming film. Cover artwork by Sarah Bachman. Episode art by Kathy Farthing. Thanks also to KalaLea, Camila Kerwin, Willow Belden, Wendy Zukerman, Caitlin Peirce, Ana Adlerstein, Sally Helm. As well as Margot, Analisa, Avery, Katy and Catherine who provided feedback on this episode. Bodies is made with support from KCRW’s Independent Producer Project, whose manager is Kristen Lepore. Special thanks to Nick White for supporting this project from the start and to the whole KCRW team. I’m Allison Behringer, this is Bodies.