Chronic pelvic pain has been found to have a troubling effect upon the self-image of people who identify as heterosexual women, as well as on their sex lives.
This group of people with CPP may believe that if they cannot engage in penetrative sexual activity, their partners will eventually give up and find another woman who does not experience pelvic pain. An inability to have penetrative sex leads them to believe that they are an inadequate sexual partner and they may describe themselves as abnormal, useless and worthless because they cannot satisfy the perceived sexual needs of their (male) partners.
CPP can impact a person’s physical, emotional, psychological and sexual health; it can compromise their personal relationships and ability to carry out daily activities. People with pelvic pain report fatigue, problems with sleep and lethargy and are more likely to experience depression or anxiety; they report lower self-esteem and feelings of shame, isolation, guilt. Some people experience pelvic pain outside of sexual activity, others may experience pain with sexual activity, and for others it may be exacerbated by this activity. For people experiencing pain with penetrative sex, this activity can become less about pleasure and more about fulfilling their perceived role as a sexual partner, keeping their partner satisfied or conceiving.
These folks have been found to hold beliefs about ‘normal’ sexuality and sexual activity, and feel inadequate when they cannot fulfill these expectations. They feel an obligation to have sex, or privilege their partner’s perceived sexual needs, over their own need to have pain-free sex. Further, instead of pleasure, sex can become about fulfilling their role in the relationship, maintaining intimacy, keeping their partner satisfied or conceiving.
My experiences with people living with chronic pelvic pain unfortunately, supports these findings: a lot of these folks believe the above to be true.
But – why? Why do people draw these conclusions about themselves? Why do women with pelvic pain prioritize their partner’s desire to penetrative sex over their desire to have pain-free sex?
One of the culprits, are dominant narratives about sex, sexuality and male desire – what ‘we know’ about sex can be some version of: it is a woman’s responsibility to satisfy her male partner via penetrative sex – which is the pinnacle of sex – and if he isn’t feeling pleasure, or reaching orgasm, it is her fault; that male desire is naturally rampant and a core part of his identity as a man – that a ‘normal’ man wants penetrative sex, and wants it all the time, period. And, in fact, if he does not there must be something wrong with him.
These narratives don’t reflect what sex therapists – and people who have great, long lasting sex lives – know about people who have pleasurable sex.
There are varying ways to approach CPP in psychotherapy; one can start, though, with asking – where does what ‘we know’ about sex come from? Who says, and why? Because this answer to the question, “Does CPP make me an inadequate sexual partner?” is, invariably, no. This is not true. One’s value as a sexual partner does not lie in the ability or inability to perform one sexual act.
Stephanie Aniol, MSW, RSW, psychotherapist