“I Just Beared Through It”: Southern US Christian Women's Experiences of Chronic Dyspareunia

Background: Research has shown that up to 53% of adult women, at some point in their lives, suffer from pelvic floor dysfunction in the United States, although it is frequently underdiagnosed. Dyspareunia is a type of pelvic floor dysfunction that is identified as pain with sexual intercourse, tampon insertion, vaginal examinations, vaginal stimulation, and other occurrences involving vaginal touch. There are a limited number of studies that use qualitative approaches investigating women’s experiences of dyspareunia. Objectives: The purpose of this qualitative study was to explore the emotional, physical, and psychological experiences of self-identified Christian women from the Midsouthern United States who have been recently diagnosed with dyspareunia associated with pelvic floor muscle overactivity. The research question was: How do self-identified Christian women in the Midsouthern United States experience dyspareunia? Study Design: Narrative inquiry was the qualitative methodology used for this study. Methods: Methods of data collection included questionnaires followed by semistructured interviews with 8 women. Results: Thematic analysis was used to discuss 4 themes: (1) misdiagnosis and dismissal (personal and medical) of chronic dyspareunia; (2) individualized strategies for coping with chronic dyspareunia; (3) sex (mis)education: influences of abstinence-only approaches, purity culture, and peer pressure; and (4) understandings about sex, religion, and pelvic pain. Conclusion: Primary care physicians, gynecologists, and pelvic floor physical therapists are encouraged to recognize the importance of factoring sociocultural aspects, INTRODUCTION Research has shown that up to 53% of adult women, at some point in their lives, suffer from pelvic floor dysfunction in the United States,1–3 although it is frequently underdiagnosed.4–6 Further, pelvic floor dysfunction affects 41% of premenopausal women specifically.7 While definitions vary, dyspareunia is generally described as a type of pelvic floor dysfunction classified by pain with attempted or completed penile-vaginal sexual intercourse.8 More specifically, deep dyspareunia entails pain inside the vagina, usually with deeper penetration, while superficial or introital dyspareunia involves pain on vaginal entry or vaginal introitus.9 A distinction is also made between pain with first intercourse attempt (primary dyspareunia) and pain after a period of pain-free intercourse (secondary dyspareunia).10 Apart from attempted intercourse, pain can also occur with tampon insertion, vaginal examinations, and vaginal stimulation that may or may not be penetrative involving fingers, dilators, vibrators, etc.8,11 Lifetime estimates for women experiencing chronic pain during sexual intercourse range from 10% to 28%.12 Occurrence increases significantly for women who have given birth vaginally, with 85.7% experiencing painful first vaginal sex within 1 year postpartum, and 44.7% and 43.4% reporting consistent pain at 3 and 6 months postpartum, respectively.13 Another study exhibited similar findings with broader ranges for postpartum women, with 30% to 60% experiencing painful 1University of Memphis, Tennessee. 2University at Buffalo, SUNY, New York. 3Sundara Wellness Center, Southaven, Tennessee. The authors declare no conflicts of interest. The authors received approval from the Institutional Review Board at the University of Memphis for this study. Corresponding author: Alison Happel-Parkins, PhD, 100 Ball Hall, Memphis, TN 38152 (aahappel@memphis.edu). DOI: 10.1097/JWH.0000000000000158 Research Report “I Just Beared Through It”: Southern US Christian Women’s Experiences of Chronic Dyspareunia Alison Happel-Parkins, PhD1 Katharina A. Azim, PhD2 Amy Moses, DPT, OMT3 VOLUME 44 • NUMBER 2 • April/June 2020 such as religion, into their patient care and treatment, and to proactively discuss them during patient assessment. Pelvic floor physical therapists are encouraged to address women’s sociocultural contexts, including potential exposure to religious messages of shame and fear, during patient intake, and possibly throughout treatment.