“Fulfilling His Needs, Not Mine”: Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States

Abstract

Introduction Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. Aim The purpose of our study was to examine women’s reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. Methods We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. Main Outcome Measure Women were asked, “To what extent was this sexual experience physically painful for you?” Those who reported any pain were asked, “Did you tell your partner that you were in pain during sex?” and, if applicable, “Why didn’t you tell your partner that you were in pain during sex?” Results Of those reporting pain during sex, most said it was “a little painful” (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43–7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner’s enjoyment, and gendered interactional pressures were the predominant themes in women’s narratives. Clinical Implications Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. Strengths & Limitations Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. Conclusion Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why.

Women’s Sexual Health During the Pandemic of COVID-19: Declines in Sexual Function and Sexual Pleasure

“…This review suggests that these inequalities, including childrearing, contributed to lower indexes of sexual function and satisfaction, which in turn provide evidence of pleasure inequality. Because some women may struggle with negotiating sexual pleasure and tend to favor men’s sexual pleasure [ 91 , 92 ], it is possible that during this pandemic, these women engaged in sex in the absence of sexual desire or in the presence of sexual pain. This is likely to have resulted in pleasureless sex and, consequently, to even have lowered levels of sexual function.…”

Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

“…The methods for the 2009 and 2018 NSSHB survey waves have been described in detail elsewhere (e.g., Fortenberry et al, 2010 ; Fu et al, 2019 ; Herbenick et al, 2010a ; Reece et al, 2010 ). The NSSHB is a US nationally representative probability survey of adolescents and adults in the USA that was initiated in 2009, with six subsequent data collection waves occurring between 2012 and 2018 (Beckemeyer et al, 2019 ; Carter et al, 2019 ; Guerra-Reyes et al, 2018 ; Hensel et al, 2015 ; Herbenick et al, 2019a , 2019b ).…”

Sexual Pleasure Matters (Especially for Women) — Data from the German Sexuality and Health Survey (GeSiD)

“…This US nationally representative survey asked about participant's experience with pleasure during the last partnered sexual event among ethnically diverse samples (Townes et al, 2021) and various age groups (Schick et al, 2010). Another line of research examined sexual behaviors (Herbenick et al, 2019) and sexual techniques related to (women's) sexual pleasure , as well as lack of pleasure relative to sexual pain (Carter et al, 2019).…”

“…Evidence suggests that in the heterosexual context, sex that women experience is different, and substantially less positive than the sex that men experience (Conley & Klein, 2022). Research shows that women experience orgasms at far lower rates than men (e.g., Conley et al, 2011;Frederick et al, 2018), that pain associated with sex is much more common among women (Carter et al, 2019;Elmerstig et al, 2013), and that women are subject to far more violence in heterosexual sexual encounters than their male counterparts (Brunner et al, 2021;World Health Organization, 2013). We aimed, therefore, to investigate the relationship between sexual pleasure and sexual health outcomes for women and men separately to examine, whether there are gender differences in these relationships.…”