Let’s talk about sex — And pain

Dr. Irv Binik investigates pain during intercourse

For some women sex can be uncomfortable. For others it can be downright painful. Dr. Irv Binik, a Psychology professor at McGill and director of the Royal Victoria Sex and Couples Therapy Service is trying to ease the pain. He has been studying the problem of sex-associated pain in women, paying particular attention to two recurrent acute conditions, pain during or after intercourse (dyspareunia) and involuntary spasms of the vagina (vaginismus).

“At the hospital I saw an unusually large number of women all complaining of pain during intercourse,” says Dr. Binik of how he got involved in such research. But it was one particular patient who really alerted him to the problem. She had come to him in pain and was exasperated by the suggestion that she should consult yet another gynecologist. Dr. Binik remembers the encounter: “I said, she’s absolutely right. Why am I sending her to a gynecologist? I am a psychologist, I’m supposed to know about pain.”

Dr. Binik soon found out that women who experience pain during intercourse have very few options. “I basically learned that there was almost no research, almost no clinical intervention. People assumed it was a physical problem or a sexual problem. Nobody focused on the pain.” So with the help of some devoted graduate students and an open-minded McGill gynecologist (Dr. Samir Khalifé), Dr. Binik set out to delve more deeply into the topic.

“I think we quickly realized that we needed to stop trying to reduce the pain either to something physical or to something psychological. It wasn’t right to consider it only as something sexual either.” Instead, Dr. Binik and his team have tried to examine the problem from all sides, focusing specifically on the pain itself. “The main issue is pain and our first step has to be to learn more about it.”

Many in the mental health profession generally consider this disorder in a sexual context. The same sort of pain can be simulated in sufferers during non-sexual situations, but Dr. Binik notes: “an integral problem for these women is with their partners and intercourse and sex.” They can get around gynecological exams, using tampons and so on but the issue of sex itself is hard to ignore.

So what can these women do to find relief? “We typically recommend a combination of cognitive behavioral pain management and physical therapy,” says Dr. Binik. When there is not adequate pain relief, surgery may be recommended. But Dr. Binik believes the critical issue is to get away from defining this type of pain by the type of activity with which it interferes.

Thanks to researchers like Dr. Binik, the Sex and Couples Therapy Service at the Royal Victoria Hospital has become a major centre. Along with initiating discussion about the painful topic of painful sex, Dr. Binik is also working on getting his patients out of the clinic and back into the bedroom – where he hopes couples will be able to change their talk from pain to pillow.

This is the fifth in a series of interviews with McGill pain researchers whose investigations are funded by the Canadian Institutes of Health Research. The project, carried out in cooperation with The McGill Office for Chemistry and Society, aims to highlight recent advances in the study of pain. Permission is granted to reprint in whole or in part.