Healing Painful Sex

A Woman's Guide to Confronting, Diagnosing, and Treating Sexual Pain

The Center for Sexual Pleasure and Health


Every Monday, The CSPH takes a look at a book or film focusing on an aspect of sexuality. This week we are featuring Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain by Deborah Coady, MD and Nancy Fish, MSW, MPH.


Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain is a comprehensive guide in which two women join forces to help other people suffering from sexual pain understand their individual conditions, take control of their healthcare and find treatment, and manage their personal and professional relationships. Nancy Fish and Deborah Coady both make careers out of helping others; Fish, a social worker with a master’s in public health, went through many doctors for her chronic sexual pain before arriving at Dr. Coady, a gynecologist with a practice devoted to treating sexual pain.  “Painful sex” is an umbrella term that encompasses all types of sexual pain experienced by those with vaginas, from Clitorodynia, to pelvic floor or vestibular pain, to complications from IBS and hormonal changes.  Sexual contact—or, in some cases, any type of contact—is excruciatingly painful for people with any of the conditions described in the book, leading to unfulfilling sex lives and possibly upsetting personal relationships.


The authors address the current medical system in the United States, which they say is not educated about sexual pain and ill-equipped for its treatment in general: doctors often have time for only 15-minute appointments with each patient, which is not enough time for adequate examination or questioning.   Women suffering from sexual pain are often told that their problems are psychological, that they just need to relax and deal with it, and that their pain can’t possibly be as debilitating as they claim.  This isn’t an anti-doctor or home remedy/holistic medicine book, though:  Dr. Coady and Fish acknowledge the limits of Western medicine while teaching their readers how to navigate within these limits to achieve freedom from pain.  It might take many visits to many doctors, it might take the cooperation of several specialists and physical therapists, and won’t be quick, but individuals who suffer from sexual pain can reclaim their bodies and their sexualities; they can heal.


However, the authors make it clear that this isn’t a diagnostic book, as diagnosing and treating sexual pain isn’t easy.  The pain sufferer (often addressed as “you”) is brought first to a place where the sufferer can articulate the types of pain they are feeling, and then the book describes a litany of different types of sexual pain in subsequent chapters.  In these chapters, the types of pain and typical reasons for the genesis of the pain are listed and discussed with the purpose of educating the sufferer and providing them with articulate information to bring to a healthcare provider.


Perhaps the most useful and original part of this book is how the authors arm pain sufferers for their meetings with doctors.  Urging the patients to be their own best advocates, the authors provide pain sufferer with scripts and suggestions for having a conversation with a doctor to determine whether or not the doctor will be able to treat their condition.  Dr. Coady knows, as a practicing gynecologist, that many doctors are overtaxed as is and don’t have the time or funds to help sufferers of chronic pain, and that, crucially, this isn’t their fault.  Pain sufferers are coached to be choosy about their doctors but not to see them as adversaries or obstacles to healing.  Ultimately, the chosen doctor or doctors should believe that sexual pain is not psychological, should understand that many visits and perhaps more than one doctor will be needed, and be willing to either do research into specific types of sexual pain or accept the patient’s own research (from scientific journals, and other legitimate non-internet sources, of course).


There can be no telling how long pain will last in many cases, or how long it will take to heal. Fish and Dr. Coady make sure to talk about the psychological toll that sexual pain can have not only on pain sufferers, but also on sex partners and family members of those suffering.  Those without partners are not left out of the “relationships” conversation, as the authors give advice for those who have begun to heal and are interested in dating.  Additionally, the authors discuss navigating the workplace with a condition that most sufferers don’t wish to make openly known. Suicidal thoughts are common in sufferers of sexual pain, and Dr. Coady and Fish address this often, stressing that if any pain sufferer finds that their thoughts are turning into suicidal plans that they need to go immediately to an emergency room.


Healing Painful Sex is a must-read guide for any female-bodied individual suffering from sexual pain who has been unable to get adequate care, as well as anyone in a sexuality profession that could encounter someone asking them for advice about sexual pain.  It’s truly comprehensive in scope and compassionate in tone, while offering practical advice for how sufferers can learn to work with medical providers to get better.  Deborah Coady and Nancy Fish aren’t offering any sort of cure-all or product, they simply want sufferers of sexual pain to know that treatment is available, and how to advocate for that treatment in a cooperative and effective manner.


More information about the book and the authors’ contact information can be found at http://healingpainfulsex.com/.



North American Menopause Society

This book provides factual medical information about quality-of-life healthcare issues pertaining to the diagnosis and treatment of sexual pain—issues that are not spoken about nearly enough. Conditions frequently misunderstood by a healthcare provider or a patient are addressed, including vulvodynia, pelvic floor muscle dysfunction, and pelvic pain. A listing of additional resources including books, websites, and organizations are also provided.

One strength of this book is the clear validation of medical conditions that cause pain with sex. There are additional discussions of individual patient situations and techniques that can be employed in order to overcome these healthcare issues.


The information is encouraging and insightful, and I think the majority of readers, including medical professionals and women suffering from painful sex, will find this book valuable.


Mickie Griffith-Autry, PhD, NP-C

Innovative Pelvic Health, LLC
Jackson, Mississippi
September 5, 2012


Psych Central

In Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain, physician Deborah Coady, MD, and psychotherapist Nancy Fish, MSW, MPH, combine their medical and psychological expertise to write a book about and for women who suffer from sexual pain.  Healing Painful Sex is concise, clear, and comprehensive, informing women of the many causes and treatments available for disorders.

Through its holistic, compassionate approach, this valuable guide empowers with knowledge, instills with confidence and gives women a direction for finding doctors who are truly knowledgeable about their disorders and able to treat their pain.  As is read in its introduction, “This book is the product of our passionate belief that all women with sexual pain need both physical and emotional support.” 

Deborah Coady and Nancy Fish provide a detailed, empathic guide that that offers a wealth of physical and emotional suppport. I highly recommend Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain.

Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed or not diagnosed at all.  Because of the multidisciplinary nature of sexual pain, which falls between the disciplines of experts, women have often been told that pain is “all in your head”  or that nothing can be done to help them.  As Coady and Fish point out, “We’re here to tell you that none of that is true.  Sexual pain is almost always caused by an identifiable, verifiable medical condition; it can be treated and is not in your head.” 

Nancy Fish had suffered from severe pelvic pain and had seen seven specialists before visiting Deborah Coady.  Coady, while having years of experience with women suffering from sexual pain, nonetheless took some time to uncover all of Fish’s difficulties.  Fish, like most women suffering from sexual pain, through inadequate treatment had several conditions that had compounded and spread.  A licensed certified social worker specializing in chronic illness, Fish found great hope in Coady’s insistence that she never give up on herself. She was inspired to form a partnership with Coady to help those with the chronic illness of sexual pain. 

Deborah Coady, through her personally developed teams of colleagues in neurology, dermatology, orthopedics, pain management, gastroenterology, urology, peripheral nerve surgery, physical therapyand psychotherapists, demonstrates in Healing Painful Sex how fruitful their holistic approach can be. As they write, “Even in your most difficult situations, you can experience a significant reduction in your pain and can find help for reintroducing sex as a joyous and nourishing part of your life.  We promise:  Things can get better.”


The book is organized into three parts. 


Part 1: Naming the Problem begins with the difficult situation of talking about sexual pain.  It helps the reader learn how to share her situation with one or two other people who can then help make medical decisions.  The book then discusses the often arrogant, uninformed or downright abusive physicians who exist.  As stated in the book, “The degree of incompetence, insensitivity, and indifference among gynecologists, other specialists, and general practitioners is hard to overstate.”  Hoping to aid their emotional healing along the way to ending their sexual pain, Coady and Fish outline the ways in which the reader can understand what to do when the doctors get it wrong. 

The first section of the book ends with a chapter dedicated to finding a doctor who will offer effective treatment and provides a detailed holistic guide on beginning one’s healing by following guidelines on pain, sleep hygiene, diet and supplements, exercise and relaxation techniques and learning of how to be gentle with oneself.

Part 2: Understanding the Problem, provides the reader nine chapters of detailed information covering the symptoms and conditions of pelvic floor dysfunction, vulvodynia, pudendal nerve pain, clitorodynia, pelvic organ problems, endometriosis, painful bladder, and irritable bowel syndrome, skin disorders, such as lichen sclerosis, and hormonal, surgical, and post-cancer causes of pain.  Interwoven with detailed explanations of the causes of sexual pain, the book contains full-page anatomical illustrations, checklists for particular disorders, and details on the types of tests needed as well as lists of the common misdiagnoses given for a disorder and ways to rule it out.  It contains details on how the various conditions can co-occur and affect one another.  It tells the potential patient of what to expect during an examination and offers guidance based on the doctor’s performance and recommendations.

Part 3: Overcoming the Problem presents valuable information and guidance devoted to fulfilling one’s life with the joys often taken away in sexual pain.  Coady and Fish hope to return libido, desire, partner intimacy, healthy relationships with friends and families to women undergoing sexual pain.  Their many personal case studies validate and underscore the valuable guidance they provide.  The book closes with excellent resources, including recommended books, helpful websites, psychotherapists, as well as relevant organizations and associations.


-- John M. Grohol, 7 Feb 2012




When Sex Hurts

Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed—or not diagnosed at all. In Healing Painful Sex, Deborah Coady, MD and Nancy Fish use their combined professional expertise as a doctor and therapist who specialize in sexual pain to provide readers with an understanding of its many causes and how to treat them, from both a physical and psychological standpoint.

Organized into three parts—naming the problem, getting a diagnosis, and overcoming pain—Healing Painful Sex includes medical checklists, illustrations, vignettes based on interviews with women and their healthcare professionals, treatment options, and guidance for moving forward after healing. Coady and Fish speak honestly and directly to sexual pain sufferers' experiences, helping them address the problem of chronic pain, understand and prevent misdiagnoses, define medical terms and conditions, and regain sexual joy.

Comprehensive, multi-dimensional, and deeply insightful, Healing Painful Sex offers women the tools to successfully take on the many challenges of sexual pain and move toward a healthy, happy future.


-- 11 Dec 2012




Atlas Wonders Book Review

I have only one question for the authors, Deborah Coady and Nancy Fish; where was this book all my life!?


Healing Painful Sex: A Woman's Guide to Confronting, Diagnosing, and Treating Sexual Pain is probably one of the most important books I've read this year alone. This book would have been a godsend when I was first diagnosed with endometriosis. Or dealing with the beginnings of IBS. Or the multiple urinary tract infections in college.


It is a hefty tome, clocking in at almost four hundred pages, with all the chocked full references included, but it is a must have on every woman's bookshelf. The book is divided into three parts: Naming the Problem, Understanding the Problem, and Overcoming the Problem. The authors give step by step instructions for everything from how to pick the right doctor (one who is caring and listens), how to figure out exactly what is causing the pain and how to begin to heal your life from the illness that splintered your world. The references are a dream guide, which include not only recommended books, but doctors, associations, physical therapists, pharmacies, places to get sexual aids, and even websites that have pain assessment tools.


Coady and Fish, even being medical professionals themselves, advise a great relationship with your primary care doctor, but also have tons of alternative healing advice to give. Yoga, deep sleep techniques, physical therapy, acupuncture, along with many others are also advised to begin the healing the process, even if you haven't found a great doctor to connect with.


The language is caring and sensitive (for the most part because my only issue with this book was that while it strives to be inclusive, there are moments when the language slips into heternormativity) and the love and understanding is felt in every page. These authors want to help every single woman who has ever dealt with sexual pain lead a pain free life.


This is a monumentally important book that needs to be on everyone's wishlist this year. Pick one up for every woman in your life. They will thank you for it.


-- Jillian L. Schweitzer



 

Library Journal. Health and Medicine Section.

Physician Coady and psychotherapist Fish have teamed up to write a book about women who suffer from sexual pain, a diagnosis in which their New York City–based private practice specializes. Offering a holistic viewpoint on this seldom-discussed and sensitive topic, the book covers issues like finding people (or even just one person) to talk with, finding the best doctor to treat the physical pain or emotional fallout, understanding the biology of pain, identifying symptoms, exploring the possibility of self-treatment, and ultimately recovering to live fulfilling lives. Empathetically written, the book employs quotes from former patients that help inform, shape, and validate the information offered and underscores the extensive experience of both practitioners in treating this issue. Excellent resources lists include recommended books and support organizations and associations, with contact information. 


VERDICT Directed to women experiencing pain, this book can also serve as a well-rounded introduction to the topic for health practitioners.


-- Elizabeth J. Eastwood

When Sex Hurts : Struggling With Pelvic Pain Disorders


Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed—or not diagnosed at all. In Healing Painful Sex, Deborah Coady, MD and Nancy Fish use their combined professional expertise as a doctor and therapist who specialize in sexual pain to provide readers with an understanding of its many causes and how to treat them, from both a physical and psychological standpoint.

Organized into three parts—naming the problem, getting a diagnosis, and overcoming pain—Healing Painful Sex includes medical checklists, illustrations, vignettes based on interviews with women and their healthcare professionals, treatment options, and guidance for moving forward after healing. Coady and Fish speak honestly and directly to sexual pain sufferers' experiences, helping them address the problem of chronic pain, understand and prevent misdiagnoses, define medical terms and conditions, and regain sexual joy.

Comprehensive, multi-dimensional, and deeply insightful, Healing Painful Sex offers women the tools to successfully take on the many challenges of sexual pain and move toward a healthy, happy future.


11 Dec 2011


When Sex Hurts : Struggling With Pelvic Pain Disorders


Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed—or not diagnosed at all. In Healing Painful Sex, Deborah Coady, MD and Nancy Fish use their combined professional expertise as a doctor and therapist who specialize in sexual pain to provide readers with an understanding of its many causes and how to treat them, from both a physical and psychological standpoint.

Organized into three parts—naming the problem, getting a diagnosis, and overcoming pain—Healing Painful Sex includes medical checklists, illustrations, vignettes based on interviews with women and their healthcare professionals, treatment options, and guidance for moving forward after healing. Coady and Fish speak honestly and directly to sexual pain sufferers' experiences, helping them address the problem of chronic pain, understand and prevent misdiagnoses, define medical terms and conditions, and regain sexual joy.

Comprehensive, multi-dimensional, and deeply insightful, Healing Painful Sex offers women the tools to successfully take on the many challenges of sexual pain and move toward a healthy, happy future.


11 Dec 2011