Dr Ruth Missed the Mark

I have mixed feelings about this advice column from Dr Ruth that I spotted on Twitter.

I was super bummed to read the first half of the first sentence, a response to the question

What are the roots of sexual pain? Also, what would you say is the best way to overcome it? 

Dr Ruth writes,

In the vast majority of cases, it is psychological...

Really? How does she know that? Judging by my stack of books on pelvic pain, that seems like outdated information, although I don't have hard data to back up my assertion. 

What I like about the article is that she asserts no woman should have pain during sexual intercourse. True.

The rest of the response disappoints. The only disorder she mentions is vaginismus, which she says is psychological. She doesn't give a single physiological reason for sexual pain, of which there are many: pudendal nerve pain, endometriosis, painful bladder syndrome, vulvodynia, clitorodynia, pelvic floor dysfunction...and those are just the ones I picked up from scanning the cover of one book sitting here on my desk.

Dr Ruth also neglected to mention how under-informed the majority of gynecologists are about these very real disorders, making it seem as though a single office visit would quickly answer that question.  

...the first thing a woman who is experiencing pain during intercourse should do is see a gynecologist. If her gynecologist gives the all-clear, then that alone will be a great help in overcoming any psychological factors.

If only it were so simple. In reality women experiencing painful sex often have to go to multiple doctors to get a diagnosis. Dr Ruth does not mention the emotional damage they suffer because doctors (and authority figures like Dr Ruth) have not provided them with adequate information.

I also doubt her assertion that getting the all-clear from a gynecologist would be a great help in overcoming psychological factors; if the root of your sexual pain is psychological, I would imagine that it would require a great amount of work to overcome that issue. 

Overall, I was sorely disappointed by this column, especially coming from such a famous figure as Dr Ruth. Here is my response to the question at hand:

Dear Reader,

I am sorry to hear that you have been having pain with intercourse. Please know you are not alone; many women suffer this at some point during their lives. There are a wide variety of physiological reasons for pelvic pain. The problem may stem from your dermatological, muscular, orthopedic, psychological, central or peripheral nervous systems, or it may be a combination of the above.

I recommend that you educate yourself first, by reading "Healing Painful Sex" by Deborah Coady MD and Nancy Fish MSW, MPH. Then start seeing gynecologists; you will probably have to see more than one to get an accurate diagnosis, because unfortunately most gynecologists do not receive adequate training in pelvic pain disorders. Be persistent. Remember that no woman should hurt during sex.

Good luck on your journey!