Guest post by Sam Evans, founder of luxury sex toy store Jo Divine

Through the work I do at Jo Divine, I talk to many women about a wide range of sexual health issues that impact upon their sexual function and pleasure. Many of them say they struggle to get the right advice, diagnosis or treatment, and are dismissed or ignored by healthcare professionals, who tell them “it is simply being a woman”, “it’s your age”, or “it’s all in their head”!

I have heard the phrase, “it’s normal”, being said on so many occasions – yet what is normal about not being able to enjoy pleasurable sex because it is so painful that it impacts upon your physical and mental wellbeing and your relationships?

Many female health issues – such as endometriosis, vaginismus, cancer, menstrual issues, premenstrual dysmorphic disorder (PMDD), urinary incontinence, vulvodynia, menopause, gynaecological surgical interventions, and vaginal atrophy to name a few – can impact upon sexual pleasure, leaving many women struggling to enjoy sex. As a consequence, I frequently hear how relationships break down, even ending in divorce.

The All Party Parliamentary Group on Womens Health (WHAPPG) found that nearly half of women need to visit their GP ten times before being diagnosed with common gynaecological complaints, with doctors often telling women their symptoms are “all in their head”, they’re “normal”, or that the patient is “too young”.

This leaves many women living with chronic painful symptoms, affecting their physical and mental wellbeing, relationships with partners, children, family and friends, and their work life too. Some even have to give up work.

We are all encouraged to be more proactive about our health, seeking medical advice if we have a problem – yet I speak to women who have been dismissed by their GP for their gynaecological or hormonal symptoms, or for wanting to enjoy a good sex life after medical/surgical interventions, just because they are in their 70s or have been given inappropriate advice.

They give up on their sex lives or endure painful sex, chronic pelvic or vulval pain, heavy bleeding (which may be a symptom of gynae cancer), painful periods and urinary incontinence, or end up believing that their problem really is, “all in their head”. Many women are misdiagnosed with depression or anxiety and are prescribed inappropriate antidepressants, including menopausal women and those with PMDD.

Is female sexual pleasure considered less important than male sexual pleasure as a result of sexist and outdated attitudes or the way in which healthcare professionals are trained? Is there an assumption that many women don’t like sex, are not having sex or are not sexual, or should not have sex after a certain age?

As a mother of three children and a former nurse, I have had gynaecological issues that impacted upon my sex life. I have been patronised by doctors and midwives who have given poor advice – including “have a glass of wine to relax” when having sex after childbirth. (This advice, I now know, is given to so many women for painful sex). What would have been more useful was recommending a pH balanced sexual lube. Many women find sex painful, especially if they are breastfeeding, as this can impact upon vaginal lubrication.

I once reported a female gynaecologist for her negative attitude towards me when I self-diagnosed a cervical polyp that bled after sex. She still didn’t seem to believe me even as she was putting it in the specimen pot. My own GP struggles to even say the word sex; he calls it contact!

Kaz Molloy, founder of Womb Cancer Support, has told me about women who’ve been asked: “Why are you worrying about sex? You’re 65 and you’ve been cured of your cancer.”

I have heard the same thing from women I advised about enjoying sex after gynaecological or breast cancer. Many say the conversation they had with us at Jo Divine is the only conversation they have had about enjoying sex after cancer. Given how cancer treatments impact upon sexual function, intimacy, pleasure and quality of life, it really should be the norm to advise patients on ways of regaining your sexual function and sex life.

One woman in her 70s told me sex had been painful due to an old episiotomy scar, which her gynaecologist had offered to cut and resuture, but warned her it probably would not work. Instead, she bought a slim vibrator and spent many evenings massaging the scar tissue to make her vagina more flexible, enjoying many orgasms at the same time. As a result, she was able to have penetrative sex again, thus saving herself and the NHS unnecessary surgery, which may not have worked, and the process has been cheap, fun and very pleasurable for her.

Sexual issues such as vaginal dryness, vaginal atrophy and low libido are extremely common during the menopause, yet I’ve heard about a GP on a menopause training course saying to another GP: “I don’t talk about sex to my patients because I am too embarrassed and it’s not my job!” I’ve also been at medical conferences where female gynaecologists smirk when you raise the topic of sex, and I’ve heard jokes about menopausal women during talk, by a male doctor, on sex and the menopause.

At the other end of the spectrum, I have spoken to women in their 20s who experience premature ovarian insufficiency (POI) and were told by their doctor not to worry about sex as they are not in a relationship. No thought to casual sex or even solo pleasure!

Many healthcare professionals (HCPs) only focus on penetrative sex, rather than enjoying sex together beyond penetration or even exploring the clitoris. One woman was advised about how she could continue to pleasure her husband as she was unable have penetrative sex! In 2018, French gynaecologists recommended that if women find sex painful they should try anal sex instead!

Some women even report being shouted at by their HCP when they find smear tests or pelvic examinations painful, especially those who have vaginal atrophy or vaginismus.

Let’s Talk about Sex

I work with many amazing proactive HCPs, such as womens’ health physiotherapists, psychosexual therapists, gynaecological cancer HCPs, and vulval pain clinics who help women enjoy sexual function and pleasure. The consultant gynaecologist with whom we created our health brochure says he treats women so they can enjoy sex, which is such a refreshing attitude, but not a commonly held view.

The multidisciplinary team approach can be really effective to help many women overcome chronic pelvic pain, vaginismus, vaginal atrophy and vulvodynia, yet many are told that their pain is imagined, that it’s just their ageing vagina, or treated inappropriately with medication that exacerbates the issue rather than alleviating it.

Many HCPs are doing an amazing job, but advice is so varied across the UK. Whatever your sexual orientation, enjoying sexual intimacy and pleasure plays a huge role in the lives of many women and their partners.

I hope, through the work I do, we are changing the attitude of some HCPs, encouraging them to support women and help them overcome the sexual health problems they face just for being female – ultimately leading to happy, healthy and pleasurable sex lives.

You can follow Sam on Twitter @SamTalksSex