Today I saw a middle-age woman for her pap. After a long visit in which we talked about her efforts to lose weight, her pending divorce, her medical history and her inconsistent medication use, I could see her muster up her courage to ask me a final question at the end of her exam. Her question was, “Is it normal to have pain every time you have sex?” I answered, “It’s not normal, but it’s very common.” I then asked her a bunch of questions about position changes, lubricant use, foreplay and previous sexual trauma. After a few therapeutic prompts from me (ex: “Many women tell me that if their partner doesn’t spend enough time making sure they’re aroused, sex is uncomfortable for them.”) we finally got to the reason for her pain: “My husband never touches me down there, and he told me I was sick because I wanted him to do stuff. He just gets on top of me and we have sex, and that’s it. He told me there was something wrong with me because it hurts all the time.” I felt that I had developed a friendly rapport with the patient, so I only had to censor myself a little bit. Instead of my first response (“Honey, your husband is an asshole!”) I went with the second (“Listen, he’s totally wrong about that! You’re perfectly normal!”). I also couldn’t hold back from a little dating advice: “If you start dating again and you find another guy that thinks like that, dump him right away, alright?” That’s right, I’m a primary care provider, a spiritual advisor and now a dating guru!
Do not have sex with this man! July 3, 2008