Sealed Lips is Mashable’s series on pelvic pain, an experience rarely discussed but shockingly common.
It isn’t news that the current state of sex education in the United States is abysmal. The specific ways in which sex ed is failing students — including lack of resources for queer youth or children who’ve experienced trauma — have long been discussed. And, while sex education has never been adequate in the U.S., the Trump administration made it that much worse by pushing for abstinence-only curriculums.
With the pandemic still his primary focus, President Biden hasn’t made any public moves to address the well-documented problems with sex education yet, but the sexual reproductive health advocacy group Guttmacher Institute is already calling on him and Vice President Harris to overhaul sex education in this country. The Institute’s suggestions include defunding abstinence-only programs and instead paying for federal sexual health services that would provide medically-accurate information as well as healthcare services (such as contraception) for marginalized young people — queer youth, young people of color, homeless youth, and the like — up to 26 years old.
May I offer my own recommendation? Pelvic pain education. Many physicians believe more than half of people of all genders will experience it at some point in their life. Despite it being extremely common, it’s rarely talked about — especially not in schools.
The problem with not talking about pelvic pain
When such a sensitive topic isn’t discussed, it’s rendered taboo. People with pelvic pain may feel shame or embarrassment, and that perpetuates the cycle of silence. By the time patients come to pelvic pain specialists like Dr. Sonia Bahlani, who has her own practice based in New York City and who treated me for my own pain, they may have been suffering for years because they don’t have the language to describe their pain, because they didn’t know their pain was a problem, and/or because they’re ashamed.
My first brush with pelvic pain — sharp sensations with penetration and trigger points (sensitive, taut, and painful muscle areas) — came at 25.
I didn’t even know the term “pelvic pain” at the time, or that this form of pain was both prevalent and treatable. I didn’t know that anyone can experience pelvic pain at different points in their lives, from adolescence to reproductive age to post menopause — and that anyone of any gender can go through it, too.
My Catholic high school didn’t teach proper sex education, but even as a sex reporter and Extremely Online sex-positive person who knows basic anatomy, like the difference between the vulva and vagina, there’s so much about my own body I didn’t know about until there was a problem.
For a few months I ignored the pain, which was easy; we were in the midst of a global pandemic and my single self stayed far away from others. When the problem became too great to ignore, I went to my OB/GYN, who told me I was completely fine.
Even so, I felt a twinge of fear that this issue wasn’t going to go away. I headed to Dr. Google, searching terms like “pain with penetration” and “vagina pain,” because I had no language to articulate what was wrong. I read stories from women who had been suffering for years with no relief, who feel constant stabbing pain, and I panicked. In my late-night rabbit hole I convinced myself that my pain would soon escalate to that level, and there was nothing I could do about it.
Thankfully, my frenzy led me to finding Dr. Bahlani (and sending a novel-length email to her office). She told me that some of her patients had pain for years — sometimes decades —before coming to her. This matched the anecdotes I’d been reading online, and it made me think: What about all the adults who aren’t privy to the same information as a sex reporter? What about school-aged children? Why does this largely treatable issue continue to live in the shadows, hurting us?
I spoke to several pelvic health experts about what needs to change when it comes to how we talk about pelvic pain, and how we’re educated about it, including the crucial information that should go into our sex education programs.
We need to go back to basics
While pelvic pain itself may happen no matter what, how one deals with it can be transformed with education. That starts with understanding basic anatomy — something that should be taught to every child, but unfortunately, isn’t. Knowing anatomy and bodily functions gives you the agency to know what’s “normal” versus what needs to be checked out by a professional.
“Why do you think kids seek this information on things like TikTok and Instagram?” asked Bahlani, answering her own question: “Because they’re not given it in school.”
She’s not exaggerating. Sex education is only mandated in 24 states (or 25, when Tennessee’s pregnancy rate for teens 17 to 19 years old reaches 19.5 or higher). Only 13 states require sex ed to be medically accurate, meaning science-based and comprehensive.
With so few states providing medically-accurate sex education — and others with no such course at all — it’s no surprise that we adults don’t know our own bodies. We don’t know what sensations are normal versus red flags, and we don’t usually talk about it with others, often because we just don’t have the words to do so. We believe we’re alone or that we’re “broken,” or all of the above. This leads to needless suffering. We think it’s just the way it is. It’s how patients come to Bahlani with the belief that “Everyone has painful sex,” as she put it.
There’s so much we don’t know. “I’m working with adult individuals who don’t even know that they have three openings in the pelvic floor and that pee doesn’t come out of their vagina,” said Sara Reardon, owner of NOLA Pelvic Health and founder of The Vagina Whisperer, an online resource for pelvic health education.
“You have to understand your own anatomy in order to be able to understand sex in general.”
Perhaps that’s why Reardon and all the other experts I spoke to emphasized the importance of anatomy and physiology education in high schools.
“You have to understand your own anatomy in order to be able to understand sex in general,” Bahlani explained. Then you can answer questions like, “What is comfortable? What is consent?”
In her first consultation with patients, Bahlani often has them look at their vulva with a mirror to increase understanding of their own physicality. By learning how our bodies function in optimal circumstances, we can then figure out what suboptimal circumstances are — like pain.
Proper education “starts with a really good understanding of anatomy,” echoed Amanda Olson, founder and CCO of pelvic tool company Intimate Rose, “so that when a young person starts experiencing pain, they know how to describe that to their provider and know exactly where it is.”
Innovative tech can help pelvic education
Emily Sauer, founder of the sex wearable Ohnut, stackable rings that can be worn on the shaft to make deep penetration more comfortable, saw the dearth of basic bodily education firsthand when the pandemic hit. In the midst of quarantine, pelvic floor physical therapists became less accessible, as people couldn’t meet them in offices. Customers kept reaching out about increased pelvic dysfunction and potential exercises to help due to COVID stress, she explained.
These customers didn’t know where else to go, so they came to Ohnut. Sauer then went to the pelvic PTs in her network to create videos to help her customers. This led to the creation of the Pelvic Gym, an online resource for pelvic health education, including exercise videos and programs.
Image: bob al-greene / mashable
Doctors need pelvic health training, too
It’s not just students in K-12 that need an increase in pelvic health instruction — so do medical students. Dr. Bahlani underwent a fellowship specifically for pelvic health, on top of her medical school training. But most OB/GYNs and other doctors aren’t taught specific pelvic health diagnoses in standard medical school courses. Both Balhani and Sauer confirmed this, and a 2015 article in medical journal Obstetrics & Gynecology states: “Knowledge of female pelvic anatomy is essential to training in obstetrics and gynecology; however, much of this teaching is done informally throughout residency.”
We don’t just need a systematic change of our early education, Sauer said, but a change in how our care providers are taught as well. Obstetrics & Gynecology‘s article describes a pilot study using existing medical school materials to improve resident knowledge of pelvic anatomy. They concluded that the pilot was “promising.” In recent years the discussion around consent in medical student pelvic exams has ramped up as well. At many American institutions, such exams are performed on unconscious people who didn’t offer consent prior. Now, some are working to change that by utilizing consent forms and trauma-informed care, which stresses patient-informed consent and language that is sensitive to assault survivors. These are hopeful signs that the field is moving in the right direction.
Removing stigmas around sex health
Proper schooling should go beyond the body. Olson and others stressed the importance of learning — or unlearning — the stigma around sex organs and cultural normalization of pain.
One step is using anatomical language, thus desexualizing and destigmatizing terms like “vagina.” By talking about bodies openly and honestly, we destigmatize periods, sex, and pain.
“Pain with periods and pain with sex…is not anything they need to be embarrassed about,” said Olson. “And there are solutions.” We need to teach both to students. We can prevent young people from thinking that painful sex (or pain, full stop) is normal — and thus prevent them coming to a specialist like Bahlani decades later with this internalized misunderstanding and subsequent distress.
Our culture normalizes pain, said Sauer, and this is especially true for women. A 2008 study from the University of Pennsylvania concluded that women waited longer than men to receive pain medication in the ER; 83 percent of 2,400 women participants of a 2018 New York Times survey said they felt they’ve been discriminated against their gender by healthcare providers. The result of normalizing pain is that we don’t even know what sensations should be addressed by a professional. Yes, anatomical and diagnostic understanding is necessary, but Sauer also wants educators to emphasize that while pain is common, it’s not normal.
Reardon reiterated Olson and Sauer’s points, saying we must normalize the conversation but not normalize the problem.
“Pain with periods and pain with sex…is not anything they need to be embarrassed about.”
In failing to teach about pain, current curriculums subsequently fail to teach about resources: what kind of resources are available and who to even go to for help. “That is fundamentally not a part of any of our understanding as someone with a vagina,” Sauer said.
This knowledge wouldn’t just be useful when experiencing pelvic pain. It could also be a preventative measure. Pelvic pain either has an underlying cause (so it’s a symptom of another problem), or it doesn’t. Seeking care early can help distinguish this and take action as needed — either dealing with the problem, thus dealing with the pain, or solely dealing with the pain.
Pelvic health coach Kim Vopni believes that, as with oral health, people should maintain their pelvic health. She said, “I recommend that as soon as people become sexually active that they incorporate pelvic floor physio [physical therapy] in their life — just like the dentist.” This includes a variety of exercises, from yoga poses to foam rolling to internal moves like Kegels. Ideally, you’d enlist the help of a certified pelvic floor physical therapist to get you started. There are also resources made by professionals online, such as Pelvic Gym, which include videos on topics like painful sex and at-home exercises that can help from pelvic PTs, and products reviewed by my colleague Jess Joho. These don’t substitute for personalized medical care, however.
Incorporating a pelvic health check by a physical therapist annually also acts as a screening tool and can spot issues sooner, which means getting treatment sooner. PT screenings can offer diagnoses for issues that, while not life-threatening, can cause severe pain if unmanaged.
Sauer hopes that, like check-ups, Pelvic Gym will eventually be a preventative tool. It took her years to receive a proper diagnosis for her own pelvic pain, and she knows this isn’t uncommon. Many people don’t seek out this information until there’s a problem — myself included — but it doesn’t have to be that way.
What we need is a paradigm shift, both in U.S. sex education and in medical training. By incorporating pelvic health teachings in schools, students would be equipped with crucial knowledge of sex, pain, and their bodies as they reach adulthood. We can change the system so that children — and adults! — don’t have to resort to TikTok or Instagram for these much-needed lessons, and everyone will feel a whole lot better.