A Difficult age

I recently read an abstract from the Journal of Sexual Medicine (Feb 2009).  The authors, Landry and Bergeron asked the question: "How young does vulvo-vaginal pain begin? Prevalence and characteristics of dyspareunia in adolescents." 
 
Interesting read.

The prevalence of dypareunia (pain with intercourse) in adult women is reported to be between 12-20%.  With vulvar pain being the most common site reported.  Prior to this, younger populations have not been studied in large scale.  First - do we really want to look at how young our kids are being sexually active?  From a medical/research/cultural aspect - of course we do.  As a Mom, I'm sort of hoping celibacy will catch on, and my daughter and I can have this conversation right before she gets married, at 30, with her PhD. in hand. 

Even worse - do we want to think about painful sexual dysfunction in the very young?  As I have treated my share of very young girls (15-19yrs) with severe vulvodynia, I applaud the authors for looking at this very difficult subject.  The results show that 20% of sexually active girls, aged 12-19yrs old reported pain with intercourse.  Of those that reported chronic problems, 67% had significant pain with initial tampon use.  There is a 4-fold increase in the prevalence of chronic dyspareunia with girls that have pain at initial tampon use.  These same girls had difficulty with all non-sexual forms of penetration, pelvic exams, tampon insertion, etc.  

We can not exactly extrapolate the results.  We do not have long-term studies showing that this 20% will be the same 12-20% that carry dyspareunia into their adult lives, but the data is compelling.   When I first started taking courses on pelvic pain, vulvodynia and sexual dysfunction, one of my instructors talked about the importance of educating girls before their first sexual experience.  Teaching them to be aware of the pelvic floor, staying relaxed, and being in control of the situation.  At that time she quoted a study (don't remember from who or where) that showed a higher percentage of chronic dyspareunia in women that had pain at first attempt at intercourse.  This new study shows that it may start earlier.  If our girls have pain with initial tampon use, or with pelvic exams - then we may have a warning sign of potential dyspareunia, and the education process can begin earlier, before it becomes a huge problem in the life of a young adult.

I hope that all girls are having an initial gynecological visit before engaging in sexual activity.  And, I hope that doctors, and parents, are using this visit as an opportunity to educate the girls about sexual health.  I know that girls get sex-ed in school, but the programs are highly political, and many schools are corralled into "abstinence only" programs.  With more and more girls being sexually active at younger ages, abstinence only programs fall far short of giving our kids the education they need to cope with the problems that they may face.

I have always felt that "an educated girl is a safe girl."   If the schools aren't giving our kids complete and accurate information, it is our job as parents to pick up the ball and run with it.  If the parent does not feel equiped to handle it, then consult with a professional.  I have a dear friend here in Tampa, that happens to be a certified sex therapist, who offers "Mom and Daughter" classes on sexuality.  She says the moms often learn as much, if not more than the daughters.

 So, talk it up!