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Painful Ideals: Young Swedish women´s ideal sexual situations and experiences of pain during vaginal intercourse
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Smärtsamma Ideal : Unga svenska kvinnors ideala sexuella situationer och erfarenheter av smärta vid samlag (Swedish)
Abstract [en]

Many young women today are concerned about their sexual health; an increasing number of them consult gynaecologists, youth centres (YCs) and general practitioners with vulvar problems such as painful sensations associated with vaginal intercourse (VIC). It is known that some women continue to have VIC despite pain. Theoretically, repeated painful VIC might elicit vaginistic reactions, which may increase the pain and induce vicious circles. Since many clinicians and researchers nowadays notice that pain during VIC often starts at young age, it is important to investigate how pain during VIC starts and is maintained in younger populations. The overall aim of this thesis was to investigate young women’s experiences of ideal sexual situations and pain during VIC.

Women aged 13-22 years participated in our studies, which used both quantitative (study I and IV) and qualitative (study II and III) methods. For paper I, a questionnaire was developed and used in a YC sample (n=300); informants for paper II were selected from that sample to participate in qualitative interviews (n=16). Another qualitative interview study for paper III with a complimentary research question was conducted in a different YC sample (n=14). For paper IV, a questionnaire was developed based on the results from study I, II and III to test the hypotheses derived from study II in a sample of female high school students (n=1566).

The findings revealed that 65% of the women reported pain related to first VIC. Among those who reported VIC during the previous month, 49% had experienced pain and/or discomfort during VIC during that same period (paper I). In paper IV, 47% of the women reported experience of pain and/or discomfort during VIC, and among those, 47% continued to have VIC, 22% feigned enjoyment, and 33% omitted telling the partner about their pain. In paper II, the women’s reasons for continuing to have VIC despite pain were: striving to reach their ideal image of a woman, characterized as always willing to have VIC; being perceptive of their partner’s sexual needs; and being able to satisfy their partner. In paper IV the hypotheses derived from study II were confirmed and showed, for example that a significantly higher proportion of women who continue to have VIC despite pain than women who did not had difficulty refusing sex when the partner wants it, felt inferior to the partner during sex, regarded the partner’s satisfaction as more important than their own, felt dissatisfaction with their sex life, and feigned enjoyment despite pain. In a multivariate model, continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex (adjusted OR 1.82; CI 1.10-3.02), dissatisfaction with their own sex lives (adjusted OR 1.76; CI 1.14-2.72) and feigning enjoyment while having pain (adjusted OR 7.45; CI 4.37-12.69).

The major reason for continuing to have VIC was that the partner’s enjoyment was prioritized higher than their own (paper IV). In paper III, we found that women without pain during VIC also felt pressure from social norms and demands and had experienced partners “driving their own race”. However, they managed to some extent to resist these unequal gender norms because of their urge to experience pleasure.

In conclusion, pain during VIC is a common complaint among young Swedish women, and a high proportion of them continue having VIC despite pain. The women’s notion of prioritizing the partners´ enjoyment before their own illustrates that unequal gender regimes affect young women’s (hetero)sexuality negatively.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 74 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1145
Keyword [en]
Adolescent, Coital pain, Constant comparative analysis/method, Dyspareunia, Gender, Sexual intercourse, Sexual situation, Vaginal intercourse, Young women
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-20277ISBN: 978-91-7393-561-6 (print)OAI: oai:DiVA.org:liu-20277DiVA: diva2:240833
Public defence
2009-09-25, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-06 Created: 2009-09-01 Last updated: 2012-02-03Bibliographically approved
List of papers
1. Young Swedish women´s experience of pain and discomfort during sexual intercourse
Open this publication in new window or tab >>Young Swedish women´s experience of pain and discomfort during sexual intercourse
2009 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 1, 98-103 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To study experience and prevalence of (1) pain related to first sexual intercourse; (2) pain and/or discomfort associated with sexual intercourse during the previous month; and (3) associations between these experiences.

Design. Cross-sectional study. Setting. A youth center in southeast Sweden. Sample. Three hundred consecutive women, aged 13-21 (response rate 98%).

Method. During a two-month period, women consulting a youth center, participated in a questionnaire study. Main outcome measures. Pain and/or discomfort during sexual intercourse.

Results. The majority of the participants, 98%, had had sexual intercourse and of those, 65% reported pain related to first sexual intercourse. Forty-nine percent (99/203) of those who reported sexual intercourse during the previous month had experienced coital pain and/or discomfort during that period, and for almost every second woman (46/99), those experiences constituted a problem. We found no association between experience of pain during first sexual intercourse and pain and/or discomfort during the previous month.

Conclusions. Prevalence of pain and/or discomfort associated with sexual intercourse is high among women visiting a youth center. Our results show that coital pain in young women is a problem which needs to be further explored.

Keyword
Adolescent, coital debut, coital pain, sexual intercourse
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16528 (URN)10.1080/00016340802620999 (DOI)
Available from: 2009-01-30 Created: 2009-01-30 Last updated: 2017-12-14Bibliographically approved
2. Why do young women continue to have sexual intercourse despite pain?
Open this publication in new window or tab >>Why do young women continue to have sexual intercourse despite pain?
2008 (English)In: Journal of Adolescent Health, ISSN 1054-139X, Vol. 43, no 4, 357-363 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Many young women suffer from pain and discomfort during sexual intercourse, and an increasing number of them seek help for their problems. It seems that some young women continue to have sexual intercourse despite pain. However, their motives are unclear.

Methods: A total of 16 women, aged 14-20 years, with variable degrees of coital pain were selected at a youth center in a city in southeastern Sweden, to explore why they continued to have sexual intercourse despite pain. The women participated in audiotaped qualitative individual interviews, which were analyzed using the constant comparative method from grounded theory.

Results: During the analysis we identified the core category striving to be affirmed in their image of an ideal woman and the categories resignation, sacrifice and feeling guilt.

The perceived ideal women had several distinct characteristics, such as willingness to have sexual intercourse, being perceptive of their partner’s sexual needs, and being able to satisfy their partners.

Having sexual intercourse per se was considered to be an affirmation of being a normal woman, irrespective of pain or discomfort.

Conclusions: These young women’s focus on a constructed ideal explains why they continue to have sexual intercourse despite pain.

Greater awareness of these beliefs among gynaecologists, sexologists, and other healthcare professionals involved in the management of young women with coital pain would be beneficial.

Place, publisher, year, edition, pages
New York: Elsevier Inc., 2008
Keyword
Adolescent; Coital pain; Constant comparative analysis/method; Dyspareunia; Sexual intercourse
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-21144 (URN)10.1016/j.jadohealth.2008.02.011 (DOI)
Available from: 2009-09-30 Created: 2009-09-29 Last updated: 2013-09-12Bibliographically approved
3. "Sexual pleasure on equal terms": Young women´s ideal sexual situations
Open this publication in new window or tab >>"Sexual pleasure on equal terms": Young women´s ideal sexual situations
2012 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 33, no 3, 129-134 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: We wanted to identify young women’s ideal images of sexual situations and expectations of themselves in sexual situations.

Methods: We conducted audiotaped qualitative individual interviews with 14 women aged 14 to 20 years, visiting two youth centers in Sweden. The data were analyzed with constant comparative analysis, the basis of grounded theory methodology.

Results: The women’s ideal sexual situations in heterosexual practice were characterized by sexual pleasure on equal terms, implying that no one dominates and both partners get pleasure. There were obstacles to reaching this ideal, such as influences from social norms and demands, and experiences of the partner’s “own race”. An incentive to reach the ideal sexual situation was the wish to experience the source of pleasure.

Conclusions: Our research further accentuates the importance of finding ways to focus on the complexity of unequal gender norms in youth heterosexuality. A better understanding of these cognitions is essential and useful among professionals working with youths´ sexual health.

Keyword
constant comparative analysis/method; gender; sexual pleasure; sexual situation; young women
National Category
Social Sciences Interdisciplinary Gender Studies
Identifiers
urn:nbn:se:liu:diva-21170 (URN)10.3109/0167482X.2012.706342 (DOI)000307675100005 ()
Note

funding agencies|Swedish Research Council|521-3003-5150|Medical Research Council of Southeast Sweden (FORSS)||

Available from: 2009-09-30 Created: 2009-09-29 Last updated: 2017-12-13Bibliographically approved
4. Why continue to have vaginal intercourse despite pain? Reasons and associated factors among young Swedish women
Open this publication in new window or tab >>Why continue to have vaginal intercourse despite pain? Reasons and associated factors among young Swedish women
(English)Manuscript (preprint) (Other academic)
Abstract [en]

CONTEXT: Pain during vaginal intercourse (VIC) is a frequent complaint among young Swedish women, of whom a considerable proportion continues to have VIC despite pain.

METHODS: In 2008, a sample of 1566 female high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward body and sexuality. In the present study we examined the prevalence of women who despite pain continue to have VIC, omit telling the partner, and feign enjoyment; as well as the reasons for such behavior.  Chi-square tests and binary logistic regression were used to examine data.

RESULTS: Forty-seven percent (207/576) of those women who reported pain during VIC continued to have VIC despite pain. The most common reasons were that they did not want to destroy sex for or hurt the partner by interrupting VIC. Feigning enjoyment and omit telling the partner about their pain were reported by 22% and 33% respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain.

CONCLUSION: Pain during VIC is reported by every third young Swedish woman and almost half of those still continue to have VIC. The major reason given is noteworthy --- prioritizing the partner’s enjoyment before their own --- and demonstrates that young women who continue to have VIC despite pain take a subordinated position in sexual interactions.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-21175 (URN)
Available from: 2009-09-30 Created: 2009-09-29 Last updated: 2010-01-14Bibliographically approved

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