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Illustration by Erin Hurley-Brown
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Dr. Tracy Hicks (left) and Dr. Diane Mrava say that better medical care is needed for the many women facing sexual dysfunction. Photo by Isaac Harrrell
The night of her honeymoon was not all that Lynn had anticipated.
"It was a big disappointment," the 27-year-old says of the first night she slept with her husband. The couple dated for six years, waiting until marriage to have sex. "I was always very nervous about sex and anticipating pain, which added to the discomfort I experienced."
Nerves caused her muscles to tighten, making intercourse extremely painful.
"I did initially feel very alone," says Lynn, whose name has been changed to protect her privacy. "Like I was the only person with this issue."
But she is not alone. Dyspareunia — painful intercourse — affects up to 22 percent of women at some point in their lives, making it one of the most frequently recorded problems in gynecological practice. Other sexual problems, including decreased libido, orgasmic dysfunction and vaginal dryness, affect two-thirds of women during their lifetime. In late March, Richmond OB-Gyn opened the Center for Women's Sexual Health and Intimacy on the campus of St. Francis Medical Center to meet the needs of patients with sexual dysfunction. The only center of its kind in greater Richmond includes gynecologists Dr. Tracy Hicks and Dr. Diane Mrava; sex therapist Katherine Bettin, Ph. D.; women's health physical therapist Cora Huitt; and compounding pharmacist Chris Currin.
"So many women have these problems, and nobody was qualified to fix them," Hicks says, adding that, as the chief of St. Francis' obstetrics and gynecology department, she felt frustrated after seeing patients with sexual complaints for more than 17 years and not being able to do more to help.
In an attempt to learn more about women's sexual health, Hicks and Mrava attended a meeting last year of the International Society for the Study of Women's Sexual Health. The society includes the top women's sexual health experts in the world.
"What little bit of stuff we did get in medical school was based on research done on men or from a man's point of view," Mrava says. Now, "there's a lot more attention being paid to women, and [researchers are] finding that the conclusions they came to based on studying men are different when they start looking at women specifically."
While the chronic stinging, irritation and rawness associated with painful intercourse has been recorded since ancient Egyptian times, studies of issues such as vulvodynia — pain in the vulva, or external genital area — only started at the National Institutes of Health in 2000.
"It's a relatively new area that is being addressed in women's health," says Huitt, a board-certified women's health physical therapist who has 40 years of clinical practice and has specialized in women's health for 15 years. "Physical therapy is one of the mainstays for this medical management."
In her practice, Huitt sees women between 20 and 80 years old from a range of socio-economic and cultural backgrounds. Although her patients are diverse, Huitt says, the majority of the women she sees have one thing in common — they aren't familiar with their own anatomy.
"One of the things I do is educate women about these muscles," Huitt says of the superficial and deep muscles that assist with intercourse and orgasm. "We don't have our mothers and our girlfriends and our sisters all going to ‘the red tent,' and as a result, a lot of this discussion is kept very quiet." (Taken from the novel The Red Tent by Anita Diamant, based on characters in the biblical book of Genesis, the term refers to a place where menstruating women gathered.)
The embarrassment surrounding sexual health and intimacy leads women to wait an average of seven years before seeking treatment.
"No one is talking to each other about it because they feel like they're the only one, and they feel broken and damaged and hopeless," Bettin says. "Then they get enough courage to [see] a doctor and the doctor will say, ‘Have a glass of wine.' A lot of doctors dismiss or pass judgment."
The multidisciplinary team at the Center for Women's Sexual Health and Intimacy hopes to serve as a refuge for women seeking treatment and advice on sensitive issues of sexual health. In addition to prescribing custom compounded hormone therapy, recommending exercises to strengthen or relax vaginal muscles and encouraging sex therapy, Hicks and Mrava sometimes send patients to a lingerie and sex toy shop to buy a vibrator.
"A lot of women associate their femininity with their sexuality," Hicks says. "If they're unable to have sex with their partner, a lot of people feel internally that there is something wrong with them."
More than a year after being married in August 2011, Lynn and her husband have not yet been able to consummate their marriage, but Lynn says she is more hopeful than she was before discovering the Center for Women's Sexual Health and Intimacy this past summer.
"Dr. Huitt has helped me to understand that many women face this problem at some point in their life," she says. "I feel as though I can see the light at the end of the tunnel.