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Two kinds of pain: sexual and non-sexual?

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

The causes of chronic pain are routinely mysterious and good help can be hard to find. But pain related to sexual behaviour or anatomy? That is even trickier. Patients don’t just have trouble finding good help for sexual pain, they often encounter blatant hostility, sexism, homophobia, and squeamish sex-negativity. And let’s be clear: although men can have trouble with this too (especially queer men), we’re mainly talking about women facing male chauvinism and mysogyny.

In that grim context, Kirsten Loop asked on Twitter: “Are there 2 types of pain in the body—sexual and non-sexual?” 63% of 44 people polled think “definitely not,” which seems high to me — perhaps a symptom of sexual pain not being taken seriously? Categorizing is what brains do, so why not embrace these categories? Here’s how I answered…

“Type” of pain usual implies one of the mechanistic categories: nociceptive pain, neuropathic pain, and the annoyingly vague “other” (unexplained primary pain). So in that reckoning, no, sexual pain is not a different type, but “just” a distinct context for any type of pain. Sexual pain can be neuropathic, or nociceptive, or other — just like pain associated with any other function or part of our body.

Venn diagram of the three pain types of pain: neuropathic, nociceptive, and “other.”

The three main types of pain… as defined by biological mechanism.

But who says we can’t categorize pain by its social and psychological context, rather than it’s biological mechanism? If an experience of pain is qualitatively and pragmatically distinct, why not grant it an identity? And, hoo boy, there’s nothing “just” about the sexual context: it has heavy cultural baggage.

Here’s one interesting test: Would someone want/need to seek different care from a different kind of professional for sexual pain as opposed to non-sexual pain? Probably! And that also probably makes it a “type.”

Every complex phenomenon can be intellectually sliced and diced in many abstract ways. There’s no reason to deny any patient the legitimacy of a category that is meaningful to her. If some people are all in the same metaphorical boat, it’s a “type” of pain that can be contrasted with all the others. And the sexual versus non-sexual distinction is one of the clearest I can imagine.