What Everyone Needs to Know About Painful Sex

Sex shouldn’t hurt. Too many people believe that having some pain with vaginal penetration is normal and to be expected. That’s simply not true. NO ONE should be having painful sex–unless it’s the kind of pain that is desired and negotiated in advance. Pain with sex is not something you just have to put up with. And, almost always, it can be resolved with a little help.

If you ignore sex pain and keep engaging in the painful action, it will almost certainly lead to worse issues down the road. And besides the physical damage, nothing will tank your libido like engaging in sex with unwanted pain. Every time you grit your teeth and keep doing the thing that hurts, you’re forging a link in your brain between that activity and pain. Over time, as sex and pain become more closely linked in your mind, your desire for sex will wane.

This is important to recognize, as one big reason that people continue to engage in painful sex is to avoid hurting their partner’s feelings or because they feel obligated to provide sex as part of their relationship. Even if simply grinning and bearing it will keep your partner from feeling rejected or uncomfortable in this moment, continuing to engage in painful sex will do your sex life more harm than good in the long term. And I suspect your partner would actually want to know. Hopefully, they want to do whatever is needed to help you have enjoyable sex.

The first step is to have that awkward conversation now. Let your partner know what you are experiencing, and that you’d like to see what can be done to help improve your experience of sex by decreasing pain. Be sure to let your partner know this is almost always something that can be resolved.

The second step is to stop participating in the activity that hurts. This is a temporary measure to make sure your body’s natural protective response doesn’t make the issue worse.

The next step is unravelling what’s going on with your body, with the help of a medical practitioner, a sex therapist, or both. There are countless potential causes for sex pain. You can start by using a high quality lubricant, and also consulting with your primary care physician. But be aware (your doctor may not be!) that resolving many issues requires the help of specialized professionals, like a pelvic floor physical therapist or a vulvar pain specialist. If your doctor doesn’t suggest one of these specialists, and your sex pain doesn’t resolve, ask your doctor for a referral to a pelvic floor PT and let them advise you on how to proceed.

If you are feeling frustrated and things aren’t improving, consider consulting with a sex therapist, who can help sort out the issues and refer you to the right resources. With the help of skilled professionals and a little bit of patience, regardless of whether painful sex is new for you or something you’ve been living with for a long time, you are very likely to uncover the cause, resolve it, and start having pain-free, enjoyable sex.

It is also important to recognize that while you are working to resolve painful sex,  your sex life doesn’t need to grind to a halt. You can’t engage in the activity that produces pain–but there are plenty of other ways for you and your partner to create pleasure and experience closeness, which is (at least as I see it) what sex is really about. There is no reason your relationship has to suffer just because one activity isn’t possible for the moment. Situations like this one are the reason I often say that flexibility is the key to a happy, healthy sex life. This is an opportunity to work on that flexibility, and perhaps even discover new ways of connecting intimately that can become favorite additions to your sexual repertoire.

Should You “Just Do It” To Fix A Desire Discrepancy?

The conventional wisdom about desire discrepancy in a relationship is “just do it.” I’ve had many clients whose previous therapists have recommended some version of this approach, ranging from “ice-breaker sex” to “it’s like doing the laundry; sometimes you just have to get it done”.

I get that when a couple hasn’t had sex in a long time, it can become difficult to find a way to connect, get started, get vulnerable, or initiate intimacy. People frequently ask me “Where do we start? We’ve forgotten how to find one another”.

The problem is that desire can be a fragile thing, in need of a gentle touch. When desire is fragile, tentative, small, or hesitant, it can very easily tilt over into aversion if emotional pressure is applied, or even perceived.

So, what’s the difference between a tentative sexual encounter that results in a stronger connection, and one that has the unintended consequence of creating an aversion, or increasing anxiety?

Willingness.

Willingness is the crucial ingredient that is required for a sexual interaction to be a positive experience. Notice that I didn’t say “desire.”  In fact, desire is optional. Willingness is NOT optional. In order to run the experiment of trying to connect sexually after a dry spell, both partners need to feel willing. They might also feel worried, anxious, concerned, shy, tentative, vulnerable, embarrassed, or anything else. But as long as they are able to identify willingness, there is a good chance the interaction will be successful.

Here are some questions you might ask yourself to help yourself get in touch with willingness:

  • When sex goes well, how do I feel about myself?
  • When sex goes well, how do I feel about my partner?
  • What do I want to express to my partner sexually?
  • What makes a positive sexual interaction for me? How do I help create that?
  • What types of intimacy sound fun to me right now?
  • What types of intimacy would I prefer to postpone for another day?

Remember, you don’t have to do everything all at once. Consider inviting your partner to do something that sounds fun to you. Let them know, for now, your experiment is to keep it simple and stick with what you’re most comfortable with.

If you would like to have a conversation with your partner about having sex, try taking turns with these conversation prompts:

  • A part of me wants to have sex because….
  • A part of me is not so sure about having sex, because…

Make sure both of you respond to both prompts, so you don’t reinforce a polarized dynamic. Then see if you can work together to come up with a strategy to help you both get something you want from the interaction, while helping one another feel as little anxiety as possible.

Desire Discrepancy Lesson #2: Look for the Blocks

I’m continuing my series on desire discrepancy this week. If you missed last week’s post on normalizing variation, you can find it here.

What do you do if you’re seeing a couple with a big desire discrepancy, their marriage is on the rocks, and you recognize that you can’t wave a magic wand and make one partner want just as much sex as the other one? Sometimes there are things you can do that will increase desire for the lower desire partner, and other times there are not. The good news is, even if you can’t directly affect desire, you can certainly help your clients remove obstacles that prevent desire from blooming.

There are lots of factors that can impede or inhibit desire, and often they fall right into your wheelhouse as a therapist. Whether or not you’ve had training in sex therapy, I’m certain you have the skills to work with issues like anxiety and depression, both of which strongly inhibit desire.

My Will Lily assessment will help you identify some very common blocks–for instance, sex pain, which is, quite understandably, a major inhibitor of desire. If your client is experiencing sex pain, they absolutely must resolve it if they are going to have any kind of positive experience of desire.

Similarly, internal or external pressure is a common inhibitor of desire. Even without full-blown coercion, it’s very common for people to feel subtly pressured into having sex they don’t really want to have, for a variety of reasons–fear of disappointing their partner, for instance, or a belief that once a sexual interaction starts, they don’t have a right to stop or redirect the activity. Over time, subtle pressure can really put a damper on desire and do lasting damage to a relationship. Will Lily can help you identify cases like this in the very first session.

As I continue this series, I’m going to be talking in more detail about some of the factors that can inhibit desire. In the meantime, keep looking for the blocks. They can take all kinds of forms. Are your clients dealing with intensely demanding, stressful work schedules? Are they listening with one ear for the baby crying in the next room? Are they dealing with grief, or working through past trauma?

Identifying and working with factors that inhibit desire is absolutely necessary to increasing desire. No matter how much desire there is, these factors will stop the action.  Helping your clients remove obstacles is what creates space for desire to blossom.