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.

Facts About Anatomy that Your Clients Need (Part 2)

Last week, I shared some useful facts about anatomy that your clients are likely to benefit from. This week, I’m back with more–this time focusing on orgasm and ejaculation for people with penises.

  • Many people with a penis can have more than one orgasm (with ejaculation) in a day. Some can have more than one orgasm/ejaculation in a sex session. If your client is distressed about reaching orgasm “too quickly,” they should know that for many, this is a possibility!
  • It is also possible to separate the orgasm from the ejaculation, and have LOTS of orgasms before ejaculating. This is an interesting mindfulness project involving awareness of levels of arousal, and there are a couple of very good books about it if you know someone with a penis who would like to explore this: The Multi-Orgasmic Man, by Mantak Chia and Douglas Abrams, 1996, and Male Multiple Orgasm, by Somraj Pokras, 2007.
  • Sometimes people use numbing agents in an attempt to avoid ejaculating “too quickly.” I’d never recommend this, as numbing agents don’t promote pleasure. They can also be passed to the partner, which completely defeats the purpose.

You may have a client who struggles with shame or embarrassment about ejaculating too quickly, or too slowly. Anxiety about sexual “performance” is very common, and anything you can do to lower anxiety and decrease any sense of “performing” will be very helpful. Focusing on intimate connection with pleasure, rather than penetration or orgasm, is an important part of lowering anxiety about sex. Normalize the fact that there is no rule book about how to have sex “right”, and that there are many ways to explore pleasure besides PIV. I’ve written many times on this blog before about building a flexible sexual relationship that doesn’t collapse when things don’t go as planned. You can read more about that here:

When Sex Doesn’t Go As Planned

Unscripting Sex for More Connection and Pleasure

Flexibility is the Key to a Satisfying Sex Life

Unscripting Sex For More Connection and Pleasure

You may have heard me use the term “scripted sex” or “linear model of sex” before. By “scripted” or “linear” I mean a concept of sex that follows a widely-accepted progression: first base, second base, third base, home.

You could add more bases, but, according to the model of scripted sex, if you are having a “good” sexual interaction, you’re moving forward from one base to another. What I mean when I say scripted sex is what most people think of as just “sex.” But in my opinion, the model of scripted sex creates a lot of mischief and bad feelings.

The scripted model of sex labels most sexual activities “foreplay,” and accepts only PIV (penis in vagina penetration) as “sex.” This means that a lot of people feel really bad or broken if they can’t have PIV or don’t want to have PIV–even though there are a whole lot of sexual activities, besides PIV, that generate pleasure and connection between partners and have the potential to lead to orgasm.

These words and ways of thinking about sex are very linear and very restrictive. They don’t leave any room for unique experiences, varying function, and perfectly normal differences between people.

What if all pleasurable sexual activities ranked the same? You could make a mutual decision in the moment about what activity you want to participate in. You could feel free to shift between activities according to what you each want or would find pleasurable in each unique moment. No meaning would be made about how things unfolded. “No PIV? Fine! What shall we do instead?”

This improvisational way of experiencing sex is more workable than the linear way in about a million ways. But it does still present some challenges. It requires some kind of verbal or non-verbal communication of desires and preferences in the moment. It also requires an ability to be flexible about expectations, and not make negative meaning about how things unfold.

For example, the scripted model creates problems when one partner wants to go from “third base” to “first base” (which is what I call downshifting). According to the scripted model, you’re supposed to go “forward”, not “backward,”–which means that people often experience a lot of negative emotions and meaning-making when their partners ask for a downshift.

“Did I do something wrong?” “Does my partner still find me attractive?” “Am I bad at (whatever activity you were just doing)?” “Am I taking too long?” These are just a few examples of very common fears that tend to rear their ugly heads when we have expectations about what sex “should” involve and how it “should” progress.

Does this ring true with your experience? Can you think of a moment when your partner asked for a downshift? What meaning did you make of it in the moment? Can you think of a moment when you asked for a downshift, and your partner made negative meaning out of the moment?

For many people, the possibility of a negative reaction to downshifting means that they hold back from expressing their preferences in the moment, for fear of hurting their partner’s feelings. But hiding your real feelings and desires during sex is a recipe for disconnection, and over time can result in diminished sexual desire overall.

A better solution is to recognize that downshifting isn’t going backwards; it is just a change of subject. If you embrace flexibility and subject changes as ways of exploring what feels best for you and your partner in the moment, rather than seeing it as a sign of failure, it can mean more connection and more pleasure, not less.