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

Facts About Anatomy That Your Clients Need

Last week, I shared my case for why it’s important to talk about sexual anatomy with your clients. I was delighted to find that the post resonated with many of my readers.

This week, I’m building on last week’s post by sharing some facts and psychoeducation about anatomy. Not enough people know this information, and I’m willing to bet you have at least one client who could benefit from learning it.

  • Fewer than 30% of people with vaginas reach orgasm from penetration alone. If you have a client who is experiencing distress because they or their partner cannot reach orgasm solely from penetration, they should know that is completely normal and to be expected. They are in a solid majority.
  • People with a clitoris take on average 25-30 minutes of direct clitoral stimulation to reach orgasm. Many people have a mistaken idea that clitoral stimulation is not necessary, or that just a few minutes should be sufficient. Again, if this mistaken idea is causing distress to your client, they should know that the way their body functions is perfectly normal and to be expected.
  • Most people with a penis can reach orgasm without being fully hard. A certain degree of hardness is necessary for penetration, but not usually for orgasm.
  • Everyone’s sex parts and bodies are different. Sexual function, preference, desire, and every other aspect of sexuality is individual to the point that comparison is meaningless. All different, all normal.

Too many people are ashamed of their sexual anatomy, the way their bodies look or function, and the ways they experience pleasure. By sharing some simple (but weirdly hard-to-find) facts, you can take away that shame, and ultimately make a huge difference in your clients’ lives and relationships. I’m going to be sharing part two of this post next week, so check back then for more anatomy-related facts.

This topic is near and dear to my heart. One of the biggest motivations for designing my online course, Assessing and Treating Sex Issues in Psychotherapy, was to make sure that therapists have access not only to the techniques and interventions they need to work effectively with sex issues, but also a solid grounding in anatomy, physiology, and sexual health.  This makes it possible to identify pressing issues, normalize human diversity, and be true advocates for clients’ health. I love to help therapists learn how to sort out the physical and emotional aspects of simple and complicated combinations of sex and relational issues. If you’re interested in learning more about the course, which opens for enrollment this February, click here.