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.

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.

Working With Undisclosed Sex Pain: Vivian’s Story

In my last post, I told you about one of my experiences working with sex pain and desire discrepancy in therapy. Today’s story from the therapy room comes from Vivian, who lives and practices in Sydney, Australia. Vivian recently took my 16-week online course “Assessing and Treating Sex Issues in Psychotherapy.”  Vivian writes:

I would describe my skill level with sex issues before I took your class as intermediate. I was comfortable asking about sex issues and I could help couples use those discussions to support more intimacy and healing of wounds. And I still got so much out of your course!

Since taking your course, I use your script to open the topic of sex with every new client, both couples and individuals. What an easy way to introduce this topic right in the first session! In the majority of cases, clients tell me there is something about sex they want to discuss, and then I use your brief assessment tool as a non-threatening, normalizing way to delve into the issues. This usually opens up a conversation between us, which in itself is diagnostic in that I get a good sense of their comfort with the topic and their interactional patterns.

It’s been surprising to me to see how often sex pain is an issue, and has so often never been revealed let alone discussed. For example, a young woman I saw last week said that pain happens “sometimes” during penetration and that she’d never told her partner. After unpacking this a bit, I was able to give them some psychoeducation, make a recommendation about how to proceed, and ask them to stop any activities that resulted in pain until it could be resolved; I was able to let them know that continuing to have painful sex can cause other problems both physically and emotionally.

With the same couple, I used several other tools and techniques I learned in your course and was able to help her be able to tell him that there were things she’d like him to do which she hadn’t been able to say. Although those were difficult conversations, and they both had to stretch to have them, I had the tools, knowledge, and the confidence to help them get there.

I am still exploring the wealth of information included in your course, and reveling in all the resources too. Thank you so much!

Kind regards,

Vivian.

www.vivianbaruch.com