ASK A SEX THERAPIST: What To Do When Sex Hurts

If you’re suffering from sexual pain, the good news is that there are plenty of options to explore.
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Vanessa Marin
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If you’re suffering from sexual pain, the good news is that there are plenty of options to explore.
Time to stop staring at the ceiling, hoping the pain will go away.

Time to stop staring at the ceiling, hoping the pain will go away.

A few years ago, the Center for Sexual Health Promotion at Indiana University reported that 30% of women age 18-59 experienced pain during their last sexual interaction. 30 percent! That number is staggering. 

Sexual pain is just not discussed that frequently. Many women operate under the belief that sex is supposed to be uncomfortable, and others push themselves to continue through the pain. The lack of discourse only perpetuates the tendency to tough it out. When you keep having sex that is painful, your brain starts to associate sex with pain. This mental stress only worsens the situation.  

If you’re suffering from sexual pain, the good news is that there are plenty of options to explore, ranging from quite simple to more involved.

Educate yourself

There are lots of different types and causes of pain during sex. Let’s go over a few:

Dyspareunia is the broad term for pain during intercourse. Vaginismus refers to a specific type of vaginal contraction that can cause pain or prevent you from having intercourse. Vaginismus comes in two varieties -- primary, where the woman has never been able to have intercourse without pain, and secondary, where the pain develops after a woman has been having pain-free intercourse for a while. Vulvodynia is persistent pain in the vulva. 

Sexual pain can also be the result of other conditions like internal cystitis, endometriosis, ovarian cysts, fibroids, tumors, or vaginal dryness. Sexually transmitted infections like bacterial vaginosis and chlamydia can result in pain. You can also experience pain from having a hymen that is fully or partially intact, if your partner has a particularly large penis, or if your partner is hitting your cervix with his thrusts. If you have a history of sexual abuse, you may also develop a pain condition.

This is just a brief overview. If you suspect that you have any of the aforementioned conditions, please do more research! 

Assemble a support team

Since there are so many potential causes for sexual pain, it’s important to see a doctor for a thorough medical evaluation. If anything, you can get the peace of mind of ruling out physiological causes.

You may also want to consider seeing a therapist or a sex therapist. If sexual abuse is a part of your history, there may be some psychological aspects of your discomfort during sex. Pain can crop up years later, or even if you think you’ve already processed the abuse. If you’ve never been sexually abused, you may still find it useful to talk about the stress associated with being in pain during sex. 

I also suggest looking into pelvic floor therapists. These practitioners specialize in pelvic pain, and can prescribe physical therapy exercises. The American Physical Therapy Association and International Pelvic Pain Society are places to start.  

Finally, you can seek support in chat rooms or forums for people with sexual pain. Feeling like you’re not alone in this can be very healing.

Managing sexual pain on your own

While I thoroughly recommend enlisting the help of professionals, there are also ways you can minimize sexual pain on your own:

● Use LOTS of lube. One of the main causes of sexual pain is vaginal dryness. There seems to be a stigma against not producing enough natural lubrication on your own, so lots of women are hesitant to use artificial lube. I can’t recommend lube enough. If you’re experiencing even the slightest bit of discomfort during sex, lube can be a game-changer. Lube can not only decrease sexual pain, but can also amplify the pleasurable sensations you feel during sex. 

● Make plenty of time for foreplay. So many women have intercourse before their bodies are ready for penetration. It’s hard for your body to get adequately lubricated if you zoom through foreplay or skip it altogether. If you’re aroused before having sex, you’ll be less likely to experience discomfort.

● Take control of insertion. Hold your partner’s penis or dildo in your hand, and ease it into your vaginal canal. Go as slowly as you need. 

● Change up your position. Woman on top can be a good position because it allows you to control not only insertion, but depth, angle, and pacing too. If you have a particularly well-endowed partner, you can aim for positions that lead to shallower penetration, like spooning.

● Broaden your definition of sex. You don’t have to have intercourse to be intimate with your partner. I know it can be upsetting to want to have intercourse but be unable to. That being said, if you can receive oral without experiencing any pain, that’s something to celebrate! 

● Give your clitoris extra love. If you’ve experienced years of painful sex, you can easily forget that sex can feel good (or you may not have ever had pleasurable sex). The clitoris isn’t usually a site of pain, but can provide an immense amount of pleasure. 

● Don’t push through the pain. I know that sexual pain can be immensely frustrating, but it’s important to stop when things hurt. Take a break from intercourse to focus on a more pleasurable activity, then give it another go if you feel up to it.

● Exercise your PC muscles. Your PC muscles drape across your pelvis like a hammock. You can find them by cutting off the flow of urine next time you’re peeing. Practice tightening and releasing them, and pulsing them several times a day. Once you get more familiar with the muscles, you can figure out how to help yourself relax internally.

● Breathe! I can’t stress how important it is to breathe. If your body is used to being in pain during sex, you’re naturally going to tense up. Try taking slow, deep breaths, in through your nose and out through your mouth. Visualize sending your breath all throughout your body, melting away all of the tension.