Pain during sex is not normal. Here’s how couples can deal with it
WWhen I was 21, I decided I wanted to become a sex therapist. Weeks later I suddenly couldn’t have sex anymore. I was happy in a new relationship, but penetrative sex became painful without warning. When it first happened, I hoped it was just a bad day. Then it happened again. And again.
Unfortunately, I wasn’t the only one with this experience. More than a quarter of women worldwide dealing with chronic pelvic pain – and those are just the reported numbers.
As time passed, the pain became worse. I felt like a failure as a woman and a disappointment to my then-boyfriend, even though he was caring and patient. Who would want to be with me? How could I ever have children?
I frantically researched possible treatments and booked medical appointments in search of answers. After ruling out other possible causes, my gynecologist diagnosed me with vulvodynia, or chronic vulvar pain, and referred me to a psychiatrist. But when I explained my predicament, her response was, “Have you ever tried drinking a glass of wine and thinking about the ocean to relax?”
I was clearly on my own.
I became increasingly disconnected from my body, sexuality and partner. On the outside, I was probably headed toward a career in sex therapy. I shut down internally when I thought about sex.
It was all devastatingly unsexy.
I finally got relief through pelvic floor physical therapy and finding the right medicine for me, after many failed attempts. But medical treatments could not heal the emotional and relational wounds.
Here’s what I’ve learned about dealing with the mental impact of chronic pelvic pain as a psychologist, sex therapist, and former patient.
Society normalizes pain during sex – and patients rarely talk about it
When counseling couples, I typically assess whether either partner is experiencing chronic pain. But people usually prefer to talk about knee problems or back pain rather than genital or pelvic pain.
Women often hear that the first time will hurt, that things are never the same after giving birth, and that vaginas simply dry out after menopause. These stories teach us that at least some sexual pain is expected, and that we should accept and endure this pain.
The researchers found that women were more than three times less likely to talk about their pain during sexual encounters in which they experienced little or no pleasure. When sex felt like what it was for someone else – instead of of someone else – women suffered in silence. Participants who did not tell their partners that sex hurt described normalizing painful sex, prioritizing their partners’ pleasure, and feeling strong pressure to meet their partner’s sexual needs.
Pelvic pain during sex can be isolating and kill desire
Pain isolates and makes people feel removed from their own sexual pleasure. It’s easier to ignore it – unless it becomes unbearable.
Chronic pelvic pain can also kill desire.
Sarah*, 38, has suffered from vulvodynia for the past five years of her nine-year marriage. “Honestly, if I didn’t have to have sex anymore, I’d be fine,” she says. “I love our life together. I love (my husband). I’m attracted to him, but I don’t think he believes me because I never want to have sex with him. I always feel guilty… I know I should want this.”
For people whose female partner has pelvic pain, sexual desire can become fraught and confusing.
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“I wish I could just stop wanting sex. It would make life so much easier,” says Sarah’s husband, Dan, 37*.
“If I say or do anything that makes her think I want sex, she withdraws and makes a joke or gets angry to avoid me. I feel like a monster because I want something that literally hurts my wife,” he says. “But if I don’t express (sexual desire) at all, she worries that I don’t like her anymore, which isn’t true.”
For now, he lets Sarah know that he still thinks about her in a sexual way – “but not too much, or too often. I just know that if I stop, the sexuality in the relationship will disappear completely.”
A sexless relationship may be workable, but a relationship without intimacy often feels hopeless.
“It hurts that my wife, the only person I care about, never wants me,” Dan says. “Sometimes I think it’s me. So deep down she isn’t attracted to me, but she doesn’t want to say it. But then I think about what she’s going through, and my problems don’t even compare. So I just try to take my mind off it.”
How couples can cope with pelvic pain
When I searched for the elusive cure for my pelvic pain, I focused on medical remedies. Most couples start there too. Depending on the cause, interventions such as pelvic floor physical therapy, medications, hormone-based therapies, and dietary changes can all help. This also applies to the use of body-safe products and lubricants.
But emotional healing requires a mind-body approach and an expansion of thinking about sexuality.
When couples experience pelvic pain, they panic because they cannot have penetrative sex. Limiting their menu to other types of sex (for example, oral sex or mutual masturbation) can feel like settling rather than a willing compromise.
Many then fall into predictable cycles: avoiding anything that could lead to sex (including kissing and cuddling), decreasing communication about sex and intimacy, and fearing whether the relationship will survive.
These patterns are especially challenging for monogamous couples who want to meet all of each other’s needs. Redefining what intimate connection is and lowering expectations for sexual pleasure and performance can benefit any type of relationship, according to the four authors of When sex hurts. It is helpful for couples to choose the types of intimacy they want to enjoy, just as they would order dessert. Instead of treating kissing as the first course of a meal, I encourage couples to enjoy it for themselves. When it’s the main event, couples rediscover why they like it in the first place.
It may help to find an individual or relationship therapist, ideally one who understands pelvic pain. I sometimes ask couples to stimulate their senses with everyday household items: think of lightly tickling with fabric, melting ice cream on each other’s skin or surprising a partner’s taste buds with pieces of food. Sensual approaches are great. But starting out playfully – like opting for sour gummy worms instead of sexy snacks – reduces tension and brings joy to the activity.
Another way to help couples connect is sensate focus, a therapeutic technique to process fears and anxiety that arise from chronic pain. A therapist or an app like Blueheart can guide couples through structured touch exercises to reduce sexual anxiety and improve intimacy, starting with non-genital touch and gradually moving to more intimate contact. The emphasis is on sensory experiences such as pressure and texture rather than sexual performance or orgasm.
Some couples choose to open up their relationship and find happiness when they remove the pressure to exclusively fulfill each other’s sexual desires. This isn’t a solution for everyone, but discussing it can provide new insights into partners’ needs and desires. For couples considering non-monogamy, a candid conversation about what they want — like a relationship where they can be authentic without guilt — and what that might look like is a good start.
Many monogamous couples consider this option as a last resort and are unexpectedly pleased with the results. They may want to alleviate the stress of differences in sexual desire, maintain or enhance certain relationship-specific rituals, or reaffirm their commitment without assumed monogamy. Couples who successfully navigate this transition experience change in fear or their relationship can work on visualizing How it can work. Therapists can help couples discuss boundaries, maintain hope, and develop plans to address any hurt feelings or confusion that arise as they create the next chapter of their relationship together.
The journey with pelvic pain does not have to mean the end of a relationship. For many, it becomes an unexpected opportunity to accept themselves and their partner and discover new dimensions of their connection.
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Mina Ratkalkar, PhD, LCSW is a licensed psychologist, certified sex therapist and the founder of New Spark Therapy based in Durham, North Carolina