This Guide to Reclaiming Pleasurable Sex: Dyspareunia & Beyond is brought to you by Rebellious Magazine for Women with support from:
Do You Find Sex Uncomfortable? You Are Not Alone
If you or a loved one find sex uncomfortable or even painful, we want to start by telling you:
You aren’t alone.
And we believe you.
We also believe that it’s possible for you to reclaim pleasurable sexual intimacy – whatever that looks like for you.
Here’s what you’ll find in this guide:
- Pelvic Floor 101 — things you need to know about the pelvic floor and common causes for sexual pain
- How to find and talk to supportive health care providers
- How to talk to your intimate partners about pelvic pain
- How to write healthier sexual scripts
- Finding sex toys for pelvic pain
- Making lifestyle changes that impact pelvic pain
- More resources about the topic
Sexual Pain and Discomfort is Extremely Common
Chronic pain or discomfort during sex is common — it’s just not commonly talked about.
Nearly three out of four people with vulvas will experience pain during intercourse at some time during their lives, according to The American College of Obstetricians and Gynecologists.
In another study, 15 percent of people with penises reported pain during other-sex intercourse, and a similar percentage reported pain during same-sex intercourse.
New forms of discomfort can arise after pregnancy, during and post-menopause, or as side effects for health care treatments. Sometimes something as banal as a yeast infection or sports injury can lead to longer-term pelvic pain.
This is not something health care providers always think to discuss, or maybe they’re not even comfortable bringing it up. Worse, patients are not always believed or taken seriously if they have the courage to raise these issues.
This causes a lot of people to suffer in silence, and because we don’t talk openly about sex, it’s easy for people to think it’s a problem with their body.
Pelvic Floor 101
Chronic pain in the pelvic region is one of the most common causes of discomfort during sex.
A lot of people don’t realize there’s a lot more to a healthy pelvic floor than kegels! If you are having pelvic floor issues, it’s important to know what kind so you can treat it accordingly. Stephanie Prendergast, co-founder of the Pelvic Health Rehabilitation Center and co-author of Pelvic Pain Explained, said there are “high-tone” (hypertonic) and “low-tone” (hypotonic) disorders.
We are most familiar with low-tone disorders. This is when the pelvic floor muscles become weak (commonly after childbirth) which can lead to incontinence, pelvic organ prolapse, and/or painful intercourse. High-tone disorders can also cause painful sex, but this is because the muscles are too tight. Other symptoms can include urinary frequency, external vulvar pain, perineal or anal pain, and pain with erections or ejaculation.
A lot of doctors, including gynecologists and urologists, still don’t adequately understand the pelvic floor and its interaction with so many other parts of the body. When you start to experience these symptoms, it’s important to get assessed by a pelvic floor physical therapist. In the meantime, however, if your muscles are too tight, Prendergast said, foam-rolling exercises for the leg and hip muscles may help, as well as pelvic floor exercises such as the pelvic floor drop. It’s also a good idea to avoid fitness exercises that increase abdominal pressure because they could aggravate the already too-tight muscles. If you have too-weak muscles, this is where kegels could help you, but it’s just as important to learn to consciously relax the pelvic floor muscles as it is to contract them.
Common Causes of Pelvic Pain or Discomfort
- Dyspareunia: pain in the pelvic area during or after sexual intercourse
- Anodyspareunia: pain in the receiving partner during anal intercourse
- Vulvodynia: chronic pain or discomfort around the opening of the vulva
- Vaginismus: involuntary muscular spasms in the tissue surrounding the vagina that cause the vagina to tighten
- Chronic Pelvic Pain Syndrome: chronic pain in the pelvic area, sometimes located in the perineum
- Prostatitis: swelling in the prostate gland that can lead to painful ejaculation.
How to Talk to Your Doctor
Health care providers might not be comfortable bringing up issues related to sex, according to Dr. Natalie Rosen, a clinical psychologist and principal investigator at the Couples and Sexual Health Laboratory at Dalhousie University. At the beginning of the appointment, tell your doctor you’d like to save time to discuss something new. If the issue makes you uncomfortable, Dr. Rosen suggests starting with something like, “I’m having a problem in my relationship,” and consider ahead of time how to segue into talking about sex.
What to Do if a Doctor Tells You It’s “In Your Head”
For many people experiencing pain during sex, their gynecological exams may look normal. People with penises may test negative for bacterial infections (a common cause of pain during sex), and people with vulvas may be misdiagnosed with a UTI even if they test negative for bacteria. This doesn’t mean the issue is all “in your head.”
It’s common for doctors to give the advice (especially to people with vulvas) to “just relax” or “have a glass of wine before sex.” This may work for some people, but it is not the appropriate response to a patient who comes to them because of painful sex.
If your health care provider doesn’t believe you, search for one who does. Before setting up an appointment, call their office and ask if their staff has experience treating people with dyspareunia, vulvodynia, or chronic pelvic pain.
Also try Googling one of these conditions and where you’re from. You may find reviews for health care providers, support groups, and other helpful information about your area.
For trans and non-binary folks, the issue goes much deeper than just being believed. Physical therapist Heather Edwards explains, “many trans and nonbinary folks report abuse, disrespect, and even assault in medical offices. Even if the clinician is trans competent, that doesn’t mean that the front desk is, and it certainly doesn’t mean that the other folks waiting in the waiting room are. For a man with vaginal pain, sitting in a pink, flowery waiting room to discuss a vaginal problem with a provider who might not be very competent with trans health needs can be daunting or even unsafe.”
Groups such as Campaign for Southern Equality and Transmission keep lists of trans friendly providers for those seeking resources. Queer patients, including cis gender folks, face other forms of discrimination by health care providers. Search OutCare Health for LGBTQ+ friendly health care providers in your area.
Read more about how to talk to health care providers including specific advice around fighting stigma for people with vulvas, people with penises, trans and non-binary people.
How to Talk to Intimate Partners
“Timing is really important. Couples fall into the trap of bringing it up when emotions are already running high,” according to Dr. Rosen. Set aside time when both individuals have the energy for an important discussion.
Dr. Rosen also suggests using “I” statements. “The point is to try and think about how to approach it from the perspective of the impact it has on you and how you’re feeling as an individual rather than blaming your partner, which can spark more defensiveness.”
Read more about how to talk to intimate partners.
Writing New Sexual Scripts
We all have absorbed societal scripts about what sex is and what we should offer our partners. These scripts can be harmful — setting up expectations about desire and sexual intimacy that we cannot meet. So what should we do?
On your own and with intimate partners, question what sex is, what you use sexual intimacy for, what feels good and what doesn’t. There are no right answers.
For instance, if a certain sexual activity causes you discomfort or pain, what are alternatives that feel better?
For chronic sufferers of pelvic pain, it’s important to remember that it’s still possible to experience sexual pleasure. For some, the goal is not to live a pain-free life (that may not always be possible), but to be able to do the things you love with as little pain as possible. It’s also very important to know your own body before teaching your partner(s) what feels good for you, especially if you’re in the midst of a pelvic pain flare-up.
Finding Sex Toys for Pelvic Pain
If you experience pelvic pain (or any kind of chronic pain), you still deserve sexual pleasure. Taking sex toy recommendations from reviews can be a bit of a gamble because every body is different. But it’s even more risky if you have pelvic pain because what works for one person’s body may not work for another’s. Dilators are a good idea if you have hypertonic pelvic floor dysfunction, vaginismus, or a tense pelvic region. Of course, dildos of varying sizes and shapes can be just as effective for reintroducing penetration to the body. Toys of “squishier” (but still body-safe) materials can be great for squeezing or tightening around if firmer materials are painful.
Vibrating toys can maybe be even more of a challenge when it comes to finding what works for you. If you have a sensitive vulva and/or clitoris, buzzier, more surface-level vibrations can be painful, but at the same time, rumblier, deeper vibrations could cause a different kind of pain. This is also a matter of personal preference, and we’d strongly suggest visiting a store where you can turn on the toys yourself and feel the vibrations in your hand before making a decision. Of course, that’s not always an option. You may just have to make as educated a guess as possible based on reviews and what you think may work for you.
Darling Nikki reviewed both external and internal toys that worked for her own pelvic pain. Those reviews can be read here and here. Her latest post was a round-up of even more pleasure products that aided her in her pelvic pain treatment.
These reviews, however, focus on toys for hypertonic pelvic floor dysfunction. For hypotonic (weaker) pelvic floor muscles, kegel balls and weights can be beneficial. People with external genitalia have fewer options available, though some may find vibrators soothing. Masturbation sleeves are an option as well depending on the kind of pain you experience.
A few of the sex toys, accessories and products for pelvic pain Nicole has found helpful from sponsor Peepshow Toys:
- Sola Cue Multi-Function Silicone Rechargeable G-Spot Vibrator
- Silk Medium by Tantus
- Doxy Die Cast Extra Powerful Massage Wand Vibrator
- WARM Vegan Leather Warming Pouch for Sex Toys + Lube
Living with Pelvic Pain
For many folks experiencing pelvic pain, it’s not an isolated phenomenon but is actually connected to other aspects of their life. For instance, vaginismus (tension in the vaginal muscles) might signify a desire for more control in life in general that’s manifesting in one’s body.
Somatic psychotherapist Kayna Cassard explains, “A lot of [people with vulvas (PWV)] come in at the end of their rope, and I talk to them about reaching for progress and not perfection, because typically what is needed is a lifestyle change.”
This lifestyle change might look like working with a therapist to find new control and empowerment in your work and relationships. Or it could mean using mindfulness techniques to more effectively listen to your body.
Read more tips about how to make lifestyle changes that can reduce pelvic pain and discomfort.
In Summary: There’s Hope
As more of us speak out about these issues, we can reduce the stigma and disbelief that too often accompanies pelvic pain. Together, we can learn to have better conversations with our health care providers and partners. New toys are available for folks with pelvic pain. And we are rewriting the harmful sexual scripts that have aided our discomfort and have not seen us as whole persons in the bedroom.
Still have questions? Email Jera at firstname.lastname@example.org or Nicole at email@example.com.
Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain by Deborah Coady & Nancy Fish
Heal Pelvic Pain: A Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence, IBS, and Other Symptoms Without Surgery by Amy Stein
Pelvic Pain Explained by Stephanie A. Prendergast & Elizabeth H. Rummer
- Beyond Basics Physical Therapy
- Pelvic Guru
- Pelvic Health & Rehabilitation Center
- You See Logic with Dr. Uchenna Ossai