When sex hurts

Two friends recently approached me with almost identical questions about what to do when sex is painful:

I have endometriosis and having sex hurts. I don't even really like having sex because it's so painful, but I try to do so every now and then. If I don't keep my husband happy, I worry that he'll go out and cheat on me. Do you have any suggestions for me, City Girl?

First of all, know that you are not alone! A study by Brigham and Women's Hospital reveals that 16% of women experience chronic pain from intercourse. 16%! The causes might vary, but if you have severe pelvic pain, then even the thought of sex might make you cringe with discomfort.

Now, as you probably know already, I'm not a health care professional or certified sex educator. (I'm a lawyer, which might explain why I love disclaimers.) Painful sex is a medical problem so I strongly suggest that you talk about this with your doctor! You can broach this question to your gynecologist, primary care physician or endocrinologist. You don't have to get into a lot of detail about your situation — just enough to get the point across. Simply explain to your doctor that you experience pain during intercourse because of whatever reason (if you know what that reason is) and wondered what he or she recommended.

No matter your religion, culture or upbringing, remind yourself that sex is not a dirty word. Also remember that you are not asking your doctor anything that he or she hasn't been asked before. And, finally, if your doctor is not someone with whom you feel comfortable talking about your body, then get another doctor! Every patient needs to be his or her own advocate, and finding a health care provider who is approachable and has a good bedside manner is your right!

If you are experiencing endometriosis or a condition that causes pelvic pain, also check with your doctor to see if you are medically-cleared to have sex. And, be specific. My doctor still laughs about the fact that when I was told I couldn't have sex for four weeks after surgery, I asked the following,

"Vaginal? Oral? Anal? What about fingers? Can I orgasm clitorally? Play with toys?"

As memorable as that interrogation was, my doctor answered every single question. I waited the time I needed to heal and was given the clearance to do everything I wanted in four weeks. If getting that specific with your doctor is too embarrassing for you, then it's okay to write your questions down and present your doctor with the list.

It's also important to speak up with your partner. No one who cares about you would want you to be in pain. Period. (If you question that for a minute, try reversing the situation to assuage your fears.) It's okay to say, "Ouch!" or "Oww!" or "Can we switch positions?" You can even bring up the topic when you aren't having sex to let your significant other know that you find certain things uncomfortable or what he can do to make the experience less painful for you.

Other ideas to make sex more pleasurable for both of you:

1. Take a pain reliever an hour before you will be having sex. If you aren't on a prescription pain medicine, then two Advil or Motrin should work. Try to stop the pain before it reaches its peak;

2. Have your man get you off once before he enters you. Make sure that your muscles are as relaxed as possible;

3. Figure out which positions and what pace are most comfortable for you. And speak up when it hurts and especially when it feels good;

4. Try some mind over matter/biofeedback techniques. If you tell yourself, "this is going to hurt, but I have to do it or my husband will have an affair," then that doesn't put you in the best mindset to have sex. What if you try to be more self-affirming? Remind yourself that you are excited to be making love with your husband. Try to retrain your thoughts to focus on the pleasure, rather than the pain;

5. Think out of the box. Literally! If vaginal sex is that painful, then mix it up. Perfect your skills at giving a blow job or a hand job. Give anal sex a try. Talk with your man as to what he enjoys or wants to explore. Find other ways to increase intimacy (notice I didn't write orgasms);

6. Plan on taking a bath after you have sex. If there's discomfort or any bleeding, you might find a bath to be soothing;

7. If you aren't going to a doctor about any of this, start! Depending on your level of pain, there might be medical or surgical options to make your situation better. If you are open to alternative or Eastern medicine, you might search for a good, licensed acupuncturist, Reiki master, or herbalist. If there are psychological issues coming into play that affect your views on or discomfort from sex, please talk to a therapist or social worker to help you process your feelings; and

8. For the guys, let your women know that you love them, want them to feel better, and aren't going to cheat on them when the sex isn't as great or as frequent as it once was. And then…stick to that!

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