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!

Two months ago, my friend and I were at Founding Farmers when she asked me for some sex advice. Her dilemma:

I come home from a long day at work and don't have the energy to pretend that I'm a porn star. I'm tired. I have to take care of dinner, clean the house, feed and play with our baby girl, and then get her ready for bed. I want to spice our relationship up, but most times, I'm just having sex so my husband is satisfied. Even then, I spend a lot of the act thinking about how much I have to do around the house afterward. And, just once I would love to come home and have him put our child to bed and have a bath ready for me!

***

I've heard this from quite a few of my friends in their 30s and 40s. Everyone's schedules are so hectic that it leaves little time and energy for sexy time. Some of that is to be expected. Marriage changes the relationship dynamic. Working in more senior positions or trying to keep a job in a bad economy compounds the stresses. Having children places huge time constraints on a relationship. What's a couple to do?*

I gave my friend a few suggestions and thought I would share those with you all. From my perspective as an outsider and friend, the goal here is to make both parties happy, while respecting the fact that time is at a premium. My friend wants romance and intimacy. Her husband wants to get laid. I think that both of them can get what they want!

I recommended that they find one hour a week to reconnect. Just one! Even if a week is especially hectic, family is visiting, or one person is sick, one hour is doable (pun intended).

For the first week, I mentioned that my friend should let her husband set the itinerary. A few days before the "Rendezvous," he should send her an e-mail, text or note with what he would like to happen. (Keep in mind, though, that there should be some ground rules about what would be an acceptable way to spend the hour. If you've never introduced anal, porn or another girl into the mix, now is not the time to do so. Work within realistic and comfortable realms.)

The purpose of the e-mail/text/note is to get communication going about sex and romance…to get both parties excited about their upcoming time together…to make the guy think more about what the woman wants and vice-versa. The ultimate goal is to bring the couple closer!

For the second week, the woman sets the agenda with the same rules. I told my friend that if what she wants is to have a bubble bath and a bottle of wine, then that could be her hour right there! There's a time and place for sex that's down and dirty, but there's also a place for romance.

I suggested alternating that mode for several weeks. If it helps to book a babysitter in advance, do so. Also, try not to pick the last possible hour in the week to reconnect. That way if there's an emergency, you will be able to reschedule. Remember that it's just one hour and that you deserve (if not, need) the quality time as a couple!

If that's worked for a month, then try planning how to spend an hour together. That involves communication, which is one of the keys to any healthy relationship. Maybe make a plan to try something new as a couple? You don't need to go buck wild, but get out of your comfort zone or your routine a bit. A new position, a new place, a toy, a sex book or a porno flick…anything will do.

Or, write a few of your ideas for how to spend the hour down and ask your partner to do the same. Put those pieces of paper in a box/bowl and then pick one piece of paper out and focus on that activity for your hour.

If one hour works with your hectic schedules, then add a second hour. You don't need to reinvent the wheel of your default relationship mode or try to spend five hours a week in bed together (unless you want to, that is). But, it's worth it for you both to find ways to reconnect on a romantic and sexual level.

Think of this like an exercise program or diet plan for your relationship. If you lose 10 pounds in a week, such rapid weight loss is tough to maintain. Likewise, most of the couples that I know don't have the time or energy to spend hours upon hours in the bedroom. Pick a realistic way to spice things up a bit! And, remember that small changes will have long-term benefits!

*I realize that this post caters to breeders or power couples, but I wanted to answer my friend's question first.

Next Post: Tips for any couple to spice things up (regardless of time, age, stage, marital status or whether there's a kid in the next room). I'll also throw in a few ideas for those women who don't particularly enjoy sex and some reminders for my female readers to embrace their bodies — whatever size and shape they are.

xoxo