Sex was painless for me for the first four years in which I was sexually active. Suddenly, seemingly out of nowhere, sex became excruciatingly painful. I needed lube during penetration where, before, my physical arousal had never been in question. Once the thrusting began, I felt a sharp, shooting pain deep inside of me. This pain was something lube couldn't touch, and I couldn't figure out what was causing it.

The Cause of Pain During Sex Isn't Always Easy to Pinpoint

Neither my gynecologist nor an ultrasound technician could figure out the source of my pain. Neither could a clinical psychologist, a homeopathist, or a hypnotherapist. By the time I figured out just how complex sexual pain disorders could be, my pain was gone. But the damage to my relationship with sex was already done.

Back in the day, diagnosing the cause of genital or pelvic pain was an either/or proposition. If your doctor couldn't find a physical cause, they just assumed it was psychological and sent you on your way. These days, thanks to a greater depth and breadth of research, medical professionals are coming to realize that such disorders are actually biopsychosexual. This means that the pain you experience during sex can be attributed to biological factors, psychological factors, social factors, or some combination of all three.

Sometimes, pain can come down a specific issue, such as an STI, a hormone deficiency, or even a treatment such as chemotherapy or radiation. Sometimes, doctors diagnose patients with vulvodynia, which really just means that you've experienced vulvar pain for at least three months, with no discernible cause.

The pain itself? It can manifest in all types of different ways, which only adds to the confusion.

Is your head spinning yet?

Treatment for Painful Sex Can Be Complex

Treatment is similarly complex and, while some women have success using dilators or going through physiotherapy, others only find relief through a more multidisciplinary approach that includes a mix of cognitive behavioral therapy, mindfulness exercises, and more.

I won't attempt to solve the problems of diagnostics and complex treatment plans in this post. But if you are experiencing painful sex, I do want to make clear that this doesn't mean the end of your intimate life. And in fact, if you're grappling with this, continued physical affection with your partner(s) is key to both your sexual and relationship well-being.

So what can you do if the thought of sex makes you squirm?

Expand Your Definition of Sex

We tend to use the word "sex" interchangeably with the word "intercourse," with the end goal being orgasm. Yet, sex can encompass so much more, including masturbation, smooching, heavy petting, dirty talk, and more. In fact, Scarleteen has a pretty awesome write-up of how broad the definition of sex can be. I am including it here here because it's important to acknowledge that even when penetrative sex seems impossible, there's so much more you can do.

Communicate with Your Partner

Once you yourself have come to terms with the fact that you might have to approach sexual activity in a different way, you can let your partner know what's up. Chances are, they know something's wrong, but they may not know why. In fact, if you've been avoiding sexual contact with them, they may assume that you are rejecting them because of something they've done...some way in which they come up short. The National Vulvodynia Association has some great information on how to approach this conversation, in addition to some of the topics you might want to cover. These include a frank discussion of how satisfied (or dissatisfied) you are with your intimate life in this moment, what triggers your pain, and what you can both find pleasure in.

Fill Your Days with Small, Affectionate Gestures

The goodbye kiss before you part ways in the morning. The low-key flirty butt pat when your partner is doing housework. The snuggles when you Netflix and chill (and by "chill," we actually mean "put on your most unflattering flannel pajama pants, settle in with your own personal pints of ice cream, and just be lazy). The quick shoulder massage when you can tell your partner is stressed out. These non-sexual gestures - the ones that make you feel loved and valued - are key in maintaining your intimate connection. Without it, you might just find that the bottom has dropped out of your more erotic connection.

Embrace Outercourse

If penetrative sex seems impossible, do everything but. Embrace outercourse. Make it your mission to search for new and exciting erogenous zones on each other's bodies. Give each other erotic massages. Engage in non-demand touching, where it is explicitly stated that intercourse is off the table, so that you have a chance to relax and just enjoy sensations. This ties back into our first point - acknowledging that sex is a vast territory just begging to be explored.

Practice Mindfulness

This may seem so trendy that you want to dismiss it. However, research shows that certain mindfulness-based therapies have actually proven to be helpful in easing both pain and pain-related distress. Part of this is due to the fact that the fear and stress that come with painful sex can cause you to tense your muscles in anticipation of even more pain, getting you caught up in a never-ending, infuriating cycle. So, mindfulness-based therapies that force practitioners to observe and reconsider their reaction to pain have been effective in treating the pain itself.

You can practice mindfulness even when you have no intention of engaging in penetrative sex. If you learn how to cultivate present-moment awareness, remaining focused on something such as the breath, you'll be able to use this newly developed skill to focus on other things that can enhance your enjoyment of sex, such as the forms of touch that actually feel pretty darn good. It's hard to feel pleasure when you're also trying not to feel pain. Let yourself feel the sensations in your body rather than trying to block them out.

Remember That There Are So Many Ways to Express Your Sexuality...


...and that your pain does not define you.