For a society that seems obsessed with sex, there’s a lot we don’t know about it. If you’ve spent any time talking to me about sexuality, you’ll quickly learn my contradicting opinions about pornography. On one hand, it can be a wonderful tool to enhance fantasies, connect with a partner, and enjoy sexually explicit art. This is especially true when watching ethically-made porn. On the other hand, too many people use pornography to learn about how to have sex because of the lack of good sex education in the US. Most porn is terrible sex education. And the outcome of this is causes us to feel shame when sex doesn’t work the they we think it should. This is especially true when dealing with pain during sex.

Here are two big ways that I see this play out. People with penises get very nervous and feel shame when they have difficulty maintaining erections (see my next blog post). And people with vulvas feel shame and confusion when sex hurts.

In most mainstream pornography, you don’t see healthy conversations leading up to sex about each partner’s needs, wants, and desires. You don’t usually see much time and space given to making sure all partners are aroused enough to enjoy penetrative sex (spoiler alert: having penetrative sex before the vulva-owner is aroused is a recipe for painful intercourse).

Some people think it’s normal for sex to hurt and that’s not true.

Here is a non-exhaustive list of things that can make sex hurt:

1. Penetration (with a penis, toy, finger, etc) without arousal
2. Penetration (with a penis, toy, finger, etc) without lubrication
3. Penetration (with a penis, toy, finger, etc) when the recipient is feeling stress, tension, anxiety or pressure
4. Penetration (with a penis, toy, finger, etc) too fast
5. Penetration (with a penis, toy, finger, etc) from a bad angle
6. Vulvadynia: pain around the opening of the vagina
7. Vaginismus: involuntary contraction of the muscles around the vagina

While dyspareunia (pain during sex) isn’t something you need to live with, it can be common. That’s why we need to talk about it. The good news is that it is often treatable!

When dealing with dyspareunia  I always suggest my clients see their gynecologist to rule out certain conditions that might be causing the issue. I also like to work in collaboration with pelvic floor physical therapists who can bring such relief by offering manual therapy as well as exercises.

In sex therapy, we treat painful sex by:

• discussing what might be causing the pain
• offering education around ways to have more pleasurable sex
• offering EMDR to treat trauma associated with sex
• exploring how past experiences may be impacting your sex life
• teaching communication skills to help you effectively explain what you need from your partner
• offering suggestions of exercises and techniques to use to decrease pain
• guiding you and your partner through tools to use at home to decrease anxiety and pain

Have questions about how a sex therapist works with someone who has painful sex? If you live in Connecticut (CT) or Florida (FL), contact me here and I’ll be happy to chat about working together.