What to do when sex hurts

Whew, so we’ve had an experience where sex… hurt.

Maybe it was a one-off, or maybe it’s been recurrent. Maybe it was going fine until a certain point in the sex, or maybe it was daggers from the get go.

You’re in the right place, so let’s talk about what to do about it.

Having an experience where sex hurts can feel stressful, traumatic, embarrassing, and taboo. We live in a culture full of sex “should,” which leaves a narrow window for what we’d call a sexual “success.”

Despite this, pelvic pain and painful sex occurs with relative frequency.

Pelvic or sexual pain can refer to any kind of pain between the belly button and the groin. It can affect folks of any gender but disproportionately affects folks assigned female at birth (AFAB), generally cisgender women and transmasculine folks. It’s estimated that pelvic pain affects up to 15% of women in the United States in their lifetimes, and 13-32% of women worldwide. Pain can be acute (occurring on one occasion) or recurrent; chronic pelvic pain (CPP) refers to pain in the vulvarvaginal area that lasts for six months or more, or is generally unresponsive to traditional treatments.

Short term

Stop having sex and don’t force it or try to muscle through it. I know this first one’s a doozy. How many of us have put our game face on and she-hulked through unpleasurable and even painful sex just to “get to the end” for our partner’s benefit? We are socialized to people please, to be “the cool girl” and to care about our partner’s wellbeing or pleasure. Perhaps we’ve had a bad experience in trying to end or avoid sex, and have faced coercion, pressure, or violence from partners in the past. Whatever the reason, if it’s safe to do so, it is often a good idea to end sexual acts that become painful. Continuing sex that is painful can damage the bodies or delicate tissues in there, or create a negative psychological or stressful association with sex that can make it harder to relax and enjoy sexual encounters in the future. This does not mean that sex or intimacy have to end, just the acts causing the pain. It’s OK to reconfigure and say, “hey, how about we do this instead,” and it’s also a valid option to say, “I’m in pain, is it OK if we end this here and take a break?” Safely exercising your autonomy in sex and having that respected can be a healing act.
Take care of yourself and any negative feelings. You don’t have to feel great about this. Chances are, whether this is your first time with painful sex or your 3,497th, it can feel devastating, awkward, humiliating, and downright scary. It’s OK to take a beat during your sex break and sit with yourself and practice self-care. Affirming your thoughts and feelings (“I wish this wasn’t happening! I feel humiliated and wish I could melt into the floor. I’m terrified; what if this happens again?”) can be a helpful way of practicing self-care, because those thoughts and feelings are valid. You don’t have to “fix” them right away, and neither does a partner(s). Understanding and being in tune with your thoughts and feelings can be healing, but in the moment it’s cool to just vent to yourself, too. Get into a more comfy position, allow your body space to relax and decompress if at all possible.
Take an inventory of history of pain with sex, if anything went wrong, & the nature of the pain. This can be helpful later, when you’re continuing to work out what happened on the way to how to resolve it. Take a mental inventory. Notice what the pain was, when it started and what may have led to that. Check in with your body about where the pain is, and the nature of it (burning, searing, stabbing, aching, zinging?). Close your eyes and focus on your abdomen, pelvic floor area, and vulva. Does it feel hot, inflamed, tight, angry, raw? These questions are all good informational check-ins that will help later. When you’ve compiled your data, it’s OK to focus on something else and not fixate on describing the pain, because that job is done. Some people find it helpful to refocus, such as by asking, is there anywhere in my body that doesn’t hurt? Or what can I feel neutral about right now? and focusing on those sensations to try to clear the mind of the pain and negative emotional experience. It’s alright if you aren’t there yet.
Set up an appointment with your doctor. If this is a new experience for you, it’s important to know that it’s not just on you to uncover, understand, and heal this painful experience. Do you have a primary care doctor, therapist, or gynecologist that you trust? Can you call to set up an appointment in the near future? Are they clueless about this type of issue? If so, you can certainly set up an appointment with a new doctor for an evaluation or get a referral to a practice that might specialize in such things. The types of doctors that might be helpful are gynecologists, urogynecologists, sex therapists, pelvic floor physical therapists, and pain specialist doctors.

Medium term

Explore self for better understanding. Some time has passed since The Incident ™. Maybe now you’re feeling some more complex feelings about all that went down, in addition to the initial shock and awe. It’s still helpful and important to check in with yourself; sitting with your self and your vulva and checking in on how you’re feeling would be helpful in building insight and connectedness with your body and spirit. How are you feeling emotionally? Physically? What’s transpired since then? How are you thinking about all this? How does this impact your relationship with sexual partners, and how has this impacted your relationship with yourself?
Lean on other women for support. There are women who get it, who have been through this before, both in your circle and without it. Pain with sex can be taboo in a culture that brags about sexual prowess and sexual conquest. But they’re there, just off the beaten path of stereotypical conversation. We know pelvic pain affects a large percentage of body-havers. They’re around you. Initiating a conversation with folks in your close circle can feel like a high-risk, high-reward activity. If you find yourself feeling more risk-averse, there are many online support groups waiting for you, one google search away — I know reddit and facebook have large pelvic pain communities, and am sure they exist on other platforms as well.
Communicate with your partner. This is a mortifying step, but certainly possible and beneficial. It’s OK to be as open as you would like to be about your experiences with pain and health stuff. Maybe you want to gush about it and get a lot of feedback, love and support. Maybe you want to just let them know you’re dealing with this privately and ask them for some space. Whatever the case, you’re allowed to set a boundary around how you’d like to proceed with your sex life and your relationship.
Educate yourself but don’t overdo it. (Get off WebMD.) There’s a lot of information out there; we live in an informational golden age. You can look up any medical symptom or malady and be transported to a realm of endless information, boundless facts and correlations and — and — Oh my God, do I have cancer?? I would say, you want to learn about this — Great! Be wary of your sources. Finding information about the pelvic floor, exercises and stretches that might help, treatment practitioners in your area, affirming sex-positive articles, we love it. Be wary of if you begin to circle the drain about various related conditions, fear-mongering, sensationalist pieces, articles with agendas, bizarre OTC pseudo-science, “buy my program” from non-reputable sources, and so on. Folks with troublesome or chronic health conditions generally are hungry for a silver bullet, and some websites and businesses and individuals want to capitalize on this, whether through ad revenue or not-scientifically-sound advice or products. Furthermore, check yourself on your late-night googling rabbit holes. I understand this is scary, and likewise there’s a lot of scary stories out there about stuff like this. Ask, “Am I benefitting from this googling? Can I take a break and come back to this (maybe not at 3am)?” And so on. Sometimes, reading a book on the subject (and there are many!) is more helpful than an endless search of link after link after link.
At the appointment: ask for diagnostic testing and referrals. The day has come. If you’ve heeded the feedback in the first point about making an appointment with a new or trusted medical professional, be prepared. I’d recommend you writing a list of symptoms and questions down for the doctor so you don’t risk mind blankness when in there (hey, it happens to me, OK?!). And certainly bring a trusted person with you if that makes you feel more comfortable or if you want someone with the big guns fielding the Q&A. Your doctor, if they’re in the field of pelvic health, will likely be able to perform some diagnostic testing to determine what’s going on, whether in the form of a pelvic exam, hearing your concerns, an ultrasound, some biofeedback, a blood test, whatever. If they’re a more generalist practitioner, absolutely ask for a referral to a pelvic health provider (as in the list aforementioned, this might be gynecologists, urogynecologists, sex therapists, pelvic floor physical therapists, and pain specialist doctors).
Work on believing and affirming yourself. This was real and it happened to you. I make this advice in the case that medical not-great stuff happens or your practitioner doesn’t take you seriously or “get it.” Medical trauma is real; doctors who are not “in the know” might hit a person with advice like “just drink some wine” or “have you tried lube?” Having a trusted person in the appointment with you might help but also sometimes these wounds of professionals not taking you seriously can leave painful marks that might deter a person from seeking medical care in the future. We are working on bolstering ourselves against that, and I get it’s tough to be taken seriously, especially as a woman patient and especially for a sexual health topic. The best affirmations come from within. You deserve to receive affirming and helpful care for the pain you’ve experienced.

Long term

Practice communicating about sexual stuff. You know, I do believe many folks come around to the reality that this is a necessity in life, experience of sexual pain under their belt or no. Sex is an intimate act, and as such generally requires some level of communication to make the experience enjoyable for all parties involved. You wouldn’t go to the movies with me without some communication and enjoy it (I want to see the edgy thriller/drama and you want to see the Marvel movie, I want to eat popcorn with 6 butter pumps but you prefer the bunch a crunch, I want to sit in the back but for some godforsaken reason you love sitting in the front row and crunching your neck bones into a fine dust) — we would have to discuss our needs and desires, negotiate a time and place, and come to some sort of agreement. Sex is similar, though of course it holds a great taboo in our culture. Communicating about sex, especially sexual pain, is understandably hard for unseasoned folks — fortunately, we’re taking some steps forward into rectifying this, in order to create a more comfy, pleasurable, and positive sexual environment into the future.
Establish a wellness routine. You’ve likely fielded some advice from healthcare practitioners at this point and are trying to determine sustainable lifestyle adaptations that work for you, maybe in the fields of diet, exercise, mindfulness, stretching, body check-ins, doctor visits, physical or mental therapy, and the like. It’s OK to try stuff on to see how it fits; it’s unsustainable to change your entire routine overnight, so don’t rush the process. .
Expand the definition of sex and “good” sex beyond sexual scripts and PIV sex. This is a big one, and a goal I work on often with counseling clients. There’s an important distinction to be had between the sex we want to be having, and the sex we believe we “should” be having. Noticing and understanding the differences between these two classes of sexual stuff is an important part of welcoming in the sexually whole and positive person we are wanting to become. For more resources on this, it’s awesome to see a sex-positive counselor, and do some self-reflection and reading on the matter. There’s plenty of articles here with your name on them! Happy trails.