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When sex is a pain

What does it mean when sex hurts? I'm not talking about consensual power-exchange here — that's a topic for another day. I'm talking about pain that happens when it shouldn't, like when you'd like to be fully immersed in the joys of deeply satisfying and pleasurable sensations, and find yourself wincing instead. It's a common problem, yet many of those affected feel alone. People often suffer for a long time before they finally discuss it with a health care provider.

Recently, a lovely woman of a certain age said to me that she was astounded when she first experienced painful sex. We shared a moment of wonder at how little it's talked about. Why is it, we asked, that we avoid discussing this thing many of us share and none of us like? I think our reluctance to discuss and ask for help to improve our intimate lives stems from this idea that "normal" people don't have sex problems. It's a myth, simply put, that love conquers all, at least when it comes to pain.

Sexual pain can be a side effect of some very commonly used medications. You may already know that anti-depressants can cause dryness and vaginal discomfort, in addition to negatively affecting sexual response and orgasm. However, since we have this wonderful early spring, I'd like to point out the lesser-known effects of antihistamines. It seems unfair that we have to choose between having an itchy, sneezy nose or a happy vagina. Antihistamines dry up mucus membranes well, but can't distinguish one kind from another. Hence, happy sex becomes unhappy and painful.

If that isn't enough, some women using oral contraceptives experience a decrease in natural lubrication and libido. Because all of these are so commonly prescribed, it isn't unusual for a person to be taking something to elevate her mood, something to control her allergies and something else to protect against pregnancy. This can be a recipe for sexual pain. Other factors, too, like stress (family, money, work), poor diet, lack of hydration and general time pressure can affect the body's response to sex. You can probably guess the cycle this suggests.

I can't solve the stress problem, unfortunately. However, I do have some ideas that might help with the pain. The first and most important adjustment is to allow time for good sex to happen. Sometimes all it takes is a more patient approach. It isn't a race to an imagined "finish." Good sex is more like a meandering journey of connection and sensation. However, when that isn't sufficient, lubricants can help.

But not all sexual lubricants are created equal. Some are better for certain activities, others are better for certain body parts and still others are best for those sensitive to additives. Hybrid lubes contain mostly water but also have a small-to-moderate amount of silicone. These allow for greater lubrication for a longer period of time. Because silicone is a large molecule, it stays on the surface of the skin to which it's applied. It also has a very long shelf life, which means it won't require harmful preservatives like parabens. Look for something thicker rather than thinner. These lubes are great for anal or vaginal sex. Some people have great luck with plain, organic coconut oil, but I've found it grainy and not quite thick or slippery enough for those with pain issues.

Sometimes the pain results from muscle contractions. There you are, desiring nothing more than to experience the pleasure of feeling your body surrounding that of your lover and your muscles won't cooperate. The contractions can affect the muscles of the vagina and anus, making this kind of sexual pain an equal-opportunity annoyer. Fortunately, it's also treatable and you'll want to consult a sex therapist.

Besides these sexual difficulties, those of us with physical maladies often have to make adjustments to enjoy sex fully. If your back, neck or legs are injured or hurting, it takes some (worthwhile) adjusting to get the most enjoyment possible. There are a variety of positional aids and technique changes that can help resolve these difficulties.

In the event that time, lubrication and positioning aren't enough, talking with a knowledgeable person might help. I've noticed there are more tools available recently in the form of both books and devices designed to assist those experiencing sexual pain. We also have some wonderful sex-positive healthcare providers locally who can help people figure out the best strategies for their specific situations. Good sex is a birthright of being human, and worth the effort it takes to get it.

Got a question, sexually speaking?

Maybe, you know, for a friend? Email it to You're probably not the only one who's wondering.

Dr. Myers is a Humboldt State University psychology lecturer, owner of Good Relations in Eureka and a clinical psychologist practicing in Arcata. Information presented here is not intended to provide specific treatment advice. Consult to find a licensed clinician who can help with individual concerns.

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Melinda Myers

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