Remember the first time? Did "IT" hurt? Well, for some women, sexual intercourse hurts every time. For as long as humans have been having sex, healers and physicians have known about this condition called dyspareunia, pain with sexual intercourse. But the medical community did not take sexual dysfunction seriously until the sexual revolution and discoveries by Masters and Johnson in the 1960's. In fact, many conditions can interfere with sex and cause pain including: low back pain, vulvodynia, interstitial cystitis, prostatitis, endometriosis, and menopause. Sometimes dyspareunia is rooted in one of these conditions. However, dyspareunia also seems to be its own separate entity requiring a specific diagnosis based on the following criteria:
A. Recurrent or persistent genital pain associated with sexual intercourse in either a male or a
B. The disturbance causes marked distress or interpersonal difficulty.
C. The disturbance is not caused exclusively by vaginismus or lack of lubrication (reference DSM-IV)
Even more informative is a description of the various stages of dyspareunia:
1. Tolerable pain at the beginning when partner enters the vagina
2. Tolerable pain throughout penetration, thrusting, and completion
3. Tolerable penetration, difficulty tolerating any thrusting, and unable to complete intercourse; usually avoids sexual intercourse
4. Cannot tolerate penetration; therefore, stops having intercourse. (reference: Headache in the Pelvis by Dr. Wise and Dr. Anderson)
You may not be interested in all this technical detail, it may be too much detail, because when "IT" hurts, "IT" hurts. So, let's talk about some out of the box and into the bedroom solutions to painful sex.
As outlined in the book called Headache in the Pelvis, some strategies for dealing with pain during sexual intercourse have been referred to as "Re-Sexualization" strategies by Dr. Howard Glazer at Cornell Medical College. The first step is to try non-penetrative sexual activities that lead to orgasm with an emphasis on non-painful intimacy. Experiencing sex without penetration can help one avoid all the stages of dyspareunia. He also recommends a book called, "Let Me Count the Ways: Discovering Great Sex without Intercourse". Imagine great sex without pain; that dream could become a reality with some new tricks for the bedroom.
Another important step for a healthy sexual relationship is to resolve interpersonal problems within the relationship. Anger, resentment, hostility, frustration and fear; all interfere with intimacy and do not belong in the bedroom. Acceptance, trust, honesty, and love are sources of positive energy that all belong in the bedroom. Workshops and counseling are great ways to start solving the interpersonal conflicts that can lead to painful sex. Additionally, some partners have experienced more comfortable and exciting sexual encounters with the technique called Tantra which minimizes the movement during sexual intercourse. Less movement might mean less pain.
The most important strategy for easing pain during intercourse is to RELAX. A majority of women who have pain during intercourse also have tender pelvic floor muscles. A constant state of tension can produce trigger points in the pelvic floor muscles eventually leading to dyspareunia. After becoming aware of feelings of anxiety, urgency, tightness, and tension, one can then start to relax. Without body awareness, patterns of muscle tension cannot change. By relaxing the pelvic floor muscles from the beginning stages of a sexual encounter to completion, sex can become more comfortable. A professional pelvic floor retraining and rehabilitation program may be needed to start this healing process.
At this point you may be asking: can hormones help or hinder sex? Yes. Can lubrication help or hinder sex? Yes. Assuming you have already tried some of these boxed approaches, now you might need some non-traditional solutions to the painful sex puzzle. Revitalizing your sex life without causing pain sometimes requires some less traditional thinking. Next time, think about a non-penetrating, non-gyrating strategy for the bedroom. Next time, find a pro-love and pro-relaxation strategy for the bedroom. And make next time, your best sex ever.