Endometriosis — where tissue similar to the lining of the uterus grows outside of the uterus — has turned her once “heavily active sex life” into “practically non-existent” at times.
“The pain, both emotional and physical, definitely took a toll on my relationship,” 34-year-old Rachel says of her marriage with Mark*.
“We struggled for years trying to go back to a ‘normal’ sexual relationship.”
But she says with patience, communication and a willingness to try new things, the Sunshine Coast couple are now in a better place.
It can be difficult and frustrating for both parties involved, but Melbourne sexologist Kassandra Mourikis says with the right approach, couples can stay connected.
“Partners [of people who experience sexual pain] can have a bigger influence on painful sex outcomes than they probably realise.
“They can either increase feelings of shame, or they can reduce that shame and remind their partner they are not a burden, and find a way together to manage that pain.”
We spoke to couples and the experts to find out the best ways to support your partner if they experience sexual pain.
What can cause sexual pain?
Pain during sex is more common with penis-vagina penetrative sex, explains Jane Ussher, professor of women’s health psychology at Western Sydney University.
Causes of sexual pain in vulva-owners can range from not being properly aroused and lubricated to medical reasons such as vaginismus (an involuntary contraction of vaginal muscles).
For people with a penis, penetrative sex can also be painful without proper lubrication and medical issues including Peyronie’s disease (a significant bend in the penis) or issues with foreskin.
The toll it takes on relationships
In the beginning of Rachel’s painful sex experiences, she would avoid sex.
She says a “drought” of a couple of years caused her and Mark to argue.
“We didn’t really address the underlying issue. We fought about silly things and are lucky we didn’t let it ruin the relationship,” she says.
Difficulty communicating about sexual pain can lead to the end of relationships, says Professor Ussher.
“You anticipate sex being painful, then you can become very anxious about sex, then avoid sex, and then that leads back into feelings of not being a ‘real’ man or woman, and failure as a partner,” she says.
In his mid-20s Jason* developed phimosis, a condition where the foreskin is too tight to be retracted.
Engaging in sexual activity with his partner Jessica* was painful.
“We were having less sex because of how painful it was and were less intimate in general,” says Jason, from Brisbane.
After 18 months of trying different approaches, like creams and stretching devices, he decided to seek the advice of a urologist and dermatologist.
He had two options; live with the pain or get circumcised.
“The latter option was the obvious choice but even it came with a risk. Jason feared a loss of sensation and worse — a botched surgery,” says Jessica.
The surgery was successful and the couple have had sex since.
Ms Mourikis says for the person experiencing sexual pain, it is difficult physically, emotionally and mentally.
“THERE IS SO MUCH STIGMA AROUND PAINFUL SEX. A LOT OF SHAME AND FEAR, PEOPLE FEELING ISOLATED AND HOPELESS.”
It can be difficult for the partner too, she says, and often they don’t share their frustrations for fear of seeming unsupportive.
“It’s OK to feel conflicted … people are allowed to feel these things and it’s important that they do.”
She says it’s important those feelings of frustration aren’t directed at the partner experiencing sexual pain.
“It’s not you versus your partner; it’s you and your partner as a team versus the pain.”
Ways to support your partner
It’s OK to make mistakes when trying to support a partner who experiences painful sex, says Ms Mourikis.
“Fear of making a mistake prevents people trying new things and going out of their way to help their partner.
“You just have to be good at making repairs.”
Renegotiating intimacy is something same-sex couples with sexual pain often do better than straight couples due to “the coital imperative“, says Professor Ussher.
“People have internalised the idea that ‘real’ sex includes penis and vagina penetrative sex,” she says.
“People who are in same-sex relationships are less likely to get caught up in all of these feelings of failure, as they are engaging in other forms of sexual intimacy already.”
Ms Mourikis says it helps to realise sex is “whatever feels good”.
“This comes down to a willingness and openness to examine their definition of sex and redefine it, so it’s more inclusive so it isn’t putting pressure on a partner to have sex that hurts.”
She says being open to trying new things can be the difference between a couple who struggles and one who stays connected.
Rachel says since her and Mark’s communication about sex improved, they have been changing things up in the bedroom.
“Intimacy doesn’t have to always include sexual penetration.”
Have a plan B
Having a plan for when you can’t have sex is wise and avoids the person with sexual pain feeling like a burden, according to Ms Mourikis.
“If you can’t have penetrative sex [it] doesn’t mean you can connect in other ways,” she says.
For Jason and Jessica, that meant doing other things they enjoy: like cooking, watching movies or exercising.
“Just dedicating time with each other without distractions like phones, emails, social media,” says Jessica.
Research the cause of pain
For the partner that doesn’t have pain, Ms Mourikis says they should increase their literacy about their partner’s experience.
“They should be aware of their triggers, what causes pain, what helps them feel better.”
Professor Ussher says knowing what their partner doesn’t want to do is just as important as knowing what they do.
“A lot of women who have extreme pain on intercourse, and even bleeding, still engage [in] it,” she says.
“I find it heartbreaking and quite shocking. That shows pressure of the coital imperative, and suggest sometimes partners are not listening.”
Communicate and check in
You knew this was coming — communication. None of the above can happen if you aren’t talking about the painful sex.
“Don’t get into the routine of not sharing your feelings,” Ms Mourikis says.
“Sometimes just checking in at the start of each day, asking ‘How are you feeling right now?’ [can help].”
She says if you are finding it hard to talk face to face about the issue, try texting or letters.
People with sexual pain are already up against so much; it’s important that couples treat it as a relationship issue, not an individual one, says Ms Mourikis.
*Names have been changed for privacy.
[This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.]