Kelly Gonsalves
July 26, 2019 12:30 pm
Nikita Vasylchenko/EyeEm, Getty Images

Not everyone’s comfortable talking about their sex life, but knowing what goes on in other people’s bedrooms can help us all feel more inspired, curious, and validated in our own experiences. In HG’s monthly column Sex IRL, we’ll talk to real people about their sexual adventures and get as frank as possible.

Painful sex.

Unless it’s your kink, those are two words that should never be placed next to each other—two words that represent completely polar opposite physical experiences, turning one of life’s greatest pleasures into what can feel like physical and emotional torture.

Yet for women and people with vaginas, experiencing pain during sex is an unnervingly common experience. According to the American College of Obstetricians and Gynecologists, nearly three out of four women have experienced pain from intercourse at some point in their lives, and research shows up to 20% of women deal with dyspareunia, which is the term for persistent pain during sexual activity.

There are many causes of painful sex, some of which are temporary and others that are chronic. Some are physical, some are psychological, and others have no known cause. Some of the most common include vaginismus (when the vaginal wall muscles involuntarily spasm in response to penetration attempts), vulvodynia (chronic pain around the vulva, often without any discernible cause), vaginal atrophy (the thinning of the vaginal walls that many experience from menopause), endometriosis (when lining from the uterus is growing in places outside the uterus), childbirth injuries, vaginal infections like yeast and bacterial vaginosis, and psychological distress (like anxiety, depression, sexual trauma, or relationship instability).

How did we create a culture of sexual pain for women?

It’s not normal for sex to hurt women. It’s common, but people with vaginas are not supposed to experience pain from intercourse. This idea that women in particular should expect pain from sex is a pervasive, dangerous myth with deep patriarchal roots, according to Dr. Ditza Katz, PT, Ph.D., a clinical sexologist, physical therapist, and founder of the Women’s Therapy Center, a New York practice that treats people suffering from vaginismus, vulvodynia, and dyspareunia. (We spoke with several of their patients, some of whose stories are included below.)

“It is a common myth that keeps perpetuating and causes women to accept pain as inevitable, suffer in silence, not speak up about the suffering nor seek help, and often develop vaginismus,” Dr. Katz tells HelloGiggles. “Historically, women were a commodity for sex and procreation…With that, women’s sexual needs and preferences were not a factor, with sexual servitude the expectation.”

Controlling women’s sexuality was a key part of maintaining the gendered hierarchy between men and women. That’s why the concept of virginity was created—to deter women from independently exploring their sexuality by making them fear being shamed by their community—and it’s why girls were made to believe their first sexual experiences would be bloody and painful. Our cultural idea of sex was oriented around male pleasure and female “purity,” pushing the falsehood that “good” women just “put up” with sex to please their husbands. These various culturally constructed narratives have mostly faded thanks to feminism and the sexual revolution, but some of those toxic messages still linger even today—including the idea that women should expect sex to hurt. (Most women we spoke with mentioned still feeling some of these pressures.)

“Women used to never speak up about pain during sexual intercourse, but we see a positive trend in recent years toward more openness, more discussions, and above all, legitimizing women’s sexual needs and feelings instead of plain dismissal,” Dr. Ross Lynn Tabisel, LCSW, Ph.D., a clinical social worker and co-director of the Women’s Therapy Center, tells HelloGiggles. “However, we have a long way to go yet with regard to gender equality, medical education, available services, and cultural and religious restricted practices.”

As both specialists point out, the fact that so many women still suffer through abnormal sexual pain today is largely because the medical establishment has invested little to no resources into researching female sexual dysfunction, developing effective treatments, training healthcare professionals to diagnose it, or educating the public to bring up this type of pain to their doctors. Most causes of dyspareunia are totally treatable; others can’t be cured, but the painful sexual side effects can be managed with proper treatment.

What’s it like being in a relationship when you can’t have penetrative vaginal sex?

The physical symptoms aside, pain experienced during sex can be particularly stressful for those involved in relationships. When sex becomes a source of pain and tension rather than connection and pleasure, that emotional stress can weigh heavily on both partners. Dr. Tabisel says the effects of painful sex are compounded “by the connection between the genitals and our anxiety mechanism (the fight-or-flight response), by the woman’s sense of feeling broken and not able to function ‘normally,’ and by the expectation and dynamics of the relationship.”

We spoke with seven couples about their experiences dealing with pain from intercourse. Their specific conditions varied. Some of the partners experiencing the physical pain were able to find treatments, surgery, or other therapeutic methods that finally made the pain stop; others are still dealing with their symptoms while experimenting with different treatments and finding other ways to stay intimate with their partners. There were also some troubling stories of pressure, traumatization, and fear.

Here’s what they told us.

“There were times when I begged him to leave me so he could have a full life.”

We had both made the decision to remain virgins until we were married. We looked forward to our wedding night with excitement and happiness. We had no idea the frustration and sadness it would bring us. It took us four and a half years to be able to have penetrative [vaginal] sex. In the beginning, we chalked it up to just nerves and the stress of the wedding, but as the weeks went on, we realized something was majorly wrong. Anytime we tried to have [penetrative vaginal] sex, it was like hitting a brick wall. My husband was unable to penetrate because my pelvic floor would tighten and not allow entrance. Soon the stress of trying unsuccessfully to have sex created fear for me.

We saw numerous doctors and [I] was told several times that I just needed to relax. They suggested drinking a glass of wine and taking a hot bath. We saw a sex therapist who suggested sleeping naked and bathing each other in the shower to create more intimacy. I saw a psychiatrist who suggested that either I didn’t love my husband or that maybe I was a lesbian. I was frustrated at every turn. We finally confided in our families the struggles we had and my brother-in-law, who was in medical school at the time, told us about a condition he had just studied about called vaginismus. We looked it up, and it was exactly what I had been dealing with.

This condition can easily break a marriage apart and alienate partners. It is a struggle for the woman, but is also a struggle for her partner. My husband was incredibly patient and supportive. He hated to see me suffer and fear him. Thankfully, we were able to remain close during those early years. We were able to enjoy intimacy together, even if it wasn’t in the traditional sense of penetrative sex. I had a difficult time allowing him to look [at] or touch my vagina, but enjoyed dry sex, or outercourse. I was more comfortable keeping my underwear on because I knew that there wouldn’t be any pressure to try sex. Being able to enjoy each other in these ways helped our marriage stay intimate and allowed us to feel close to one another.

The depression that accompanies vaginismus was difficult for me. My self-esteem and confidence plummeted. I didn’t feel like a complete woman or worthy of my husband’s love. There were times when I begged him to leave me so he could have a full life. He felt like a failure as a husband and struggled with not feeling like he had anyone to talk to. We were grateful for our family’s support once we told them. My brother-in-law researched how to help and finally came across The Women’s Therapy Center in New York. With time and care, they were able to cure me! Since then, we have enjoyed a healthy sex life. We have two children that I was able to carry and deliver vaginally.

—Megan (37) and Wyatt (38) from Monterey, CA, together 17 years

“We were both very satisfied with oral sex.”

I dealt with [vaginismus] for about 17 years and finally was cured at age 36.

I kept attempting to have intercourse with my boyfriend, but we were never successful. We relied on oral sex for most of our relationship…My then BF (now husband) and I actually had an amazing sex life. We were both very satisfied with oral sex and were able to keep that spark alive until way after we were married. We only started to really address it once my biological clock started ticking loudly, and we were both wanting children.

My husband was always very supportive and never put any blame on me—he was sexually satisfied. He really only started getting a bit more anxious when he was ready to have children. The amount of patience he had while we were dealing with this was simply amazing. We really have communicated very well from the beginning. We were not shy about our sexual preferences and always communicated what we liked and what we didn’t. He was very supportive emotionally as my hope was starting to dwindle. … Open dialogue was a really huge part of our success and the fact that we were both still very sexually active with each other and didn’t go dormant like many relationships that go through this.

—Marilena (47) and Frank (48) from Clifton Park, NY, together 28 years

“The OhNut has really helped—that and my vibrator.”

I have both interstitial cystitis and endometriosis…When we first started dating, my husband and I used to have sex several times a day. As my condition got worse, though, we stopped because it was beginning to hurt. We used to be able to do any position imaginable (in any place imaginable!), but now there are a few things I can’t do that I used to be able to do (like lifting my legs above his head) unless we’re using an OhNut and a lot of (natural) lube.

There used to be a lot of passion, but right before our wedding, I was in the worst pain of my life. It was two months before my diagnosis, and I wasn’t sure we’d even make it. He didn’t even want to touch me (for fear of hurting me), and I felt gross, ugly, bloated, and unwanted. We ended up fighting a lot, until one day I just broke down in his arms and explained to him exactly how I felt. I told him every tiny thing and why I did the things that I did. He held me while I cried…now, he’s super supportive if I want to try something new that may help us.

We kiss a lot. I think that helps me feel closer to him…I need that connection no matter what. When sex was easier for us, it was easier to be super passionate, but now we have to try a little bit harder to give each other what the other needs. The OhNut, as I mentioned earlier, has really helped. That and my vibrator whenever I can’t tolerate penetration. I also buy a lot of lingerie (that hasn’t changed!). It helps to get us in the mood, plus it makes me feel pretty (especially if I’ve been flaring all week). I usually cook dinner dressed up, and that gets things started.

It’s really important that we’re open with one another. He knows if something hurts or if I don’t like something, I am going to tell him (and vice versa). If we couldn’t talk to each other the way that we do, I don’t know if we would have made it through the rough patch…We can honestly say that we’ve beaten the challenges. While we may have to prep a bit more now (there’s definitely less spontaneous sex), we’ve still got it.

—Tabitha (25) and Joe (27) from Harrison, NJ, together three years

“I don’t really think my husband understood what I was going through.”

Our sex life isn’t terrible, but it’s not mind-blowing either. When I wasn’t being treated for my pain [caused by vulvodynia, diagnosed two years ago], we tried to have sex as often as I could. My husband is a very sexual person, so I tried my best to fulfill his needs, but sometimes the pain was unbearable. This resulted in my insecurities as a wife and a woman…During sex, it would feel like a raw, burning feeling. After sex, I would be in pain for hours. The best way I can describe the pain is acid being poured over a thousand tiny cuts. It would take hours for the pain to go away, and I usually would be in tears.

I don’t really think my husband understood what I was going through, and it was hard trying to explain. I wanted to have sex with him, but the thought of what I had to go through afterwards completely turned me off. I ended up in a constant feedback loop of physical pain and emotional and psychological trauma. I never initiated sex, although I wanted to, for fear of the pain. Whenever he tried to initiate, I would tense up, which didn’t help either. I found myself not wanting to have sex for the pain became too unbearable. Physically, emotionally, and psychologically, I was exhausted.

We still have sex. I’ve been prescribed tricyclic antidepressants to help manage my pain. I take them every day. The thought of having to take something every single day for the rest of my life depresses me, but I’ve become more hopeful. I’ve had pelvic floor therapy, a nerve block, and a PRP procedure that has helped tremendously. On a scale of 1 to 10, my pain has gone from a 100 to a 3. I’m hopeful that things will continue to improve.

My husband loves me regardless and has vowed to stay by my side as I try to navigate this debilitating condition. Although he doesn’t agree, I do believe that vulvodynia has affected our relationship. For me, not only have I struggled with the physical pain but the emotional attachment to it as well. I have become insecure and unsure of myself and my capabilities to not only pleasure my husband but also myself. Sex, the thought of, the act, it used to give me extreme anxiety. There were times where I wouldn’t even want my husband to touch me because I was fearful about it leading to sex.

For my husband, it has been frustrating. He doesn’t talk about his feelings much, but he has voiced how he has felt at times. We talk about vulvodynia often. I try to find different ways to explain my pain and how I feel. He supports me in all of my efforts to seek relief. He’s learned to become gentle with me. We don’t really schedule sex, but we try to have it at least once a day. Sometimes even that can be too much for me.

For me, lots of lubrications and foreplay [are helpful]. I need time to warm up. Oral sex helps. EFT tapping has helped me release the emotional attachments to my pain which has helped me tremendously…Self-care is a big one for me because I need to be mentally clear to enjoy sex. Stress can hinder so many aspects of our lives. Learning to let go of things that I can’t control has helped me.

—Charde (28) and Neal (25) from Jacksonville, FL, together three years

“I lost a lot of my desire knowing I couldn’t have penetrative sex.”

It was very depressing because prior to all the pain [from vulvar vestibulitis], we were very sexual, so it really messed up a lot of our connection, not being able to have sex. He never tried anything since he didn’t want to hurt me, and I didn’t try anything since I had no desire because I knew it would be painful. Unfortunately, we couldn’t have sex for about six years due to pain except when we tried different treatments and had to have sex in order to see if the treatments worked, which they never did. Also, around the two-year mark, we wanted to have another baby, and I was afraid that with all the things I was trying, the pain may get worse so we decided to try and get pregnant sooner [rather] than later to get it over with. That way if I needed something drastic (like surgery), I would have already had my kids in case I couldn’t have more after.

Emotionally as a woman I felt less than. I felt that I wasn’t a good enough mom, lover, partner, wife, woman, and that I was broken. Emotionally he felt sad he was hurting me, that I had to feel an obligation to make him happy, which he didn’t put pressure on me, but I did express that I wanted him to find others to enjoy sex with since I couldn’t give it to him. He was conservative, so hearing that made him feel very sad for us. He also felt less of a man since he couldn’t make me happy or know what to do to help. He didn’t know what to do so he stayed away so as to not make me feel obligated, but I needed physical support in the way of hugs, kisses etc. which he didn’t know how to give, so we both were very separated emotionally as well as physically. We did some communicating and trying to figure out what to do, but we were clueless. My identity was all about sexuality, and to not have that was so damaging.

Unfortunately, I couldn’t have sex at all or any finger penetration, so we had to do oral or clitoral stimulation. I lost a lot of my desire due to knowing I couldn’t have penetrative sex. We tried different positions for fun play [without vaginal intercourse] to make things more interesting, but we struggled getting excited. We tried to connect emotionally, but we didn’t have a very intimate emotional relationship after so many years of not being close. We did dabble in some swinging relationships (minus sex with others) so we could find ways to stimulate each other better with real-life fantasy etc., which actually worked really well for quite a few years. We also made sure at least once a week we spent some alone time to go to a movie, dinners, beach, etc.

It affected us in a pretty bad way as after six years of no enjoyable sex, having pretty major depression and no intimacy together, plus small babies, we wound up just being friends living together in a marriage of contentment until it wasn’t content anymore. After my surgery [vestibulectomy, a treatment for vulvar vestibulitis], we found it to be successful where we finally were able to have sex, but within the following five years together, we were together but emotionally apart. It was emotionally empty, and the physical connection was lost, but we had a good friendship. We finally decided we were better off friends and got an amicable divorce. There were a few other things that led up to the divorce too, but it was a stonewall effect where one thing led to another. Both he and I are in new solid relationships and both very happy. I am able to have pain-free sex and enjoy it greatly with no ill effects. Emotionally and physically doing great!

—Stacy (48) and John (49) from Boynton Beach, FL, together 21 years and divorced seven years ago

“She is more than a vagina.”

Charlene: Emotionally, for me, the biggest struggle was identity. For the longest time I felt as though I was less of a woman and, even worse, less of a woman for my husband…It wasn’t until about a year before treatment that I started understanding what identity actually meant and how a circumstance (vaginismus) doesn’t define that. My identity as a wife isn’t dependent on my sex life. But rather, for me, my identity is in the fact that I am fearfully and wonderfully made and that I have so much more to offer my husband other than sex. I’m his helpmate and his best friend. For me, my identity is rooted in the love that the Lord has for me and knowing that this too shall pass and that my condition isn’t just for me to learn and grow from, but to maybe other women as well.

Logan: As a guy, on the outside looking in on something that your wife is struggling with, it’s really hard not to be able to provide and help her out in a tangible way. Emotionally, it was a constant battle to not take this as a personal affront to me, but rather giving her that grace in understanding it’s a very real condition. Physically, it sucked. I had this awesome wife that I wasn’t able to fully enjoy intimacy with, because her mind and body [were] working against her. In working through the emotional side, I had to take a step back and learn to provide for my wife in other ways since this wasn’t something I could just take away from her and easily fix it. I listened to her, showed her grace, and I made sure that I never did anything to make her feel less than. Physically, there [were] so [many] other things to enjoy than actual sex itself. She was (is) more than a vagina, so there was more to focus on than just that.

Charlene: We would make out, I would give my husband fellatio (blow job). Since I wasn’t a fan of him kissing/touching me at my vagina/clitoris, we’d focus on other stimulative areas such as my breasts. And, so we wouldn’t have to get up and go to the bathroom for him to finish, he would just finish on my chest or my back side depending on what position we were in at that point. It definitely helped relieve the physical frustration that we both felt and kept us emotionally (and physically) connected to one another.

—Charlene (22) and Logan (23) from Fredericksburg, VA, together seven years

“Redefining expectations has helped minimize her anxiety.”

Her: I have primary, provoked, neuroproliferative vestibulodynia. I know that’s a lot of long words, but I’m lucky to have a specific diagnosis.

Him: Supporting my wife through something like this is mostly easy because A. She didn’t ask for this, and B. I didn’t marry her so I could have sex with her. We love each other immensely and marriage is a system of support. Redefining expectations has helped minimize her anxiety and maintain intimacy. Yes, there have been months of celibacy in our marriage, but my sexual frustration has nothing on having to witness my wife feeling broken and insufficient. It helps to remind myself what I said to her on her wedding day. She’s stuck with me, for better or worse.

More frustrating than not being able to make love to my own wife is when people assume we “must” be having tons of sex because we’re still considered newlyweds, or when people make side comments like, “You’re gonna get yourself some tonight, eh?” No. No, I probably won’t. Raising awareness for sexual pain is so important.

Her: Sex is finally “on the table” per se, but it doesn’t look like what we’re told to think it should. It’s not spontaneous or rough or fast or all that sexy, honestly. A lot of the time it still feels like physical therapy or a medical procedure. I have to spend time preparing with stretches and heat to relax the muscles. His penis fits now, but once its in, we don’t move. For now, he’s able to play the role of my dilator and that’s a big accomplishment for us! Fortunately, we still have intimacy in our relationship in other ways while we work toward a “normal” sex life, whatever that means for us.

Him: We also find that we’re light years ahead of other couples who’ve been married around the same amount of time as us as far as expressing intimacy. Hugging, cuddling, kissing, back rubs…all that matters. Sex is more than just penetration. We try to be as intentional as possible, and she’s really good at saying “Hey, let’s do this tonight.” It’s up to me to listen to her for what she likes and what she doesn’t. I for sure don’t put any undue pressure in the situation. Her lady parts have been poked, prodded, stretched, cut up, sutured, and examined by doctors and physical therapists enough these past few years. All of which has taken a toll on libido. So it’s going to take some time and a little more patience. I’m okay with that. She’s worth it.

—Woman (29) and man (35) from Washington, D.C., together three and a half years

“There’s more to life than sex.”

I am mostly cured [from primary provoked vestibulodynia] by surgery now, but still struggling to overcome the reflex muscular pain borne from a lifetime of just pushing through it.

Our sex life is relatively normal, surprisingly. After I did some physical therapy, I was able to desensitize the area a little. It was mostly retraining my brain, not really fixing the problem. Penetration always hurt, but once we got past that, with patience and always slow and gentle, it sort of numbed up on its own because it got used to being touched. Then we could have sex as normal. But a side effect was that we didn’t participate in penetrative sex as often as probably other couples. We used outer-sex more often than not because it was mutually pleasurable and didn’t hurt me…My husband did feel very concerned that penetration caused me pain. It was very distressful for him, because he did not want to cause me pain. I had to reassure him I wanted to keep trying.

When we were planning our wedding was when I got my official diagnosis of vulvodynia—I had no reason to believe I would ever have completely pleasurable sex. And the idea of giving birth with this condition, someone always sticking something in me constantly…I thought I’d failed [at] being a wife before I even started. I told him he should find someone else. I told him he should find a woman with “a working vagina.” He wasn’t bothered at all and told me that whatever it was, we would face it together and work through it. And I quote him: “There’s more to life than sex.” But we always knew non-penetrative sex was completely pleasurable and satisfying for us both, too.

My husband’s answer to this is “slow steady, lots of foreplay and lube, being cognizant of what your partner wants and/or needs and value your time together as you slowly work up to the event. Your partner is worth the extra time and effort.” For me, knowing that outer-sex, non-penetrative sex, was always an option really eased my mind. I didn’t feel like I HAD to have penetrative sex. That lack of pressure is really a huge relief.

—Rachel (32) and RJ (33) from Salt Lake City, together 14 years

Interviews have been edited and condensed.

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