Getting to Know Your “New Normal”: Tips for Sex When You Have Pelvic Pain

It can be incredibly frustrating when a part of the body we strongly associate with, and expect to give us, pleasure ends up causing us chronic pain. If you have chronic pelvic pain, what do you do if you want to get sexual with yourself or someone else? How can you be physically intimate if you’re in pain? How do you talk to your partners? If it starts hurting, should you stop?

For the last couple of years, I’ve experienced pelvic pain and painful sex. I know that it can feel like your body is betraying you, that your condition will never improve, or that you’ll never be able to have the kind of sex you might want to have. It can be both physically and emotionally exhausting, especially if you have a partner who doesn’t understand. My quality of life is a lot better now that it was two years ago, and I don’t always experience pain with vaginovulvar sex. I’m not glad I had the experience I did, but I did learn a lot about my body, myself and my partner, and I learned how we can communicate better with each other — both about sex and in general.

First things first: if you have pelvic pain and sex is the last thing on your mind, that’s totally valid! Maybe your current goal is to be able to stand for long periods of time without your thighs aching. Maybe your biggest concern right now is the constipation that can accompany a tense pelvic floor. Maybe sex (and/or masturbation) just isn’t your thing anyway. But if it is and you are struggling to figure things out now that your body doesn’t seem to want to cooperate with you, don’t give up hope. There are ways to still enjoy sexual pleasure.

How to communicate with partners

It can be really difficult to explain chronic pain to someone who has never experienced it. If you don’t know where to start, begin by giving them something like this very article — or my first article about pelvic pain — to read. It will give everyone involved the same language to work with. For example, if you say you want to have sex, what you have in mind may be very different from what your partner has in mind. These are conversations that are important to have in any relationship, but they are especially important when chronic pain is involved.

Try your best to be very clear about how you’re feeling, especially if any of the feelings you have are negative. It is both common and valid to feel frustrated, sad, or angry when you’re trying to be sexual and your body isn’t responding the way you want it to or the way it used to. If you want to be sexual with your partner, but are feeling nervous, anxious or worried about potentially experiencing pain, tell them ahead of time.

Make sure to tell your partner that these feelings are not about them, but about your pain and/or your body. If you become frustrated, that doesn’t necessarily mean you're frustrated with them. The same goes for feeling angry or sad. Your partner may decide ahead of time that they aren’t comfortable being sexual with someone who may get upset during sex, even if it is for reasons unrelated to them. That can be really disappointing, but if that’s the case, you have to respect that person’s boundary. Everyone involved should be aware that negative feelings may come up during sex (whether someone has pain or not!), and you’ll have to be prepared to deal with them, either by working through them in the moment or completely stopping intimate activity for the time being.

These conversations might be more difficult than you anticipate. They may take time. They require patience and maturity from everyone involved. Try not to get discouraged if your partner doesn't understand right away. Maybe you don't even understand your own feelings and need some time to process. That's okay, too.

How do I know if I should stop?

If you want to stop, for any reason — including things that aren’t even about your pain —then by all means, you should stop.

When we’re talking about stopping sexual activity (or not) based on physical pain, sometimes it can be difficult to decide whether or not to stop. Every body is different and everyone experiences pain differently, but often it’s possible to tell the difference between pain that only causes temporary discomfort and pain that may cause longer-term harm.

If you can’t tell the difference, your safest bet is to just stop. The more you deal with pelvic pain, the better you will get at differentiating between “superficial” pain (pain that is more “surface” level, like tissue friction) and deeper pain (the kind of pain that causes aching and throbbing in the joints, muscles, tendons—deeper parts of the body).

Because I’m not a doctor or medical professional, I can’t tell you what is best for you, but I can explain my own experience. Sometimes when I have vaginal sex, the tissue feels tender. I may need lube or I may need more of other kinds of sex to help my body further relax. Usually there is an underlying pleasure even when I’m experiencing this pain, meaning the sex feels good, but I have some discomfort that I can alleviate by things like deep breathing or adjusting angles.

Sometimes, though, I’ll try to have vaginal sex and it will be difficult to insert anything or, once something is inserted, thrusting will cause deeper pain, the kind of pain that doesn’t feel like it can be alleviated by minor adjustments. This is when I know I should stop, and that if I try to “push through” the pain, I am most likely causing more harm than good. I want my body to remember that sex can be pleasurable: I don’t want my body to continue to associate vaginal sex with pain. (Remember, a common cause of lingering pain is the body’s anticipation of pain. Our bodies remember pain and they can have long memories. Some physical responses are out of our conscious control.)

Again, if you aren’t sure, stop. Pause. Breathe. Decide if you want to continue sexual activity or stop for now. If you are seeing a pelvic pain professional (like a pelvic floor physical therapist), they should be able to talk to you about sexual activity and different types of pain and help you make the decisions best for your body and your situation.

Get to know your own body (again)

When you experience any kind of chronic pain, your body is bound to change. Don’t be surprised if you don’t like the kinds of touch you used to like or if your body responds differently to touch. These changes may be temporary, or they may be more long-term.

Pelvic pain can be internal, external, or both. For a short time, I experienced clitoral pain. While that didn’t last, my clitoris is still much more sensitive than it used to be. I used to love powerful vibrators; now I sometimes struggle to find toys with vibrations that are gentle enough for me. I don’t know if my body will ever go back to “normal,” or if this is my new normal. I thankfully no longer have clitoral pain, and I am able to find toys that work with my body, but it was definitely unexpected to feel my body change and to need to get “reacquainted” with it.

Masturbation can be a really important part of rediscovering sex and intimacy when you have pelvic pain. You’ll learn what your body likes now. Plus, becoming more comfortable with your own body’s current needs, limits and desires — and without the extra pressure of needing to consider and communicate with someone else — can make it easier to guide partners you may be getting intimate with.

Time is important, whether you're alone or with someone else. Your body may need space and time to relax and get comfortable. Again, the body remembers, so if your body associates pain with sex, it can tense up and cause even more pain. Though it may be frustrating, being patient and listening to your body will help it overcome that unconscious anticipatory tension. It may sound strange, but if your body “knows” that if it feels deeper pain, you will stop, it will begin to trust you. Pushing through the pain will only make things worse.

An important way to prioritize pleasure when you experience pelvic pain is to make sure you have plenty of time, and prepare all of the things you need ahead of time. If you’re using toys, make sure they’re all washed and ready to go. Have your lube and your gloves and/or condoms ready; maybe even a hand mirror if you need to get a good look at yourself. Make sure you’re warm enough: if you’re cold, your body may tense up, which can make it difficult to relax and release muscle tension.

Be gentle with yourself. You may even need to “re-learn” how to masturbate. I did! I got so used to using sex toys and vibrators to masturbate that when I got too sensitive for toys, I had to go back to basics and masturbate very gently with my fingers. I wore nitrile gloves and used lube to create as little friction as possible. It was frustrating at the time, but now I feel like I have a longer list of ways to experience sexual pleasure!

Remember to go in with realistic expectations. Prepare for the need to pause or stop sexual activity altogether. Anticipate the need to communicate directly with your partner about how you feel. You of course can't prepare for any and all situations that may arise, but understand that things may not go according to plan. This may not sound very sexy or fun, but if you go into a solo or partnered experience with unrealistic expectations, it’s easy to feel discouraged or frustrated when things don't turn out the way you hoped. Orgasms are great, but sometimes our bodies don’t cooperate—and contrary to popular belief, you don’t need an orgasm to have a pleasurable experience or for sex or masturbation to “count.” Have fun, be communicative, and expect the unexpected. As long as you have fun and experience pleasure, it counts!

Think beyond your genitals.

Satisfying, pleasurable sex doesn’t need to involve genitals or internal stimulation (like vaginal or anal entry). Sex is anything that gives you sexual pleasure whether or not it involves the equipment between your legs. In fact, if you start to think about sex as something beyond genital stimulation, suddenly a whole new world opens up before you. There are many more erogenous zones on the body: nipples, thighs, neck, lower back, the inside of your elbows. It’s different for everyone!

A fun game to play with a partner (or even just by yourself!) is one where you go back and forth touching each other on parts of the body that aren’t commonly thought of as sexy or sexual and see how it feels. Tell your partner where you’d like them to touch you. When they do—if they are comfortable with it—tell them how it feels (or let your moans and heavy breathing do some of the talking for you). Better than you thought? Not as good as you expected? This is a great way to find different and surprising erogenous zones on each others bodies.

Full body cuddling can also be intimate and satisfying. Snuggle up under a warm blanket or get close and dance together, letting your hands wander (or not, if you’re not feeling it). Make out, tickle each other, whisper fantasies into each others ears, depending on your pain and/or comfort levels (for instance, tickling may not be a good idea if your pelvic floor muscles are already very tense).

If you are ready to mix some genitals into the equation, consider mutual masturbation. Mutual masturbation is usually described as masturbating in front of your partner. Watch each other masturbate or maybe just focus on yourself while you’re both in the same room. Another great way to mutually masturbate, is to “help” each other. This might mean taking turns with each other or it might mean having one hand on yourself and the other on your partner. It can be very sexy and intimate to be stimulating yourself while your partner touches, kisses, or licks various erogenous zones on your body. This is an especially good idea if you’re experiencing pain and aren’t comfortable with someone else touching an area of your body that hurts. This can also be a great way for your partner to see what works for you by watching you touch your own body.

You don’t have to take your clothes off in order to have sex. There were times when I would keep my underwear on when I got intimate with a partner, so they didn’t have to worry about hurting me. This usually involved mutual masturbation and me using a toy on myself over my underwear. This can be a great workaround if you have external pain and skin on skin contact is too much. Remember, just because one of you wears your underwear doesn’t mean you both have to. You get to make all the rules—and change them up whenever you want to.

The need for release

Let’s say you’re experimenting and you’re having fun with your partner, but you really feel like you need sexual release. Sexual arousal creates some physical tension, so a lack of release can sometimes heighten the pain you already experience. The discomfort caused by increased blood flow, which happens during arousal, is known as vasocongestion (you may recognize the slang term “blue balls,” though it can be experienced by everyone with every kind of body parts, not just people with testes). If you give the body some time to “cool down,” this discomfort usually resolves itself. It can also be resolved through orgasm by yourself or with a partner. Some people use it as an excuse to pressure their partner into doing something sexual for them when their partner doesn't want to--that's not OK.

Relieving vasocongestion may be easier said than done if you have difficulty reaching orgasm because of pelvic pain. There were times when I had to abstain from orgasms longer than I would have liked to. I had been used to being able to orgasm for any reason (whether sexual release, stress relief, or just for fun) whenever I felt like it. When I started experiencing pelvic pain, my body couldn’t always handle the stimulation needed to induce orgasm. If this happened, I would stop what I was doing and give my body a rest. Usually within a few minutes, my body would start to relax and the need for release would subside. Over-the-counter anti-inflammatory medicines (like naproxen sodium or ibuprofen) can also help vasesongestion subside.

Everyone will handle this differently. The reason I bring it up is not to tell you how to deal with it, but to let you know that if this happens to you, you are not alone.

Products and devices to ease painful sex

There are lots of different gizmos and gadgets out there to help ease pelvic pain. Below are some of my favorites. None of these are necessarily required for treatment of pain. If these products aren't accessible to you (whether due to cost, lack of privacy, or some other reason), that doesn't mean you can't still heal your body an/or experience sexual pleasure.

Dilators: Dilators look like dildos, but some see them as more of a medical device than sex toy. Dilators usually come in sets of three to five and they are meant to insert into the vaginal canal to reintroduce the feeling of something filling it. The smallest is usually the size of a small finger, and they get progressively bigger. This way you can get used to your vagina having something inside of it, often in preparation for internal vaginal sex. If you want to be able to have this kind of sex, a good set of silicone or glass dilators is a great place to start.

The Ohnut: The Ohnut is a product that seems so simple, it’s a wonder that no one invented it sooner! But when you take a closer look, you can tell just how much thought and care was put into the creation of this device. Ohnut is an adjustable device made up of four interlocking rings that are placed at the base of a penis, dildo, or dilator to create a buffer between bodies (or toys and bodies) to customize the depth of entry. You can use one ring or all four, that’s the beauty of Ohnut! This will not work for all kinds of pelvic pain, but if you have pain deeper inside, this may help. Ohnut was created for bodies with vaginas (including neovaginas) but it may also be used for anal entry as well. You can read my full review of the Ohnut here.

Sex toys: There really is something out there for everyone. The best way to find something that will work for you, especially if you have pelvic pain, is to go to a shop in person and handle the products. Progressive, feminist, and/or queer-owned sex toy shops are known for their bright lights, educated staff, and floor samples of toys that you can turn on and fondle in person. If you don’t have access to a shop like that, there are some great online retailers that are just an internet search away.

You can find dildos of all shapes and sizes and vibrators of all power levels. Everybody has a butt (yay butt plugs!) and vibrators are great for both penises and vulvas. There are even some fantastic independent toy makers out there who offer lots of different sizes and firmnesses of their toys so if you’re looking for something small and soft in particular, your best bet is a small independently owned company. Some creators have even started offering penis sleeves. While sex toy manufacturers have historically focused on creating toys for people with vaginas, now people with penises have more choices than ever before.

A note on size: Don’t let mainstream media make you feel bad or dictate your preferences for you. We’re often told bigger is better, that we should aspire to the largest dildos and want the most powerful vibrators. These are the kinds of toys that get the most reviews, but the truth is that toys like that don’t work for many of us. You’re not weak if super powerful vibrators hurt and you’re not missing out on anything if you can’t handle huge dildos. The more you listen to and trust your body, the more pleasurable your experiences will be no matter the size or power level of your toys.

What is important is that you listen to your body and be patient with yourself. Pelvic pain is not an easy thing to deal with, especially when you feel like you can't talk about it with others the same way you might talk about a different kind of chronic pain. You may feel disconnected from or betrayed by your body. This is normal. You may feel like you’re too young to experience painful sex or painful orgasms, but people of any age or genital makeup can experience pelvic pain. You are not alone. Don’t think of this as a problem to overcome but an experience to learn how to deal with. It could be short term or long term, it may come and go. Remember that there will be ups and downs. The good news is, we are making advances daily in understanding pelvic health and there are lots of us out there working hard to normalize and facilitate conversations surrounding pelvic pain and sexual health.

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