Written by Leslie Quander Wooldridge
After connecting on Tinder in 2014, Stephanie, 38, and Brandon, 41, thought they weren’t a match in real life. But they stayed in touch, became work partners, and ended up falling for each other the following year. With their relationship redefined, the California residents were using the “L” word. And having sex. Lots of it.
Stephanie wasn’t, and isn’t, alone. When it comes to chronic pain, 70 percent of those impacted are women, reports Harvard Medical School.
Chronic pelvic pain, which Mayo Clinic defines as pain in the area below the belly button and between the hips that lasts six months or longer, is one type. Plus, nearly three in four women will have pain during intercourse at some point in their lives, which can be temporary or long-term, according to the American College of Obstetricians and Gynecologists. Chronic pelvic pain, if it happens, can be debilitating. And hard to diagnose. It was at least six months after Stephanie’s issue began—and after she did her own research—that she was finally diagnosed with vulvodynia, a type of chronic pain with no identifiable cause. (The vulva is a woman’s external genital area. The vagina is internal.)
“It was clear that sex was painful,” Brandon tells Playboy, explaining that he didn’t want to hurt her. “It was confusing. I didn’t understand it, [and] I was concerned.”
Today, the pair is engaged to be married. But Stephanie’s pain is worse. Like millions of women around the country, she’s trying to manage it. And the two have had to make sex-related adjustments.
Is it possible to help when your partner has this kind of pain—and still have some intimacy? The short answer is yes. Just be willing to learn. And try.
“It is never normal to have pain with sex unless you want to—unless that is part of the sexual act, which is mutually agreed upon,” says Katherine W. McHugh, an Indianapolis gynecologist who specializes in chronic pelvic pain.
I would want a man to know that this is not something that’s in a woman’s head. This is not something that a woman is making up to get out of having sex.
But many conditions are not infectious or contagious. In fact, pelvic pain can come from other chronic conditions, Mayo Clinic confirms, including:
• Endometriosis (tissue typically found in the lining of the uterus grows outside the uterus)
• Interstitial cystitis/painful bladder syndrome (recurring bladder pain and a frequent need to pee)
• Fibroids (noncancerous growths in the uterus)
• Vulvodynia (pain can be felt in one area or multiple areas of the vulva)
• Other musculoskeletal or nerve problems (including fibromyalgia and pelvic floor dysfunction)
Chronic pelvic pain can come and go. It can be linked to certain activities and even affected by stress. Or it can be constant.
“Endometriosis has taken over my life,” explains Lindsey, 39, a D.C. resident whose condition has brought everything from extreme backaches and burning in her stomach area to severe bloating. Her pain, which started in 2015, is impossible to predict. “I have had sex. It is an enjoyable thing. But endometriosis has made it so it can be unenjoyable, and that’s difficult,” Lindsey says. “I would definitely like a healthy sex life with someone who is understanding.”
Treatment for pelvic pain can vary widely depending on the condition and can include medication, physical therapy, lifestyle changes and even surgery.
“There’s a lot that goes into a treatment plan,” says McHugh. But, though some people can have pain for months and even years, she says “there is hope for these women.”
First—whether you’re in a relationship, dating or hooking up—know that pelvic pain is real. “I would want a man to know that this is not something that’s in a woman’s head. This is not something that a woman is making up to get out of having sex,” Lindsey explains. So if a woman tells you she has pain, take her seriously. And understand that it can be difficult for her to even discuss. Also remember women should never feel forced or pressured to have sex, McHugh says. If your partner wants to be intimate, there are things you can do to support her and encourage a mutually pleasurable experience. (And whatever you’re doing, remember safer sex practices.)
One of those things is to communicate before sex. McHugh suggests a no-pressure setting, like at the kitchen table. How to start? “Ask women what their experience of the pain is like,” says “Alex” Caroline Robboy, licensed clinical social worker and founder of Sex Therapy in Philadelphia, a group focused on individual, couples and sex therapy.
Some women report burning. Some report pressure. With intercourse, some might describe a stabbing sensation, which might get worse in certain positions. And others can have a different experience entirely. Plus, many women also feel guilt about their pain, says McHugh, even though it’s out of their control. After you discuss her experience, ask what you should know if you have sex. “A really important question is, since [guys] themselves don’t have the pain, how would they recognize when she’s experiencing pain?” Robboy explains.
This conversation also is a chance for you to share concerns and feel like part of the solution. “I have found success with really encouraging a ton of communication—talking about things in advance, in detail,” McHugh says to Playboy, noting that this helps build trust.
Get slippery. “Sometimes people experience pain because they’re not properly lubricated,” Robboy says. So, a good lube should be your best friend. And using it doesn’t mean you’ve failed at anything. Silicone-based lube can be a good option, unless your partner has vaginitis (vaginal inflammation), discharge, or irritation, says McHugh. In those cases, water-based lube—though it doesn’t last as long—tends to be less irritating, she adds. (Note: If you’re using condoms, never use oil-based lube because it can cause condoms to break. And nobody wants that.)
Try different positions and techniques. Creativity is key. “Maybe you’re going to focus on pressure, tempo, body parts, sounds. Maybe a different week you’re going to focus on visualization,” Robboy says. Some positions may be more pleasurable than others—one woman might avoid missionary while another might prefer it. One woman might green light anal sex while another might feel aghast at the thought. So ask what she likes and experiment.
But don’t get stuck on intercourse. Yeah, it’s a classic. But other kinds of sex can feel good, too. If pain precludes intercourse, for instance, oral sex might be something to add to the menu. You also may want to consider things like mutual masturbation, dirty talk, sex toys (like external vibrators), breast play and even massage.
“Once you start to really understand how someone’s body works—and get someone feeling safe, and creative, and sexy—it’s a much stronger foundation to then start trying for penile-vaginal intercourse,” Robboy says. “And then, if it’s starting to be painful, you’ve got so many other areas to revert back to that are really fun.”
Observe and communicate during sex. “Sometimes women will be like, ‘Ouch that hurts,’” Robboy says. Or they may deal with pain by flinching, pulling back, or distracting and redirecting you, she adds. Alternately, women might feel pain but completely avoid saying or showing it because they’re trying to push through or please you, McHugh says. So, check in during sex to make sure she’s okay. If she’s in pain, stop and reevaluate. And consider following up after sex to talk about the experience, Robboy says.
Relax your expectations. Sometimes pain may prevent her from doing basic things like sitting at a desk or wearing tight pants. Or her condition may leave her tired. Sometimes, like any other person, she may not be in the mood. So, sex may be completely off the table. If this happens, try to be understanding. Be willing to take a time out from couples sex. And know that the entire situation can be just as frustrating to her as it is to you—if not more so.
Consider looping in a professional. For longer-term issues, you may want to talk to a therapist, whether you go alone or together. A therapist also can help suggest new ways to get physical or offer help if either of you are feeling depressed or dealing with issues like guilt. You may also want to ask your partner if she’d like you to attend a medical appointment with her. “Oftentimes, I see patients and their partners,” notes McHugh. Be patient. Slowing things down gives you time to discover intense, novel and pleasurable ways of connecting.
“The end result after a couple has gone through this—after a couple has acknowledged the pain, has dealt with the pain, has gone through the treatments for the pain and now can have comfortable enjoyable sex—the result is so worth the time and energy,” McHugh explains. Another great thing? “The sex tends to be really amazing because they are very invested in the enjoyment of the other person,” McHugh adds.
So support each other. Good times could lie ahead.