How can I make sex less painful and more desirable?

March 26, 2009 3:23 PM

Sex is nearly always painful, which is probably why I rarely want it. How can I fix this?

I've been married for 6 years, and my wedding night was the first time I had sex (though it wasn't for my husband). It was fairly painful and there was quite a bit of blood (which was probably normal), although there was definitely pleasure as well. Since then, I have not been able to have sex without bleeding a little, and it is usually painful. I can't tell where the blood comes from. The pain is at the vaginal opening and almost feels like I'm tearing, although I don't think I am. It doesn't feel like a spasm and it does subside after a little bit, but I am usually sore afterwards.

I've talked to my doctor about this and she's examined me a couple of times, and found nothing wrong. I do get the occasional yeast infection but it clears up with treatment. My husband is not exactly small, which may have something to do with it. Lube helps. :-) Foreplay doesn't seem to make much difference unless there's almost none, but that's usually not an issue.

I really do enjoy sex once we get going. However, it's getting going at all that's a problem. I think subconsciously I expect it to hurt and so I avoid it. It doesn't help that I'm on antidepressants and hormonal birth control, both of which help kill any sex drive I do have; the depression itself probably contributes too. As far as oral sex goes...further confirming that I (well, we) are just plain weird - we both really enjoy giving oral sex but feel uncomfortable receiving it.

I guess I need help with two things. One: how can I make sex stop hurting? Two: what can I do to make myself *want* to have sex? Like I said, we both love it once we get going, but initiating it is hard - I just can't work up the desire. My husband and I have a loving, normal relationship otherwise, and we communicate more openly than most couples I know. We've talked about this multiple times and he insists that he feels fulfilled/satisfied, etc. But I still feel like I'm depriving him of a healthy, active sex life. We have sex probably 10-15 times a year. That doesn't really bother either of us, but I feel like it *should*. Hence this question.

Any advice is welcome. Throwaway email is [e-mail]

posted by anonymous to health & fitness (19 comments total)

Take a painkiller before hand?
Have a glass of wine?
Try another sort of relaxant?
Do you masturbate?
Vaginal walls are stretchy, perhaps you could get started with a dildo a bit smaller than your husband?
Second opinion from a GYN?
Talk to your doctor about the antidepressants killing your sex life, alternatives?
posted by silkygreenbelly at 3:41 PM on March 26

Has your doctor ever mentioned the possibility of you having vaginismus? [That is the most helpful website on the topic that I've found, and you can just ignore the kits they are trying to sell you (unless you feel like that is what you need).]

I've dealt with vaginismus for a long time, and even if that isn't your issue, I still empathize a lot. I think the most important thing that has helped me to progress is just to commit to having sex more regularly. Depending on what your schedules are, that might mean at least twice a month, or twice a week, whatever. You might not feel like it when the time rolls around, but making it routine may help you to relax about it. Practice makes perfect, and all that. This might also help alleviate your worry that you aren't satisfying your husband's needs (which could somehow be adding to your physical discomfort as well).

You already know about lube and foreplay, so the only other major thing I can recommend is to find some relaxation techniques that work for you. If it is vaginismus that you are dealing with (which is what it sounds like to me, in my non-professional opinion), that pain near your entrance is caused by the tightening of your PC muscles, so doing relaxation exercises will help alleviate the discomfort there.

Feel free to send me a message. Good luck!
posted by liverbisque at 3:43 PM on March 26

Oh yes, I think I may have mentioned this before, but several GYN's never told me my uterus was tilted. One finally did and remarked that it might make certain positions uncomfortable. Does changing positions help?
Is your husband long? Is he hitting the cervix which would cause discomfort?
posted by silkygreenbelly at 3:44 PM on March 26

I should add: if you end up thinking that you might have vaginismus, don't be afraid to keep going to different doctors or therapists until you find one that actually knows what you are talking about, and doesn't just insist that you "look normal down there" so that it's all in your head. People don't seem to very informed about this issue.
posted by liverbisque at 3:48 PM on March 26

Vaginusmus Awareness Network is a peer site for women who are experiencing or have experienced vaginismus.
posted by Sidhedevil at 4:00 PM on March 26

just anecdotal: my friend had vaginismus, and her doc prescribed a topical numbing cream (I think a mild lidocaine? I don't remember) and she said it made a world of difference. And it took about five docs before she found one who took her complaints seriously.
posted by pipti at 4:28 PM on March 26

Please see other doctors...a shrug and an "I don't see anything wrong" isn't enough. I know how much this can affect your life.

I am seconding vaginismus or vestibulitis, although I don't remember there being bleeding.

I have struggled through the same issues (again, minus the bleeding), and my gynecologist thought it might be vaginismus, vestibulitis, or both. I tended to think both because I had symptoms that fit both diagnoses. She sent me to biofeedback therapy which helped quite a bit, and helped me be way more concious of how I was tensing up my muscles. I remember when my doctor first made me actually notice how I was tensing up - I had absolutely no idea I had been doing that.

I recommend The V Book as a good resource - it covers lots of issues but vaginismus is one of them.

I am not completely pain free, but it has improved dramatically. It is almost imperceptible if I use lube. And don't feel like you shouldn't "have to" use lube. I admit that I felt that way for a while, but seeing how much better sex was with it made me get over it. It is hard to work up the desire or initiate sex when you know it will hurt. Sometimes it becomes a vicious cycle where you anticipate the pain, so you involuntarily tense up, and it just gets worse. This is why I say that you should not take an "I don't know" for an answer from your doctor - getting help can really improve your quality of life (and I never would have imagined just how much it does impact quality of life to be in this situation until I went through it).

You and your husband should have as much or as little sex as you want, but pain should not be a deciding factor. Memail me if you have any questions.
posted by DrGirlfriend at 4:30 PM on March 26

IANAD, but it sounds more like vulvular vestibulitis than vaginismus. It could even be a combination of both conditions. The combination of your birth control pill and antidepressants might be drying your vaginal entrance out to the extent that you're experiencing tearing and bleeding. You may even have an almost-constant low-grade yeast infection that is causing these problems as well. There are things your doctors can do to help restore your natural moisture, such as changing your birth control pill and/or giving you topical estrogen cream.

Memail me if you have any questions. (I'd go into more specifics here but the entire Internet doesn't need to know everything about my vagina.)
posted by thisjax at 4:38 PM on March 26 [2 favorites]

I'm also going to chime in with Vestibulitis as a possibility; I'd highly recommend the Vulvodynia Survival Guide. I suffered from vestibulitis, and took years before I found a doctor that believed me, but now have 95% pain-free sex. Which is just amazing. I am so, so sorry that your doctor hasn't bee more helpful and you have had to deal with this for the last six years. You can memail/email me for more details of my experience and treatment if you'd like.
posted by rhapsodie at 5:04 PM on March 26

Just to throw it out there, could your hymen still be partially in tact? You mentioned having seen your doctor, so it is unlikely...
posted by good for you! at 6:43 PM on March 26

Masturbate (or have your husband stimulate you, gently at first, perhaps with his fingers instead of with his tongue) to lubricate yourself. This should help, since you mentioned that once it gets going, it's ok.

Failing that, or in addition to that, get yourself some lubricant and apply it before intercourse. There are lots of different kinds. Astroglide or KY are commonly available at most pharmacies. There are version with lactic acid or a small amount of capsaicin that will create a "warm" feeling without irritation.

Have you spoken with your partner about increased foreplay or different kinds of foreplay to get yourself (more) into the mood before intercouse?
posted by porpoise at 8:11 PM on March 26

RUN to another doctor.

If you tell your gynecologist that after six years, you are in pain and bleed every time you have sex, so that you only have sex about once a month, and they "don't see anything wrong," they should make it their business to find out what exactly is the problem. Oh wait, it is their business.

I am so sick of women getting the brush-off from their gynecologists. Please find a doctor who will take your concerns seriously and give you more than ten minutes in the stirrups. You should be getting tests, trying different antidepressants, etc. You and your husband deserve the sex life that you want.

Rant aside, how big is "not small"? I'm assuming that you don't have too many penises to compare it with. Measure your husband's penis (seems like girth would be the problem here if the pain is around your opening) and take it in to your doctor. If that's what it turns out to be, it'll be a lot easier if you have sex regularly. You basically want to keep yourself stretched out, or you'll shrink back every time, just like after childbirth.
posted by thebazilist at 9:05 PM on March 26

Nthing vaginismus. If this is happening for this long, something might be there. Get a second opinion.
posted by JauntyFedora at 3:05 AM on March 27

Yeah, I think a new doctor might be in order. Also, I've looked at both those vaginismus websites linked above before, and they are both really useful reads about vulvar/vaginal pain in general. Some years ago, not many doctors knew about vaginismus or vulvodynia. I think this is changing, but maybe finding a younger physician might be better. They might be more up on the latest research/treatments (I know this was true when I was shopping around for a gynecologist; my sister, who is a fairly young physician herself, recommended finding either someone fairly young or someone who had spent some time working in a research hospital -- her advice was good. My new doctor listens more and seems more up on current treatments).
posted by bluefly at 7:34 AM on March 27

comment from someone who would prefer to remain anonymous.

"I would nth the "see another doctor" - especially if bleeding is involved.

That said, I have been in a very similar situation (pain during intercourse near the vaginal opening, but no bleeding in my case) - and this had the same effect on my sex drive and desire for intercourse, and my husband and I were not happy. But over the last few years, I have changed certain things and begun to really enjoy intercourse. Here are some suggestions based on what I did (in no particular order):

- Hormonal birth control pills can seriously dampen your sex drive (I swear that is 1/2 of the design); you may want to consider another form of birth control. After getting off the pill for this and other reasons, my sex drive went up a great deal. I then used a diaphram with spermicidal jelly happily for years (the jelly is also great lube), but this may have covered by g-spot and lessened my pleasure in intercourse; I now have an IUS which I love and which seems to have no ill effect on my sex drive or experience of sex.

- fear itself can make sex more painful - you tense up just before intercourse, which then makes it more painful, which makes you more fearful. It's a terrible cycle - which hopefully can be stopped with more lube and better intercourse.

- but lack of sex can also make intercourse more painful. For women, not having sex can let the muscles on our pelvic floor get weak. If the pain is at the vaginal opening, this sounds a lot like weak pelvic floor muscles (do you feel "worn" after intercourse?) - but fortunately this can be easily helped with Kegel exercises (http://en.wikipedia.org/wiki/Kegel_exercise). The explanations online aren't very clear, but the exercise itself is very simple: when you are peeing, stop the flow of urine for a count of ten seconds, and then release. This helps you isolate the specific muscles - and you should do it a few times each, a few times a day (not too much at first). You don't have to be urinating, but it's easier to figure out just what to do that way - once you know, you can do it anytime, anywhere. No one even knows you are doing it.

- finally - masterbation can also help your sex drive - whether on your own, or with a partner. Especially if you masterbate to erotica which features great heteosexual intercourse* - that will make you begin to mentally associate intercourse as a sexy thing in and of itself. This is, of course, why explicit romance novels are so popular with women - they feature loving sexy couples having great intercourse, and are very much oriented towards the woman's experience of sex (as opposed to most visual pornography or a lot of generic online erotica - but do avoid the creepy kidnap ones; fortunately they are out of fashion now.)

Kegel exercises and changing my birth control ended the pain of intercourse for me, but I didn't really enjoy it greatly (it was rather neutral) until I began to mentally find it sexy through good erotic romance fiction. I now look forward to intercourse, and am often the one to instigate it during our love-making, whereas before I didn't enjoy it and rarely looked for it. It's not a matter of pleasing your husband - these problems are also robbing you of a good sexual experience which you deserve just as much. (Though my husband does feel for your husband, having been in the same place.)

If you have any further questions, or would just like to talk, my own anonymous email is: [e-mail]

(*not that non-heterosexual erotica isn't great, but it's the straight intercourse you want to get good associations with.)"

posted by jessamyn at 8:37 AM on March 27

I'm not experienced with any of the medical problems, which have been covered pretty well already, but I am a little concerned about the emotional dynamics of your sex life. Obviously your abundantly apparent (please get a new OB!) medical issues have informed some of your psychological responses to sex, but numbing cremes aren't going to immediately burst open the doors of a brand new sex life if you and your husband don't move beyond your basic anxieties regarding sex and foreplay.

First, oral sex/masturbation is awesome and everyone should experience it at least once a week. Two-person sex is stupendous in its own right, of course, but sometimes sexual organs just deserve some, um, "me time." You and your husband sound like you're emotionally ready to perform oral sex in that you both enjoy giving it. This is an exponentially better situation than when two high school kids want to receive oral sex but get bored performing it. Now you both have to accept that in order to really please each other, one of you will have to lie back and accept the pleasure. You'd prefer if it your husband was truly having a great time while you went down on him rather than feeling nervous and guilty, right? Then tell him that, lady, and he'll probably tell you the same thing. Sexual reciprocity isn't always penis + vagina.

Secondly, maybe you can rethink birth control, and ask your new OB for another option that doesn't kill your sex drive. This is a really common side effect of the pill, and I've personally gotten to the point where I was convinced part of the dosage's efficacy lay in its ability to squash my libido. Maybe just switching to another form of BC will help you out. Condoms are another option, especially now that there are so many better brands than Trojan and Durex.

There seems to be a lot of shyness and naivety shrouding your sex life. This is your husband, the person to whom you are ostensibly bound for the rest of your life. Be open and honest about your anxieties instead of writing off any bumps in the road as "well, maybe we're just weird." That's a pretty inefficient way to handle a potentially awesome recreational activity.
posted by zoomorphic at 8:56 AM on March 27

I came back here to add something that occured to me last night. When I started to see a specialist for my issues, the pain went away completely during her examination. I couldn't feel the usual pain, so I was unable to help her pinpoint the location. It might have been the look on my face of complete exasperation that made her tell me, "I believe you. I believe you have pain, sometimes these things happen during an examination. We won't give up." I was so relieved to hear her say that and it made a big difference because I felt more relaxed and confident in seeking treatment for this. As was mentioned above, there are too many doctors who brush this off when they don't see any apparent physical issues right away.

It's also really cool to see women discussing this topic openly. I don't think this is as uncommon as it may seem, you can sometimes feel like you are the only person going through this kind of thing.
posted by DrGirlfriend at 9:38 AM on March 27

Have you found the other thread about vulvodynia on Askmefi? Here is what I said then.

Unfortunately, I'm still not better, but I have a new doctor now (actually, I'm about to start this really cool program in Vancouver).

I went through a period this fall where things started getting worse and I lost interest in making out cause I was so frustrated and afraid things would hurt. And using lube burned, which really limited what I could do. Recently though my boyfriend and I had a really good conversation about what exactly I wanted and was afraid of. I also started reading erotica to him as foreplay, which is actually really fun. I also got treated for a possible yeast infection and started using moisturizer and the burning stopped. My doctor also recommended For Yourself, which I'm still working my way through but I am really identifying with what she's saying.

I think something that made everything worse was knowing how much my boyfriend wanted to make me feel good so I let him, for example, go down on me, even though it hurt cause I didn't know what else to tell him to do. Don't do this! You get into that terrible cycle where it hurts because you think it will. Find something you like, even if it's just reading erotica while curled up with your partner. And use excessive quantities of lube.

Feel free to mefi mail me if you have any questions. It's very therapeutic for me to talk about it, so I will gladly go on and on if you let me!
posted by carolr at 11:01 AM on March 27

I went through this myself, and regular sex definitely helps. My gynecologist gave me a dilator to get me comfortable with having something in there, but I can't say it helped me too much. My significant other is of a certain girth that the dilator couldn't really match. What really helped me was lube. Try KY Liquibeads for you, and Astroglide for him/you. Use plenty and see how it goes for you. Good luck!
posted by xiaolongbao at 4:46 PM on March 27