When Love Hurts

For readers of a certain age the title above will bring to mind an angst-ridden song made famous by Nazareth in the ‘80s. But what follows is not so much about love as about sex, which is the physical expression of romantic love. Usually when people use the word ‘sex’ they are talking about penetrative sexual intercourse. This is actually a very narrow (and heterosexist) view of what sex is. But more about that later.

So to sex. (And the discussion which follows is largely limited to female sexual pain and heterosexual relationships). In an ideal world, sex is enjoyable, and so memories of past experiences of sex are pleasurable and positive. Thus when a person thinks about sex, pleasurable memories and expectations are brought to mind. This person will anticipate sex as they might a mouth-watering meal; they expect to experience pleasure.

But what if sex hurts? What if the person’s expectation is of pain rather than pleasure? Unfortunately this is the reality for many people. More commonly women, but men can also experience pain during sexual intercourse. The information that follows is more applicable to the issue of female sexual pain, although many of the comments are also relevant to men.

When pain, rather than pleasure, is anticipated, the person’s emotional response is obviously very different. The expectation of pain creates anxiety, and the natural physical response is to tense up. This can become a self-fulfilling prophecy, as being very physically tense will increase the chance that sex will be painful. This is especially true for women, as to allow comfortable penetration of the vagina by their partner’s penis, the muscles at the entrance of the vagina need to be relaxed.

When considering sexual pain, it is useful to separate the cause of the pain, from the factors that are maintaining the pain. The causes of female sexual pain can be due to both physical and psychological factors. Some of the common physical causes are skin conditions that cause pain and inflammation of the vulva (the area around the entrance to the vagina). Conditions such as endometriosis can lead to deeper pain within the vagina during penetration. Hormonal factors, particularly around menopause, can also be a factor. Very tense pelvic floor muscles are also a common cause of pain during sex.

In terms of psychological factors which cause sexual pain, the most obvious is a history of negative sexual experiences such as sexual abuse. Other possible causes are relationship problems, anxiety, stress, and depression. Negative attitudes about sex can also lead to sexual pain problems.

So there are a number of potential physical and psychological causes of sexual pain. However once the pain problem persists and becomes chronic, psychological factors are always part of the maintenance of the problem. Thus a psychologist or sex therapist experienced in working with sexual pain can help with addressing the avoidance, and negative thoughts and expectations that inevitably develop when sex hurts over and over again. Psychological treatment will also involve a broadening of the definition of sex to include sensuality and non-penetrative ‘outercourse’, with a focus on pleasure from various sources apart from penetrative intercourse. This will take the pressure off sex, and allow physical intimacy to be restored.

If you are experiencing pain during sex, you should also consult your doctor and seek a specialist opinion from a gynaecologist, as accurate diagnosis of the issue will allow you access to the most appropriate treatments from the large range available. Other health professionals that may be useful include a physiotherapist who specializes in pelvic pain problems, and a dietician, who will be able to suggest dietary changes that can reduce inflammatory problems.

So, although deeply personal, sexual pain is not untreatable. There is a great deal that can be done to reduce suffering and improve physical intimacy. Seek help if LOVE HURTS for you.


Is my sex life good enough?

Most of us are concerned about how we are perceived by others. It is part of being human to want to be accepted by others and to fit in with the group. We are social animals after all. Our perception of ourselves as sexual partners is part of this broader sense of self
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How to Tell Your Children You’re Separating

Having counselled a number of couples through the separation process, it has become clear to me that there is one step that isn’t well covered in the publicly available materials on separation and divorce. That is: How do you tell your children that you’re separating?
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Sex therapy

Here are some recommended books on the topic of sexual relationships

The New Male Sexuality by Bernie Zilbergeld

Resurrecting Sex by David Schnarch & James Maddock

The Sex-Starved Marriage by Michele Weiner-Davis

Rekindling Desire by Barry McCarthy & Emily McCarthy

Getting It Right The First Time – Creating a Healthy Marriage by Barry McCarthy & Emily McCarthy

Becoming Orgasmic by Heiman & LoPiccolo

Sexual Awareness by Barry McCarthy & Emily McCarthy

The New Love and Sex After Sixty by Butler & Lewis

Sex-Life Solutions by Janet Hall

The New Joy of Sex by Alex Comfort and Susan Quillan

When Your Sex Drives Don’t Match by Dr Sandra Pertot

Coping with Erectile Dysfunction by Michael Metz & B McCarthy

Women’s Sexual Health by Gilly Andrews


Self-help websites

These websites are recommended by our clinicians:
« . . . continue reading “Self-help websites” »


Self-help books

There are many useful self-help books that are based on reliable research. Here is a list with links to each.
Addictive Behavior
Controlling Your Drinking: Tools to Make Moderation Work for You by William R. Miller
Responsible Drinking: A Moderation Management Approach for Problem Drinkers by Frederick Rotgers
Sex, Drugs, Gambling and Chocolate: A Workbook for Overcoming Addictions by A. Thomas Horvath

The Wisdom to Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse by Kelly G. Wilson

ADHD in Children and Adults
Learning Outside The Lines: Two Ivy League Students with Learning Disabilities and ADHD Give You the Tools for Academic Success and Educational Revolution by Jonathan Mooney and David Cole
Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Client Workbook (Treatments That Work) by Steven A. Safren, Susan Sprich, Carol A. Perlman, and Michael W. Otto
More Attention, Less Deficit: Success Strategies for Adults with ADHD by Ari Tuckman
Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents by Russell A. Barkley
Taking Charge of Adult ADHD by Russell A. Barkley
The ADHD Workbook for Kids: Helping Children Gain Self-Confidence, Social Skills, and Self-Control by Lawrence Shapiro

Anger Management
Anger Busting 101: The New ABC’s for Angry Men & the Women Who Love Them by Newton Hightower
Anger Management for Everyone: Seven Proven Ways to Control Anger and Live a Happier Life by Raymond Chip Tafrate and Howard Kassinove
The Anger & Aggression Workbook by John J Liptak & Ester A Leutenberg
The Anger Control Workbook by Matthew McKay & Peter Rogers
The Anger Workbook: An Interactive Guide to Anger Management by Les Carter & Frank Minirth
Rage: A Step-by-Step Guide to Overcoming Explosive Anger by Ronald Potter-Efron

Hair Pulling behaviours
Help for Hair Pullers: Understanding and Coping With Trichotillomania by Nancy J. Keuthen, Dan J. Stein, & Gary A. Christensen
The Hair-Pulling Problem: A Complete Guide to Trichotillomania by Fred Penzel
What’s Happening To My Child: A Guide For Parents’ Of Hair Pullers by Cheryn Salazar
You Are Not Alone: Compulsive Hair Pulling, the Enemy Within by Cheryn Salazar

Breaking Free from Depression: Pathways to Wellness (Guilford Self-Help Workbook Series) by Jesse H. Wright
Feeling Good: The New Mood Therapy by David D. Burns
Mind Over Mood by Dennis Greenberger & Christine Padesky
Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back by Michael E. Addis & Christopher R. Martel
The Feeling Good Handbook by David D. Burns
The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (includes audio CD narrated by Jon Kabat-Zinn) by J. Mark G. Williams, John D. Teasdale, Zindel V. Segal, & Jon Kabat-Zinn

Generalized Anxiety Disorder (GAD)
Mastery of Your Anxiety and Worry: Workbook by Michelle G. Craske & David H. Barlow

Overcoming Generalized Anxiety Disorder – Client Manual: A Relaxation, Cognitive Restructuring, and Exposure-Based Protocol for the Treatment of Gad (Best Practices for Therapy) by John R. White
The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy

Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding by David F. Tolin, Randy O. Frost and Gail Steketee
Compulsive Hoarding and Acquiring: Workbook by Gail S. Steketee & Randy Frost
Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring by Michael A. Tompkins, Tamara L. Hartl, Randy Frost and Gail Steketee
Stuff: Compulsive Hoarding and the Meaning of Things by Gail S. Steketee & Randy Frost

No More Sleepless Nights by Peter Hauri & Shirley Linde
Overcoming Insomnia: A Cognitive-Behavioral Therapy Approach Workbook (Treatments That Work) by Jack Edinger & Colleen Carney
Overcoming Insomnia and Sleep Problems by Colin A. Espie
Relief from Insomnia by Charles M. Morin
Say Good Night to Insomnia: The Six-Week, Drug-Free Program Developed At Harvard Medical School by Gregg D. Jacobs
The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia by Paul Glovinsky & Art Spielman
The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need by Stephanie Silberman

Obsessive-Compulsive Disorder
Brain Lock: Free Yourself from Obsessive-Compulsive Behavior: A Four-Step Self-Treatment Method to Change Your Brain Chemistry by Jeffrey M. Schwartz
Kissing Doorknobs by Terry Spencer Hesser
Mastery of Obsessive Compulsive Disorder – Client Workbook by Edna B. Foa & Michael J. Kozak
Overcoming Obsessive Thoughts: How to Gain Control of Your OCD by Christine Purdon & David A. Clark
Overcoming Obsessive Compulsive Disorder by Gail S. Steketee
Stop Obsessing!: How to Overcome Your Obsessions and Compulsions (Revised Edition) by Edna B. Foa & Reid Wilson
Take Control of OCD: The Ultimate Guide for Kids With OCD by Bonnie Zucker

Panic Disorder
10 Simple Solutions to Panic: How to Overcome Panic Attacks, Calm Physical Symptoms, & Reclaim Your Life by Martin M. Antony & Randi E. McCabe
Don’t Panic by Reid Wilson
Mastery of Your Anxiety and Panic – Fourth Edition (MAP-4) by David H. Barlow & Michelle G. Craske
Panic Disorder: The Facts by Stanley Rachman & Padmal De Silva
When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life by David D. Burns

Posttraumatic Stress Disorder (PTSD)
I Can’t Get Over it – A Handbook for Trauma Survivors by Aphrodite Matsakis
Reclaiming Your Life After Rape by Barbara Olasov Rothbaum & Edna B. Foa
Reclaiming Your Life from a Traumatic Experience: A Prolonged Exposure Treatment Program Workbook by Barbara Rothbaum, Edna Foa, & Elizabeth Hembree

How to Accept Yourself (Overcoming Common Problems) by Windy Dryden
Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind by Kristin Neff
Self-Esteem: A Proven Program of Cognitive Techniques for Assessing, Improving, and Maintaining Your Self-Esteem by Matthew McKay
Ten Days to Self-Esteem by David D. Burns
Think Confident, Be Confident: A Four-Step Program to Eliminate Doubt and Achieve Lifelong Self-Esteem by Leslie Sokol and Marci Fox
Think Confident, Be Confident for Teens: A Cognitive Therapy Guide to Overcoming Self-Doubt and Creating Unshakable Self-Esteem by Marci Fox and Leslie Sokol

Social Anxiety Disorder (Social Phobia)
Managing Social Anxiety by Debra A. Hope, Richard G. Heimberg, Harlan R. Juster & Cynthia L. Turk
Overcoming Shyness and Social Phobia by Ronald M. Rapee
Overcoming Social Anxiety and Shyness by Gillian Butler
The Shyness and Social Anxiety Workbook by Martin M. Antony & Richard P. Swinson

Specific Phobias
The 7 Principles of Public Speaking by Richard Zeoli
The Confident Speaker: Beat Your Nerves and Communicate at Your Best in Any Situation by Harrison Monarth & Larina Kase
Flying Without Fear by Duane Brown
Living with Fear by Isaac M. Marks
Mastering Your Fears and Phobias: Workbook by Martin M. Antony, Michelle G. Craske, & David H. Barlow
Overcoming Specific Phobias – Client Manual: A Hierarchy & Exposure-Based Protocol for the Treatment of All Specific Phobias by Edmund J. Bourne
Overcoming Animal & Insect Phobias: How To Conquer Fear Of Dogs, Snakes, Rodents, Bees, Spiders & More by Martin M. Antony & Randi E. McCabe
Overcoming Medical Phobias: How to Conquer Fear of Blood, Needles, Doctors, And Dentists by Martin M. Antony & Mark A. Watling

The CBT Toolbox: A Workbook for Clients and Clinicians by Jeff Riggenbach

The Relaxation and Stress Reduction Workbook by Martha Davis, Matthew McKay & Elizabeth Robbins Eshelman

These books are recommended by our clinicians, and you can look at the book by clicking on the picture:


Body image
Children’s mood
Divorce and separation
Learning problems
Obsessive Compulsive Disorder

Sex therapy
Sleep problems
Social anxiety and shyness

Relationship issues: Handout

Here’s a useful handout about some relationship issues