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.