There’s no rule that says sex has to be penetrative.
By Breena Kerr
[W]hen sex hurts, women often feel alone—but they’re not. About 30 percent of women report pain during vaginal intercourse, according to a 2015 study in the Journal of Sexual Medicine which surveyed a subsample of 1,738 women and men ages 18 and older online.
Awareness of painful vaginal sex—sometimes lumped under the term Female Sexual Dysfunction (FSD)—has grown as more women talk about their experiences and more medical professionals start to listen.
Many conditions are associated with FSD, including vulvodynia (chronic vulva pain), vestibulodynia (chronic pain around the opening of the vagina), and vaginismus (cramping and tightness around the opening of the vagina). But they all have one thing in common: vaginal or vulval pain that can make penetrative sex anywhere from mildly uncomfortable to physically impossible. However, you can absolutely still have sex, which we’ll get to in a minute.
First and most important, if you are experiencing any type of genital pain, talk to your doctor.
There’s no reason to suffer in silence, even if it seems awkward or embarrassing or scary. Your gynecologist has heard it all and can help (or they can refer you to someone who can). The International Pelvic Pain Society has great resources for finding a licensed health care provider who specializes in genital pain.
“We don’t yet know why women get vestibulodynia or vulvodynia,” Kayna Cassard, M.A., M.F.T., a psychotherapist who specializes in vaginismus and other pelvic pain issues, tells SELF. “[There can be] many traumas, physical and psychological, that become internalized and add to vaginal pain. Women’s pain isn’t just ‘in their heads,’ ” Cassard says.
This kind of pain can affect anyone—regardless of sexual orientation or relationship status—but it can be particularly difficult for someone who mostly engages in penetrative sex with their partner. The important thing to remember is that you have options.
Sex does not have to revolve around penetration.
Hell, it doesn’t even need to include it. And for a lot of people, it doesn’t. Obviously, if P-in-V sex is what you and your partner are used to, it can be intimidating to consider redefining what sex means to you. But above all, sex should be pleasurable.
“The first thing to do is expand what ‘counts’ as sex,” sex educator and Girl Sex 101 author Allison Moon tells SELF. “Many people in heterosexual relationships consider only penis-in-vagina to count as sex, and everything else is some form of foreplay,” she says. But sex can include (or not include) whatever two consensual people decide on: oral sex, genital massage, mutual masturbation, whatever you’re into.
“If you only allow yourself one form of sex to count as the real deal, you may feel broken for enjoying, or preferring, other kinds of touch,” Moon says.
To minimize pain, give yourself time to prepare physically and mentally for sex.
That might sound like a lot of prep work, but it’s really about making sure you’re in the right mindset, that you’re relaxed, and that you’re giving your body time to warm up.
Heather S. Howard, Ph.D., a certified sexologist and founder of the Center for Sexual Health and Rehabilitation in San Francisco, publishes free guides that help women prepare physically and mentally for sex. She tells SELF that stretching and massaging, including massaging your vaginal muscles, is especially helpful for women with muscle tightness. (Too much stretching, though, is a bad idea for women with sensitive vaginal skin that’s prone to tearing.)
Starting with nonsexual touch is key, as Elizabeth Akincilar-Rummer, M.S.P.T., president and cofounder of the Pelvic Health and Rehabilitation Center in San Francisco, tells SELF. This puts the emphasis on relaxation so you don’t feel pressured to rush arousal.
Inserting a cool or warm stainless steel dilator (or a homemade version created with water and a popsicle mold) can also help reduce pain, Howard says. Women can tailor the size and shape to whatever is comfortable. If a wand or dilator is painful, however, a cool cloth or warm bath can feel soothing instead. Again, do what feels good to you and doesn’t cause pain.
Several studies have shown that arousal may increase your threshold for pain tolerance (not to mention it makes sex more enjoyable). So don’t skimp on whatever step is most arousing for you. That might mean some solo stimulation, playing sexy music, dressing up, reading an erotic story, watching porn, etc.
And of course, don’t forget lubrication. Lube is the first line of defense when sex hurts. Water-based lubricant is typically the safest for sensitive skin. It’s also the easiest to clean and won’t stain your clothes or sheets. Extra lubrication will make the vagina less prone to irritation, infections, and skin tears, according to Howard. But some people may also be irritated by the ingredients in lube, so if you need a recommendation, ask your gynecologist.
Now it’s time figure out what feels good.
Women with pain often know what feels bad. But Howard says it’s important for them to remember what feels good, too. “Lots of people aren’t asking, ‘What feels good?’ So I ask women to set what their pleasure scale is, along with their pain scale. I ask them to develop a tolerance for pleasure.”
To explore what feels good, partners can try an exercise where they rate touch. They set a timer for 5 or 10 minutes and ask their partner to touch them in different ways on different parts of their body. Sex partners can experiment with location, pressure, and touch type (using their fingertips, nails, breath, etc.) and change it up every 30 seconds. With every different touch, women should say a number from 0 to 10 that reflects how good the touch feels, with 10 being, “This feels amazing!” and 0 meaning, “I don’t like this particular kind of touch.” This allows women to feel a sense of ownership and control over the sensations, Howard says.
Another option is experimenting with different sensations. Think tickling, wax dripping, spanking, and flogging. Or if they prefer lighter touch, feathers, fingers, hair, or fabric on skin are good options. Some women with chronic pain may actually find it empowering to play with intense sensations (like hot wax) and eroticize them in a way that gives them control, according to Howard. But other women may need extremely light touch, she says, since chronic pain can lower some people’s general pain tolerance.
Masturbating together can also be an empowering way for you to show a partner how you like to be touched. And it can involve the entire body, not just genitals, Akincilar-Rummer says. It’s also a safe way for you to experience sexual play with a partner, when you aren’t quite ready to be touched by another person. For voyeurs and exhibitionists, it can be fun for one person to masturbate while the other person watches. Or, for a more intimate experience, partners can hold and kiss each other while they masturbate. It feels intimate while still allowing control over genital sensations.
If clitoral stimulation doesn’t hurt, feel free to just stick with that.
It’s worth noting that the majority of women need direct clitoral stimulation to reach orgasm, Maureen Whelihan, M.D., an ob/gyn in West Palm Beach, Florida, tells SELF. Stimulating the clit is often the most direct route to arousal and climax and requires no penetration.
Some women won’t be able to tolerate clitoral stimulation, especially if their pain is linked to the pudendal nerve, which can affect sensations in the clitoris, mons pubis, vulva, vagina, and labia, according to Howard and Akincilar-Rummer. For that reason, vibrators may be right for some women and wrong for others. “Many women with pelvic pain can irritate the pelvic nerve with vibrators,” says Akincilar-Rummer. “But if it’s their go-to, that’s usually fine. I just tell them to be cautious.”
For women with pain from a different source, like muscle tightness, vibrators may actually help them become less sensitive to pain. “Muscular pain can actually calm down with a vibrator,” Howard says. Sex and relationship coach Charlie Glickman, Ph.D., tells SELF that putting a vibrator in a pillow and straddling it may decrease the amount of direct vibration.
Above all else, remember that sexual play should be fun, pleasurable, and consensual—but it doesn’t need to be penetrative. There’s no need to do anything that makes you uncomfortable physically or emotionally or worsens your genital pain.
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