Valid Love
Discussions and interviews about all things love: Kink, Intimacy, and alternative relationships, including the relationship with yourself.
Valid Love
Sexual Pain: Breaking the Silence
Rebecca and Leah delve into the often-overlooked issue of sexual pain, discussing its prevalence and the shame that keeps many suffering in silence. They explore the critical distinction between pain being common but not normal, emphasizing that persistent sexual pain requires appropriate investigation and treatment.
• Types of sexual pain including superficial versus deep pain and pain during versus after penetration
• Sexual trauma as a major cause, with the body developing protective responses during intimacy
• Religious and cultural conditioning, particularly purity culture, creating disconnection from bodily knowledge and pleasure
• Vaginismus (involuntary tightening of vaginal muscles) as a common condition requiring specialized treatment
• Medical and hormonal factors including endometriosis, PCOS, menopause, breastfeeding, and medication side effects
• Treatment approaches including pelvic floor physical therapy, dilators, somatic therapy, and couples therapy
• The importance of partner involvement in the healing process
• Realistic expectations about recovery timeframes, typically taking at least a year
• Myth-busting common misconceptions about sexual pain being normal or inevitable
• The option to redefine what sex means for you and your relationship if penetration remains painful
Recommended resources: "Come As You Are" by Emily Nagoski (with accompanying workbook), "The Sexual Healing Journey" by Wendy Maltz, and "Pure" by Linda K. Klein.
Contact us at podcast@validlove.org with your questions or comments.
Hi, I'm Rebecca. Hi, I'm Leah. Welcome back to Valid Love Podcast. Today we are going to talk about sexual pain.
Speaker 2:Sexual pain, and I think we're specifically talking about people with vulvas, correct? Yes, okay, correct. Just want to make sure that clarification's there.
Speaker 1:Yeah, and we're talking about this because it's super, super common and it also goes really really like people don't talk about it because there's a level of shame, there's a level of embarrassment, and so a lot of people suffer in silence, and I just want to bring awareness and help to people who may be suffering in silence and learn more about it and what you can do, because it really happens to a lot of people.
Speaker 2:I was going to say I feel like it's so common, but it also shouldn't happen. Yeah, so it's like common, but not quote unquote, normal, like if you're experiencing sexual pain, it is good to go explore why that's happening, because I feel like so many people are like, oh, like, yeah, it hurts when we have sex, but like that's just sex. Because I feel like so many people are like, oh, like, yeah, it hurts when we have sex, but like that's just sex. And it's like, oh, honey, no.
Speaker 1:Well, yeah, and a lot of people have the experience that it's quote unquote always been like that for them, and so they think that maybe that's how it is supposed to be, and so they don't really have the framework, especially if they're a person who, like, doesn't really talk about sex with other people. Maybe they just don't know that that's not how it's supposed to be right. So, yeah, super common, not something to feel ashamed of. But before we dive into all of this, we do want to say that there are a multitude of reasons for why someone may be experiencing sexual pain and trauma, and sexual violence is within that list. So we will be touching on some of those topics today.
Speaker 2:Yeah, no, and I always appreciate a good content warning, and I also want to point out like this is Leah's area of specialty.
Speaker 1:This is one of my areas of specialty. I have been doing this since the beginning of my own private practice, what like eight years ago. So this, yeah, this is what I work with.
Speaker 2:So how do people get referred to you, Like if they're experiencing sexual pain? How do they end up with you?
Speaker 1:Word of mouth, because so many clinicians in the area that I work know that this is a specialty of mine and then also probably from perusing, you know, my website, and then I also pair up with pelvic floor PTs, physical therapists so sometimes we just have a co-referral system going on, but those are the main ways people find me Okay, excellent. We are going to talk about throughout this whole episode. We're just going to be calling it sexual pain, because I don't really see the point in using its official term just because it makes it easier for people to follow along.
Speaker 1:But the official term is dyspareunia, that's pain during or after sex, but we're just going to talk about it as sexual pain. That sexual pain looks a ton of different ways, so we're going to just talk about what that even means, because you could be experiencing, someone could be experiencing some kind of sexual pain in the same room. Someone could experience a different kind and they feel different. They experience it different, different. So we'll start with, you know, like superficial versus deep pain. Superficial is when it's like happening more at, like the entrance of the vagina, vaginal opening, usually described as something that like burns, stings, feel sharp. And then deeper is when it's maybe happening deeper, like within the, the lower abdomen, usually during like penetration. Deep penetration. This is more described as like an aching, pressure, cramping. Do you work with this very often?
Speaker 2:Sometimes, but it's usually in the context of a relationship versus like an individual with sexual pain. It's interesting, though, because I've seen a lot more superficial pain happen, like after childbirth, yeah Right, so tearing can happen. A lot of different things can happen. Right, things change, things change, and so it's really interesting to see. Obviously, pelvic floor PT is something that I typically refer to for a lot of things. I also keep a set of dilators in my office, just to be like these are what these look like.
Speaker 2:This is what this does. I also have a monster cock in my office, so like I just have a monster cock. Yes, it's a dragon oh yes, it's a dragon. That's kind of fun. So I just keep an assortment of things, but I don't pull out the monster cock for superficial pain.
Speaker 1:I don't think. Yeah, I would highly advise if someone comes to you for sexual pain, you don't start with the monster. That might scare some people off.
Speaker 2:So my cute little dilators come out.
Speaker 1:Yeah, we'll talk about dilators and why they're important in a little bit, but that is the greatest thing that you can do.
Speaker 2:But when do you see deep pain? Like what? Are some causes of the deep pain? When?
Speaker 1:do you see deep pain Like what are some causes of the deep pain? So I mean, there's so many causes for all of these and a lot of them like overlap because they could look different for people, Right? But I think deep pain sometimes happens with some more like hormonal issues, sometimes more trauma issues, but it's sometimes more like medical issues, I guess.
Speaker 1:Just like endometriosis played part of deep pain, more like medical issues, I guess, just like endometriosis played part of deep pain, yeah, pcos, yeah, exactly so more like medical hormonal types of things usually exist within the deeper pain, but not always. And then we have pain with penetration versus like pain that lingers Again, all of like you could have. You could experience a multitude of these all at once, right? So yeah, pain with penetration is obviously like pain that is happening during the act of being penetrated by something, whether that's like a tampon, finger, toy, penis, and this can be like momentary as the thing is entering, or sustained throughout the entire you know penetrative experience, where it doesn't really go away, but it is happening primarily during the penetration.
Speaker 1:And then pain that lingers, that's like when you're done having sex or doing anything else that would require penetration, and that can last for minutes, hours, days, just a lingering pain. And again, the different causes of this. I would say that pain that lingers is potentially more due to a hormonal, medical aspect, whereas penetration we're talking a lot about vaginismus, which we'll talk about in a little bit, but yeah, I mean, there's just so many, I can't even list all the things that Go to a doctor. Please talk to someone they can go through it all Interesting.
Speaker 2:you say go to a doctor, because in my experience a lot of clients, like OBGYNs, don't know what to do. But what kind of doctor?
Speaker 1:do you go to? That is also my unfortunate experience. So I've had to really like vet you know gynecologists in the area to make sure that they have an awareness and specialty of sexual pain so that I can refer people to them. And that list of people is like small, unfortunately, although in the area that I primarily work, I've worked there long enough that I have a pretty great list of things. But yeah, it's important to find, because medical gaslighting is a thing and people may say that it's like what you're experiencing isn't real, or that it's like in your head, or that it's anxiety. So we really want to be mindful of the practitioners we are choosing. We want to go to someone who's going to listen to us and believe us and help us explore it.
Speaker 2:That makes sense and it's interesting because a lot of times there is a huge anxiety component. Oh, absolutely yeah, but it's not the only component. It's not the only component. It's not the only component. But what I will say with anxiety and something that I talk to my clients with if we think about our pelvic floor and like when we have a lot of anxiety, we clench, yep, right, that's so normal and those muscles do get overactive from. If we live in that clenched state, it's hard to really relax our pelvic floor but we're not going to have pain. That's lingering through anxiety impacted sexual pain.
Speaker 1:Exactly yeah. Anxiety is usually not going to be like a cause of lasting pain like that.
Speaker 2:And so if you're doing some somatic exercises and deep breathing, like if you're doing some of that work with anxiety, and you're still experiencing pain, anxiety is probably not the cause, right, yeah? And so I think that's worth mentioning, because anxiety does have a big component, but it's not the end-all be-all.
Speaker 1:It's not the end-all, be-all and it's usually a part of something that's like, already been happening, right? So like, if you are having pain during sex and you don't know what that's what I don't know say that you've been having sex for a while and it hasn't been painful, and you go into an experience and it is painful, and then after that it continues to be painful. Well, your anxiety is now going to grow every time you think about having sex, because now it's painful All of a sudden, you don't know why. And so now the two have become intertwined. But anxiety wasn't the cause of it.
Speaker 2:It just happened to join up in partnership. Yay, anxiety, we love that. Anxiety just really likes to make friends, really likes to make friends with everything.
Speaker 1:And then we have primary versus secondary pain. So primary pain is like if it's been present from the beginning of sexual activity. Usually this is like when pain has maybe, quote-unquote, always been a part of your sexual map or experience may show up during the first time you try to use a tampon or have a pelvic exam or try to do penetrative sex. And then secondary pain is more so, like when it develops after you've not had pain during sex. It kind of just suddenly comes out of nowhere or like gradually grows. And again, all of those are just different signs of things.
Speaker 2:I think, something that I wish we could do in a podcast, but I don't really know how is talking about the anatomy to begin with, like if we could show a diagram, that'd be really helpful. Obviously, there's no diagram.
Speaker 1:No, but usually I think pelvic floor physical therapists will do that work with people where they're like at least the ones I refer to like bring out the anatomy, show people how things work, because a lot of people don't know how vulvas and vaginas work.
Speaker 2:Yeah, we had a pelvic floor PT come to my practice and kind of talk to everyone about when you would refer, and it was really helpful, just one to see the anatomy but also explaining how your like vagina and your anus are all like both in play with their pelvic floor. And so something that really stuck out to me that she had mentioned, and she's like, if you find yourself clenching with going, like, with needing to poop, like that's also a sign of a pelvic floor issue, of like when you have to go suddenly and you're clenching and she's like that can also be a pelvic floor interesting it was fascinating to hear about that, like how many people she gets to come to her because they can't regulate their bowel movements very well, interesting and it's all.
Speaker 2:And again she showed the model. I don't remember the model because that's not something I've had come up, but it was was fascinating, huh. But you know, my my first experience was pelvic floor. Pt was actually after I had my second kid. I had so much like superficial pain and I didn't really understand what's going on and what it was is it was all my scar tissue. It was all my scar tissue from. So I had a vaginal birth and then I had a C-section but it wasn't having pain. So I had pain after the C-section but I wasn't having pain. So I had pain after the C-section but it was my scar tissue from my first pregnancy. Whoa, it was bizarre. Where was that interacting?
Speaker 1:Well, I had two babies two years apart. No, but I mean like, were you experiencing feet pain, Superficial pain?
Speaker 2:Superficial pain and I had labial tears. So I tore up into the side instead of down. Ouch, most people with vulvas having babies, they tear down. I you know surprise, I tore up into the side instead of down. Ouch, most people with vulvas having babies, they tear down. I you know surprise, I tore up. I like to surprise people.
Speaker 2:I'm different, love being a little different. And it wasn't, it was a sightless. So when we tear after delivering a baby, there's first degree and then fourth degree is the worst. Fourth degree is pretty much all the way through. Mine was a second degree, so it was like it required stitches, but it wasn't like a third or fourth degree. Yeah, it's not fun, but it was scar tissue seizing. And so I went to pelvic floor PT to work on those muscles. And I had heard about it because my kid's grandma was going to pelvic floor PT and she was in her seventies at the time because she couldn't hold her pee very well, which is common for people who are older and have had babies, and so it was just so interesting, like these different experiences and this is before I started doing sex therapy.
Speaker 2:Like I didn't start doing sex therapy until like six months later. Yeah, but it was just so interesting to have that experience.
Speaker 1:Yeah, thank you for sharing that because, yeah, I do not have any personal experience with going to PT for this, but it's cool that.
Speaker 2:well, it's not cool, but it's nice that you can talk about it, and it was a great experience. Every pelvic floor PT that I have met has been so thoughtful of consent, has been so thoughtful of bodies. Most of them are trauma-informed I personally have not encountered one that isn't but I think when the bulk of your training is around people's pelvic floor, they should be trauma-informed?
Speaker 1:Absolutely, do you have a list of providers for this area? Good, excellent. So, yeah, I mean, the statistics show that around 75% of women will experience sexual pain or do experience sexual pain at some point in their lives. Again, because there's just so many different causes. So we're going to talk about some of the most common causes of why this shows up for people. Number one, unfortunately, is sexual trauma, and unfortunately, a majority of women also experience sexual trauma, so it would make sense that these are intertwined. So, after someone experiences sexual trauma, there's a multitude of ways in which that can show up in the body afterwards during intimacy. That can look like dissociation, numbing, pain responses, and all of this is just your nervous system really trying to like protect you and guard you from an experience that was previously scary, and now it's trying to like understand it in a safer context, and it doesn't really know how to do that. Yeah, do you have anything to say about?
Speaker 2:that. I think something else to note here is, when we talk about sexual trauma, we are talking about the spectrum of sexual trauma. Yes, I think, sometimes think, if it's not like a penetrative sexual trauma experience, that that's the only way you can have sexual pain in relation, and that's not necessarily true. That is not true. Any part of feeling violated at all like again, regardless of penetration can still show up in the body during sex.
Speaker 1:Absolutely yeah, it does not have to. Sexual trauma does not have to be from any penetration. I've seen it show up in so many, so many, so many, so many ways and the body remembers those ways and responds accordingly and again has a really hard time then putting sex in the context of like a safe, loving relationship, and that causes anxiety, that causes your body to do a whole lot of things. This is usually where we'll start to see some of like the involuntary clenching because someone's having an anxiety response or a trauma response during sex and then it's painful. So sexual trauma is definitely a huge one.
Speaker 1:Next up is just like honestly, this is the one I see, this is the one I see the second most, which is religious and cultural conditioning, where we're really talking about how purity culture, shame around desire, really creates this fear of sex, and I see this a lot in people who didn't have sexual conversations about sex. What to expect? So then people are coming out of a purity culture, going into a marriage knowing that they are going to have sex with their partner, but not really knowing what that looks like, what that means, not having much of a context for what that's supposed to be like for them as women or people of all of us, and that causes a ton of anxiety for a lot of people.
Speaker 2:I think so. I, in my practice, I see this the most primarily because I don't do a lot of like. I don't do a lot of primary trauma work. So a lot of times I will see clients who've experienced trauma, have done their trauma work and then come to me to get back on the saddle, if you will. Yeah, but I see a lot of people for religious and cultural conditioning, and so when we talk about purity, culture too, and that lack of knowledge about sex, is that also means a lack of knowledge on an orgasm Yep, how to achieve orgasm, what are the pleasure centers in our body? And so sex can be painful because we're not sure what we're doing.
Speaker 2:Yes, our partners are not sure what they're doing. Yeah.
Speaker 1:And then there's also this like cultural script that goes along with it, which is just that, like sex is just something, you know, obviously context dependent, but sex is something that you do in a marriage. It's kind of like what's expected of you with your husband and there is no talk of like pleasure and so it's not an expected part. And so then they go into and they hear that, like you know, sex is painful the first time, right. So now they're having a sexual experience for the first time that they're really anxious about, don't know what to expect. That sex ends up being painful because it's kind of scary and like all these new things are happening and then the sex is painful. Usually people don't really enjoy it and that becomes like the script in their head of like, oh well, this is just how it's supposed to be, because this is like a duty. This is what I just show up and do. Lay back and think of England, yeah.
Speaker 1:Yeah exactly Lay back. But yeah, then that creates something that starts lasting over time. And then they're, you know, five years into a marriage and starting to learn that that's not maybe how it's supposed to be, and they're showing up and there's a lot of grief with that too, and a lot of confusion and a lot of like how did I not know that it wasn't supposed to be like this? So? But then you have a body that's been experiencing the stimuli with pain for so long and it takes. It takes a lot to start working on, start undoing.
Speaker 2:It's interesting and this is related but not related. You know how my ADHD brain works. I was having a conversation actually last week about how a lot of times with the monarchy, the first time they like have sex, it has to be watched by everyone. So, like that consummation, what? Well, you have to prove that they had sex and their marriage is valid, right? So we were talking about the context of Marie Antoinette and her husband, okay, which, whatever his name is, because no one cares about him, but they were like teenagers and have like a room full of 100 people.
Speaker 2:Like watching them have sex for the first time, talk about anxiety. Like who's going to enjoy that if you're not like now, they're like an exhibitionist. They may live their very best life, right, but if you're not an exhibitionist, you're not going to enjoy that. Like it's not. Like they had Viagra back then. That's a lot. I did not know that that was very, very common with the monarchy, because they had to prove essentially that the marriage was valid. If a pregnancy resulted, they had to prove that it was from that union.
Speaker 1:Wow, thank you for sharing Anytime. My random tidbits. Definitely did not know that.
Speaker 2:But I mean, luckily we don't do that.
Speaker 1:No Today.
Speaker 2:Hopefully you know, in some cultures, you know, you lay a cloth down to make sure that the woman bleeds.
Speaker 1:Oh, I really want to talk about that because that is so problematic for so many reasons. I mean, like women will in some cultures will, like could be like put to death for that if they don't bleed, which is like terribly. Yeah, because you can break a hymen and have nothing to do with sex. Yeah, your hymen can break before sex and riding a bike and hitting a bump too hard, right, like we are kind of sold this idea that during the first time you are supposed to bleed, but that's not necessarily true and a lot of people don't. And usually, if you're not, it's because you're like really relaxed and enjoying yourself, and if you do bleed a little bit, you might be a little more anxious or like just depending on a lot of different contexts, right, but yeah, and you can bleed at different times during sex, if it's not your first time oh sure, like yeah, that could just be like, if you're close to your period
Speaker 2:medical you could get things going. A lot of reasons can cause bleeding versus not experiencing bleeding. I once knew someone that had to have their hymen surgically removed because it was so thick.
Speaker 1:No Interesting. That can happen too. Anatomy yeah, that's all a part of it too.
Speaker 2:There's just so much that goes on the next to me. But yeah, you have to have it removed because it will not break. Wow, and just because how thick it is, it can be the strongest hymen in the world.
Speaker 1:It is the strongest hymen in the world.
Speaker 2:It is really protecting that purity.
Speaker 1:So, yeah, this whole you know, back to like, this whole I guess we call it like the good girl script, and how it essentially disconnects women from their bodies, knowing what to expect during sex.
Speaker 2:And so then they go into sex not knowing what it's supposed to be and then kind of just accepting whatever it ends up being, even if that's painful. So when you talk about the good girl script, it's like that idea of like you seem perfect and you're modest and have no interest in sex but you're expected to be like what's the word I'm looking for? I don't know what is the word I'm looking for. I don't know what is the word I'm looking for. I keep saying freak in the sheets but that's the technical term.
Speaker 2:It's like what is the phrase I'm looking?
Speaker 1:for? Well, I mean, I would love to do a whole I think we've talked about it before like a whole episode on like the Madonna horror complex. Yes, so fascinating. But yeah, the idea that like, in some regard you're supposed to be like prim proper and put together and show up in this one way and then like, maybe in your relationship you're also expected to like show up as this, like in this really sexual way. But if you don't, if you never learned about sex or like had much of a chance to develop a sexual identity, like that might be really hard for you, you know. So I work with a ton of people really on this topic of deprogramming shame, but then also working on developing their own sexual identity and like separate from their husbands or their partners or whatever it is Like who are you sexually, what are you, what do you like, what don't you like? A lot of times they're just so used to kind of going along with whatever their partner likes and so they have no context of even thinking about like their own pleasure.
Speaker 2:So oh, cause I mean and we've talked about this before in this podcast is like I've worked with so many people who didn't know how to masturbate till their mid twenties or older. Yep, yep, like, just not a clue. And so it's like if you don't know your pleasure, how are you expected our partner to know our pleasure, right? Um, there are so many times where my homework is go masturbate, yeah.
Speaker 1:Yeah, I literally give people that homework a lot.
Speaker 2:Just go do it, feel around, see what happens.
Speaker 1:Well then also, you know like explore the ways in which you find some stimulus right, Like some people like to watch videos, some people like to read erotica, like what is a way to kind of get you in tune with, like feeling desire turned on. And then how do we like incorporate that into your own sexual script, your own sexual identity? What does that mean for you all that stuff?
Speaker 2:and I think there can be, like going on with this idea, some guilt and shame shame specifically around what we're interested in, like, oh, I'm turned on by this thing and it's something that feels wrong and so a lot of like I need to shut that down. So it's like what makes it wrong.
Speaker 1:Right, yeah, where's that coming from? Yeah, lots of deprogramming, yeah. So tell me more about vaginismus. So this is actually the most common thing I see. So for me personally, I see vaginismus the most, and then I see the religious context, religious cultural context, and then I see sexual trauma context, religious cultural context, and then I see sexual trauma. But I'm kind of the same as you where, like, I work within a trauma lens, but usually they're doing like deeper, more targeted work on that beforehand and then they're coming to me for what's going on after.
Speaker 1:But vaginismus is basically like the involuntary tightness of vaginal muscles and this, this is what's happening throughout. A bunch of these causes, right? So whether it's anxiety, trauma or like the fear of pain or the lack of knowledge, all of that is going to make your body tighten when it comes time to having sex. And it's not your fault. You don't know that it's even happening. Your body's just trying to like pretty much safeguard you from penetration and so everything just gets really tight.
Speaker 1:Sometimes penetration can't even happen because it can get so tight. But if something is getting in there, that's usually pretty painful because that muscle is now clenched. There's also medical conditions that can keep that muscle really, really clenched. That isn't even technically about anxiety, but then again anxiety shows up, holds hands, because now we've associated this thing with pain and now we're anxious about it, which makes complete sense. So things to look out for for this is yeah, if you have, like, any issues putting in tampons, the penetrative pain, if you find yourself really like avoiding vaginal exams because you're worried, well, if you have anxiety around it and you're worried about whatever has to go into you at that, like those are some probably pretty common signs that you're experiencing vaginismus.
Speaker 2:It's so interesting, I'm actually doing a research literature review right now on vaginismus with queer women. Yeah, because, if you think about it, do you know a lot about lesbian culture? Yeah, so, right, we have the touch me, not lesbians, right, like that don't enjoy receiving pleasure or receiving touch during sex, yep. And so there's some research to show that there are high levels of vaginismus in these touch me, not lesbians. But if penetration isn't a part of your sexual script, then how do we flip it right Of? How can I enjoy pleasure and sex and not worry about the pain that I may experience? And that doesn't mean that if you're a touch-and-not lesbian, that you all have vaginismus. That's not necessarily true, but we are seeing high rates of vaginismus and really, really, really low diagnoses rate. Because, again, if penetration is not important, right, for your sexual script, then there's not really a draw to address it. Sure, that makes sense and so it's wow, it's an interesting, an interesting topic. Because, yeah, it's curious, this again, this touch me, not style. Where does that come from?
Speaker 1:yeah, what's happening there, and vaginosis one of is one of them, yeah, one of the reasons can you send me that absolutely interesting, absolutely, um, so, with people with vaginismus and pelvic floor dysfunction, really overall, uh, we, we don't just tell people you know people aren't coming into us and we're just like, okay, well, you just like need to relax and then like things will, because the body is now literally attuned to having an involuntary response and so you can relax all the live long day. And when someone comes at you with something to penetrate you with, your body's going to clench up. There is no relaxing through that, because you have to reteach your body. That penetration is safe and can be pain-free. And that's where we really start talking about dilators and sending people to pelvic floor therapy. And that's often what happens at pelvic floor therapy is you'll start using dilators to like slowly, work on. Do you want to explain what dilators are?
Speaker 2:Yeah, so they are a. Usually they're silicone-based and so the smallest one's typically the size of your pinky Yep, like as small as your pinky and they go up in size. And you are looking at relaxing the muscles in your vulva. So you would stick this pinky size dilator in with lube, right, especially if that's really uncomfortable, absolutely, and you're kind of pressing on the external, not the external. You're pressing on the muscles around to try and relax it. So, thinking about like a foam roller that you use, like rolling out your muscles after working out, this is very similar, but in internal, exactly.
Speaker 1:And so the dilators go up in size and as you do this work, your muscles are learning to relax and you're learning how to relax with them, and that is a part of it. But it's not just like a mental you relax thing. And then your body is also learning over time to disassociate the penetration with pain, because now you're not experiencing pain as much during every penetration, and so you're learning to trust, and your body's learning to trust, that this doesn't always have to come with pain, and the more we can go into an experience not expecting pain, the less we're going to clench and get anxious and have the fear of pain.
Speaker 2:I have found success with clients who do some sort of clitoral orgasm ahead of time to help their body relax a little bit more, and then try the dilator and they have more of that natural lubrication.
Speaker 1:You can also use lube, but the body is just a little bit more relaxed, yeah, so I do encourage some sort of orgasm ahead of time yeah, and sometimes, when we've done enough of this work and we're because a lot of the time people with vaginismus like have not it's been around long enough that they not all the time but they haven't yeah again really like learned that sex can be pleasurable and enjoyable. So eventually you can also get to a point where, once the pain is pretty pain-free, then you learn, yeah, like okay, can we experience orgasm with penetration also happening? And like can that be pleasurable? Can we see that both of those things can be paired?
Speaker 2:So yeah, lots of. And I also want to point out that if you don't want to work on the vaginismus or this pelvic floor dysfunction, if that's important to you to leave it alone and you don't want to address it, you can change your sexual script. Yeah, oh, yeah, I've had straight couples that have redefined what sex is for them, sure, and so it may be mutual masturbation. Redefine what sex is for them, and it may be mutual masturbation. It's exploring different things and so that's okay. Like, if you're like, you know what, I am happy with my sex life without penetration. Okay, boo, like, live your life.
Speaker 1:Yeah, yeah. How could we redefine sex and what that means to us? Because sex can look like a whole lot of different things without penetration.
Speaker 2:Because I feel like something that happens and I see this especially in heterosexual couples is shame that they're not having the kind of sex they think everyone else is having. But are you?
Speaker 1:enjoying the kind of sex you're having. Well, and you know I mean working with this within a couple's context. Sometimes the harder parts to navigate are, you know, like what, if you have one partner who's like, yeah, I want to redefine, like, what sex means to me and I don't want to work on this and I don't want to have penetrative sex ever again and their partner's like, oh, like, I want to support you and I love you and I like, want you to be comfortable and happy, but like I would really miss penetrative sex right, like I would still really want that in my relationship. And then you get to navigate all those topics and conversations and it can be fun figuring out how. It can be fun figuring out how, yeah, yeah.
Speaker 1:So the next cause, common cause, is, like we talked about, medical and hormonal issues. So endometriosis, pcos, sometimes hormonal birth control can mess things up and cause some pain issues. Menopause, especially Breastfeeding Breastfeeding Anytime that your hormones are doing wild, wacky things, you're going to potentially like experience more dryness, which can cause pain, or just overall just have things going on that are causing pain, inflammation, nerve pain, not even like trauma-informed providers, but just like well, I mean, yes, trauma-informed providers, but someone who can talk about like this large scope of things that are happening to help figure out what exactly is going on right Like because multiple of these things could be going on at once.
Speaker 1:And it's hard too because I know, especially with endometriosis, that can't even be diagnosed unless you're like having surgery, and that is deep pain, that is deep pain, that is deep pain.
Speaker 2:I know we also look at how pregnancy and I mentioned breastfeeding impacts, like our hormones and like breastfeeding specifically causes a lot of vaginal dryness. Yeah, and so, guys, lube's your friend.
Speaker 1:Lube is your friend. There's no shame in using lube Absolutely not. But there's women, anyone. There's no shame in using lube sometimes if you need it, just because, again, so many different factors go into our bodies and how they work and you could need lube. You know, one day of the week and the next you're good to go. You know, and that's, that's OK, when you are in your cycle. Yeah.
Speaker 2:Oh my God, when you are in your cycle Right, like people like I'm really horny once a month. Well, honey, you're ovulating. You're ovulating, and so your body is going to produce more natural lubrication Yep, versus when you know you're closer to your period. Because what happens in your cycle is your estrogen is up until you ovulate, and then your estrogen drops and your progesterone goes up yeah, and so when progesterone is high, we have a little bit more dryness Yep, right, versus when estrogen is high. And so that's why menopause is so impactful Right, because we're not having as much estrogen as we were before. And so I think what can be really helpful is just understanding our cycles and our bodies. Well, sex hurts more at this particular time of month. There could be a reason for that, yeah, and so exploring that a little bit, absolutely.
Speaker 1:So if you are experiencing any of the sexual pain that we've talked about today or for any of the reasons, we definitely want to work on finding a trauma-informed pelvic floor therapist, you can always call people ahead, ask the questions like hey, would you call yourself trauma-informed? What does that mean to you? You, what does that look like? Um, somatic therapy, sex therapy, emdr if there's, I mean any component, but that's like especially useful for a trauma component. But any body-based approaches to therapy are really going to serve you here, because there is um so much of it. I mean, it's your body, right? So, like the therapy isn't just cognitive, behavioral therapy isn't going to do it. You can't reframe your way out of that one. Your body has to learn some things within it. So and all of that is meant to you know, rebuild safety and connection with the body. That's like the point.
Speaker 2:So this is something I'm curious about what if you don't feel safe with your partner, like emotionally safe with your partner?
Speaker 1:That plays a huge component, and you should be in couples therapy discussing that. And yeah, so I don't just see individuals when it comes to sexual pain. I just also see a lot of couples who are like working to navigate it, because I think it's pretty largely helpful to have the partner in there to assess what's going on in the relationship number one but also so that they can understand what's happening, because so much of the time the partner doesn't know and doesn't have the tools and knowledge and like maybe the way in which they are handling their partner having sexual pain is creating like emotional unsafety because they don't they don't know the things Right. So I do always try to invite partners in. If I'm seeing someone individually, I'll at least try to invite their partners in for like a few sessions, even if it's just like hey, can you like listen to some of these things we're learning, so that you can have a different way in which you're like framing this in your mind and in your relationship.
Speaker 2:Yeah, I think that's a really good point because I've had some people come to me and I'm curious your spiel. So it's typically like when we're experiencing any type of sexual dysfunction, the first thing we look at is medical relationship, health and trauma, Yep. And a lot of times it's like, oh well, like yeah, I'm happy in my relationship, and then we come to find out that there's a lot of stuff happening that needs to be sorted through. But they're expecting results for their sex therapy and it's like, yeah, but we're not going to have results with our sex therapy when we're feeling unsafe in a relationship.
Speaker 1:Yeah, and how the partner is approaching this is huge a lot of the time, because there's just a lot of misunderstanding. So, yeah, but that also comes with working with people on like reframing sex, with like curiosity and communication and consent and really like making sure that those things are in either the individual's relationship with the self or with their partner, because that's what's going to create more safety. And then, yeah, this work is slow. I have never, and it's unfortunate because a lot of the time the partners are like okay, well, you're like doing this work now, so we should be able to just like start having like penetrative sex again, like really soon, and it's like no, no, like this takes some time and I don't like want to freak anyone out, I just want to normalize it.
Speaker 1:It usually takes at least a year. Just want to normalize it. It usually takes at least a year, and that's. You can obviously do the most that you can do and it's going to quote unquote speed it up, to like, if you're doing somatic therapy and pelvic floor therapy and you're like really going at it in all the ways it can help quote unquote speed it up. But it is multi-layered work, it takes a lot of time. Trust takes a ton of time to build with anyone, and especially with yourself, with your own body, like and I really just want to normalize that. We want to encourage like slow, consent driven exploration of what feels good and like reestablishing trust with yourself, with your partner. All of that just takes time and that's okay.
Speaker 2:Yeah, I tell clients all the time this is a very layered approach. Some layers take no time, some layers take a lot of time and success is just movement. It isn't a full trifle now, it's just movement. And so taking that time, I think something else I want to call attention to is we talked about the impact of purity culture earlier and if we're talking about working with our partners, so if we're looking through a heterosexual lens of a woman is experiencing sexual pain and we have that narrative we talked about the Madonna horror concept but we also think about the narrative that's put on men of like you're responsible for your wife's sex, right, and so you're not a man if you're not doing a good enough job, or whatever that looks like.
Speaker 2:And so I think we also need to backtrack and think about what are the scripts that they're experiencing as well. Absolutely, and there's going to be some reframing and relearning on their end too. Absolutely, because I don't think we talk about that a lot and, granted, a lot of straight men aren't coming to my practice typically. Yeah. Yeah, I think that narrative is important to unlearn too. So if one of us in a relationship is having to unlearn a lot of stuff, we need to look at what our partner also has to work through as well.
Speaker 1:Absolutely yeah. In the religious and cultural context, that's also pretty huge. Yeah, what does the partner believe about sex, too, and how is that impacting the whole thing? So yeah, thank you for adding that.
Speaker 2:Absolutely.
Speaker 1:Yeah, so we're just going to move on to just like a little bit of myth busting around this, because there's just so much, and we're just going to answer like common questions I guess people would have, but a common question that I get all the time is is it is this just like in my head? Is this just anxiety? And again, no, your body's having a very real response. Your brain is then having a real response to that.
Speaker 2:Right, and they're holding hands and even if it is anxiety, that doesn't mean it's just in your head. Yeah, absolutely.
Speaker 1:Right, like it's all about the fear of pain during sex, just like a panic disorder is like the fear of a panic attack, and the fear itself is then creating more anxiety, which is then leading to the panic attack, right? So yeah, is it in your head? I mean, to an extent there's a component. You mean everything's in your head.
Speaker 2:Yeah, but it doesn't make it any less real.
Speaker 1:Right, and people are often talking. You know, like, how do I talk to my partner about this? Well, if they're asking me that question, I'm just going to invite them into. I'm going to invite your partner into the room so that we can all talk about it together. And it's not just on you to like play a game of, like telephone or like inform your partner about all these things you're learning.
Speaker 1:So invite your partner to a trusted professional and see if they are open to that, and if they aren't open to that, that's the difficult dynamic for you to navigate.
Speaker 2:It's so interesting because I invite partners in a lot and sometimes the reaction to being there is like what?
Speaker 1:Yeah, why am I here Like?
Speaker 2:what's happening.
Speaker 1:Sometimes I'm literally like I just want you to sit here and listen, like I'm actually not going to interact with you. I just want you to like learn what we're learning and just see, like, what we take away at the end.
Speaker 2:My favorite is when my client has built this thing up in their head and then the partner comes in and the partner's like I didn't realize that was an issue and it's just like all that anxiety comes crumbling down, because it's like you mean I've been spiraling about this for months and it's not even on your radar, it's not even Like oh no, I'm good.
Speaker 1:And then people are asking you know, can I, will I ever enjoy sex again? Well, that looks very different for everyone and that's like such a subjective experience. But if we are doing the work, the multi-layered approach, we're gonna see, and if not, then we're gonna reframe what that means to you and what that means for your life. Pleasure and how we get pleasure. Yeah, how do we just experience pleasure even if it's not related to sex, right?
Speaker 1:so and then, yeah, common myths, especially within, like, the religious and cultural context that, like, pain is normal. No, it's common, it's not normal. I don't know what else to say about that. I mean, it is what it is it's common, not normal. But it happens to a ton of people all the time. If you love your partner, sex won't hurt. I don't. That's. That's not how that works either. No, because your body's having a response that has probably maybe nothing to do with your partner Exactly.
Speaker 2:Or love Something that has come up before in sessions is this like people don't think about having orgasms during foreplay, yeah, so when your body gets more aroused, your cervix gets higher, which accommodates more room for penetration, if you will. How?
Speaker 2:nice of you to make room in here, thanks, In case you're pulling out the monster cock like you need that cervix to be a little bit higher. But so many clients I've worked with had not thought about having some sort of clitoral orgasm ahead of time, and that can make a really big difference in how you're able to enjoy penetration, and so, yeah, you can orgas, in how you're able to enjoy penetration, and so, yeah, you can orgasm during foreplay.
Speaker 1:Oh yeah.
Speaker 2:And sex doesn't have to end at orgasm. Nope, there are other ways to explore. Yep, I just think that's important Get the orgasm.
Speaker 1:Absolutely Get the orgasm. So, yeah, we really want to, you know, remind people that common, not normal, but you're not broken. I think that's like a huge script I work with too, with women coming in and like really feeling othered and like broken. They're talking about, they're like listening to all their girlfriends like talk about sex and they're just like kind of sitting alone in that, being like God that's just not how I experience it Right and like feeling really like lonely or like ashamed to even like speak up or say anything about that. So you're not broken. It's definitely not your fault. Your body is probably doing something that feels like protecting itself, right.
Speaker 2:So we need to figure out what it's protecting from Exactly. How to remind it it's safe.
Speaker 1:Exactly, and everyone deserves a pain-free, pleasure-filled life, but also sex life, if that's where you want to take it, you know, something we didn't talk about is the impact of SSRIs. Oh, yeah, ssris. We would put that with probably like medical hormonal. But SSRIs are going to dry you up, they are going to drop your libido. That is such a hard one because it's like the worst trait in the history of ever right.
Speaker 1:It's like I have to. I'm feeling happier now, but like I do not. I don't want to have sex at all. But yes, that's that's hard to work with. That's when we really start to like talk about, like exploring what stimuli may help, even like trigger some of that responses. That's when we really start talking about spontaneous versus responsive desire, which we've talked about on previous episodes.
Speaker 1:But to to recap that, that's like two different types of desire, right, like some people can just like kind of get horny at the drop of the hat and like have sex in the kitchen out of nowhere. And some people are like no, like I need to like be touched, stimulated. I can't just like woo me, yeah, woo me. Let's like set a scene, like I kind of need things to be exactly a certain way to even be able to like access that. So usually a lot of the time I see a lot of people who struggle with like they were having spontaneous desire before and then they went on SSRIs and now they're like what the fuck is this? What do I do here? And then we have to talk about responsive desire and they they have to learn a whole new like sexual script of how to even get into having sex, and it's often a way in which they're not used to and it just all feels different.
Speaker 2:And we talk about medical gaslighting. I feel like I've had so many clients gaslit of like, yeah, but at least you're not depressed. Well, sometimes it just impacts the libido and it's like. No, like there's well, butrin is a common antidepressant there's a, there's different ones.
Speaker 2:You can definitely like try to see if you can like mitigate some of that so talk to your doctor and if they blow you off, you might want to consult with a different doctor. You know, our next episode should be about different desires, like managing relationships with different desire patterns let's do it all right.
Speaker 1:I love that, okay. So yeah again. You're not broken. This isn't your fault. You deserve pain-free, pleasure-filled life, but if you want to include that in your sex life, you also deserve that. So yay. And if you want to contact us, oh yes.
Speaker 2:Podcast at valid loveorg.
Speaker 1:And you do post resources for our stuff, sometimes, so good books to mention here are, come as you Are, which most people have probably heard of at this point, and there is a newer edition as well.
Speaker 1:Is there? Excellent, and it comes with a workbook. So, come as you Are is going to like talk about your body desire. It's going to talk so much. You're going to learn so much, so many things, and there's a handy little workbook that goes along with it. And then there is the Sexual Healing Journey by Wendy Maltz and Pure by Linda K Klein, which is about some of those like cultural things we talked about.
Speaker 2:I love it. Well, we'll see you next time.
Speaker 1:Bye.
