FYI: the following blog post discusses mature subject matter.
In working with a patient recently, it has come to my attention that the interwebs are lacking good information (or any info for that matter) for the partner of a female pelvic pain sufferer. Now there were some things that I could find, but they were either discussions in a scholarly journal or a recent blog post I found that didn't much like men by the way it was written.
In working with my patient, I knew that WHAT she wanted to give her partner to help him become a part of her healing journey was neither of the above. In the past, I have basically educated my patients on specifics and the differences of males vs females and given suggestions on foreplay, positioning and such. But this time, it would be best in a letter form. I know that many a past patient would have also greatly benefitted from an actual letter addressed to their partner. Pain with intercourse is a delicate and sensitive subject. Not everyone is at ease in speaking about their sexual preferences and voicing their discomfort. In fact, women are actually quite good at not complaining about pain with intercourse. Some studies discuss the rates of women who have pain with sex as high as 1/3rd of all women!
So here is probably the longest blog post ever here.
Read on if you would like to see what a pelvic physio would suggest to a partner of a female pelvic pain sufferer. I post this here, in hopes that it can help many other women and give them something to discuss with their partners if they are experiencing pain with sex. If you have pelvic pain, I would suggest you work with a pelvic physio like myself as well as consult with a talk therapist or psychologist who specializes in sex therapy such as Karlaina Brooke, Psy.D. who gave great expert input in the making of this letter which I had posted her previously and am now updating to reflect her contributions.
Both of us have practices her in Vancouver, Washington, but we are both in contact with colleagues throughout the country and can likely help direct you to professionals in your area if you are not local to us.
Dear Partner of Pelvic Pain Sufferer,
You are reading this letter most likely because your significant other is being treated for pelvic floor pain. You are a key part of the solution and very much a part of her story with this. She will not be able to completely resolve these issues in a vacuum, without your involvement. So this letter is to bring you into the healing team if you will. Thank you for your love and support of your partner.
Research shows that 30 percent of women report pain during vaginal sex and "large proportions" don't tell their partners when sex hurts. A lot of this has to do with our culture around sex. Movies depict a very male centric version of intimacy and sex. This includes both parties involved being aroused at the same rate with the typical climax. Women are told before their first sexual experience that it will likely hurt. And sometimes they still have pain the second, third and beyond. Individuals often feel guilty or shame when they do not become fully aroused at the same time as their partner. Full arousal is very important for women to be able to not experience pain with intercourse.
Sometimes they need to have already had an orgasm before being able to tolerate vaginal penetration. When it comes to true pelvic pain with intercourse, the partner of course feels guilty, but often powerless to change the situation. This is where this letter comes in. I hope to convey some ideas that can be used by both parties with the goal of both having an enjoyable time without pain.
1) COMMUNICATION. Have you ever met a neighbor, heard their name and then later forgot it? And then every future interaction with them, you are killing yourself trying to remember their name… AWKWARD right? How awesome would it be to ask their names 5 years into living next to them? Well, this is sort of similar when a couple gets into a pattern with their sex routines. After awhile, it can feel really awkward to talk about changing the routine due to feeling like you will hurt the other’s feelings or are a bit shy about discussing details despite having a great relationship. This REALLY MATTERS. It is important to have a candid, yet respectful conversation about intimacy. We should not feel bad about asking for more foreplay or to have a sexual experience that does not include penetration if they are having pain. Yet we do. Both partners should be able to discuss their feelings. This needs to be a conversation where you both feel safe. Both should do their best to not be offended.
2) AROUSAL. As was mentioned above, humans are aroused differently and within different amounts of time. Men can be aroused through mental or physical stimulation (and often quite quickly). Women are a bit more complicated. As much as they may love and feel safe with their partners, some people often require much more time to become aroused. It is important that we are considerate of this and not shame the other if they are not aroused as quickly.
3) PAIN. Pain is the body’s way of communicating a perceived threat. The instinct to protect is stimulated by this pain. If a certain pain persists, the body becomes accustomed to responding in a protective way. This can turn into the body being in perpetual protect mode with the corresponding muscles going into spasm and can then become shortened. For women with pelvic pain with penetration, their pelvic floor muscles often become perpetually spasmed and shortened. Their body will likely go into protect mode when their partner comes on to them, despite them wanting to reciprocate. This is where changing up the routine and allowing the woman to experience intimacy and orgasm without penetration is particularly important. Their body needs experiences that are both pleasurable and non painful to help her nervous system reset and begin to associate intimacy as pleasurable and not as an impending painful experience.
4) Even partners who are female, and share the same anatomy can feel similar feelings of guilt or confusion when they feel they've caused their partner pain. They too need support and empowerment regarding how they can join the treatment team.
5) FOREPLAY. Even though Hollywood would have us believe that all sex is hot and heavy, this is not the case. If we are going to help our partner relax, we need to take the scenic route. And I don’t mean 2 extra blocks on the way to the local coffee shop. Try setting a timer before proceeding beyond foreplay. Try 15-20 minutes. Try to not involve any touching of genitals of either partner. If one person wants to go beyond this point and the other still wants to stay in this phase a little longer, you don’t proceed further. When it comes to the partner who is trying to resolve pelvic pain, they is in charge of this.
6) PENETRATION. This is where SLOW and COMMUNICATION is key. If we get too excited here, pelvic floor muscles can go right back into protect mode… regardless of arousal. Your partner needs to be both really relaxed and also feel in control. Confident that if they communicate to slow things down or pause, that their cues will be heard and obeyed. Often for males, there can be an instinct to go fast, but an orgasm can happen at any speed. Respect your partner. Know that they are very likely quite used to not communicating their discomfort and good at it. They will have to work at this too.
**Though our culture and media focus on penetration as the goal, expanding a couple's repertoire of being intimate and erotic without penetration is an important thing to add to their toolbox. It is also a way to continue being intimate while the female partner is in treatment and not yet able to attempt penetration. Later, they can continue this so that intimacy is not only tied to penetration.
7) AND ANOTHER THING… the nervous system is designed to calm down and become LESS PROTECTIVE in the presence of POSITIVE STIMULI. This can include thinking of happy thoughts, laughter and favorite music, singing and BREATHING. These are all ways to communicate to the brain that it’s ALL OK. Be sure to focus on PLEASURE in as many ways as you can.
In the end, intimacy should be about connection, trust and love. When we engage in sex with our partners, no one wants to cause the other pain. This is meant to be enjoyable. This is where taking the above concepts to heart can help both parties involved.
With Much Respect,
Your Pelvic Physio
Author: Buffy Stinchfield, MPT with contributions by Karlaina Brooke, Psy.D
To download the link to the letter in PDF, click HERE.