Sexual pain in women can hurt more than your sex life. Bergeron, Rosen, and Pukall (2014) suggest, “The experience of sexual pain during intercourse is extremely distressing to both the sufferer and their partner, who may feel confused, guilty, sympathetic and/or deprived. The consequences of this problem extend beyond sexual intercourse and affect individual psychological health, as well as relationship satisfaction” (Principles and Practice of Sex Therapy, p.159). While sexual pain may affect your psychological health, it is also true that your psychological health is also impacting your sexual pain. Here are the 7 most common psychological contributors to sexual pain in women:
Psychological fear is about having negative beliefs about penetration. Fear may be causing you to avoid penetrative sex or experience any kind of physical intimacy with your partner.
While the fear of penetration or pain is highly common (especially in women who were raised more conservatively or religiously), the most common penetration related negative belief is fear of genital incompatibility. For example, you might think that “My vagina is small and will not be able to accommodate my partner’s penis”. Believing that having a small vagina often leads to a catastrophizing thought, and this catastrophizing thinking may prevent you from engaging in a positive sexual experience. Other related fears such as fear of failure, fear of success, fear of abandonment, fear of disappointing your partner, and fear of being judged or observed need to be addressed in therapy.
- Untreated Trauma
Some of the untreated trauma might be a big-T trauma, such as history of sexual abuse or domestic violence. In addition to big-T traumas, small-t trauma can be equally concerning. Experiencing psychological or emotional abuse from a previous partner or a parent, unprocessed grief, and any life adjustment that has gone without addressing such as getting a divorce or moving to a new city are important to evaluate in sexual pain treatment.
- Anxiety, Stress and Any Other Psychological Concern
Whatever happens outside of the bedroom impacts what is going on inside of the bedroom and vice versa. In sexual pain treatment, it is crucial to monitor and regulate your anxiety and stress level. The more anxious you feel, the more tense your pelvic muscles will be. Psychotherapy focuses on stress coping skills, as well as provides you with the tools that you need to manage your anxiety levels inside and outside of the bedroom.
Other psychological concerns such as trauma, grief, depression, ongoing substance abuse, and insomnia need to be addressed simultaneously with sexual pain issues.
- Body Image Issues
It is common to have a negative body image when experiencing sexual pain. Women with sexual pain often have the thought that “My body is failing me” or “My body is betraying me.” When your body experiences pain, your anxious mind may jump to a conclusion and tell you, “There is something wrong with your body” or “Why aren’t you like other women?” Psychotherapy helps you to explore and identify the negative body images and helps you to build a better relationship with your own body. Sexual pain treatment aims to help you to see your body as your ally, as opposed to something that fails you.
- Relationship Issues
Sexual intimacy often occurs with the presence of emotional intimacy. When you feel emotionally safe in your romantic relationship, you can feel like “I can talk about anything with my partner. I know that they won’t judge or criticize me, and I won’t offend or hurt them.” Lack of emotional safety in your romantic relationship may prevent you from engaging in open communication with your partner. Sexual communication, such as letting your partner know what you like/do not like or if you experience pain can significantly improve your sex life. Emotional safety is the key to healthy sexual communication.
If you and your partner are highly conflictual or conflict-avoidant couple, re-establishing emotional safety is a required initial step in psychotherapy.
- Conflicting Beliefs About Having a Child
Sex is not always about reproduction, but sometimes it is. When one partner is eager to have a child, it does not mean the other partner is always on the same page. The differences between your and your partner’s desire to become a parent may cause one partner to avoid penetrative sex or can shorten the duration of penetrative sex. It is important to talk to your partner about each other’s thoughts about whether you want to have a child, and whether now is a good time to do so.
- A Partner’s Sexual Problem
Couples therapy is helpful in assessing each partner’s sexual functioning. Often, a woman comes to therapy with sexual pain issues and considers, “I am the only one who needs to change or put in all of this work to make this problem better?” Commonly we also see that male partners experience sexual dysfunctions too such as delayed ejaculation. As your male partner’s ejaculation time delays, you may assume that you are not attractive enough or your body is not cooperating to make your partner achieve an orgasm. If your partner takes longer time to orgasm, it is helpful for him to see a sex therapist. Many male sexual dysfunctions may negatively contribute body image issues in their female partner. Similarly, if you are a same-sex couple, your partner may also be experiencing sexual issues such as vaginismus, endometriosis, or low sexual desire.
If you are experiencing sexual pain and can relate to any of these psychological reasons that I have provided, please contact us. Let us explore your psychological reasons together!