When Sex Hurts

The following was originally published in Pink and Teal, a magazine for women living with cancer. However, there are many reasons why sex can be painful, so the advice below may be useful to all women who have experienced pain or discomfort during sexual activity.

Sex is supposed to feel good! But sometimes our bodies just don’t cooperate with our primal urges and it can be more of a pain than a pleasure. Many women suffer in silence after a cancer diagnosis and their support team (friends, family, medical professionals and partners) may discount sex as insignificant in comparison to the complex challenges of treatment and recovery. But sex, however you define it, is significant. For many people, intimacy, affection and pleasure are fundamental to quality of life.

Women diagnosed with breast or gynecological cancer may find sex painful for a number of reasons including:
•Lack of lubrication. Friction is an inherent part of sex, but without adequate lubrication, it can be uncomfortable and even painful. Cancer treatment, including medication, radiation and surgical removal of the ovaries can inhibit the body’s natural lubrication by lowering estrogen production.

•Thinning of the vaginal walls. This too may result from chemotherapy and treatment drugs that reduce estrogen production.

•Tenderness and inflammation of the vagina. Radiation therapy can damage healthy tissue causing irritation and the development of scar tissue that may resist stretching during penetration.

•Pain, tingling or numbness in other areas of the body (non-genital) as a result of cancer treatment.

•Muscle tension and/or spasm. The stress of treatment, medical exams and the recovery process can result in tension throughout the body and spasm of the pelvic muscles. These muscles surround the vagina and chronic tension can make penetration uncomfortable or painful.

•Reduced sexual response. Some cancer treatments include the full or partial removal of sexual organs including the ovaries, labia, clitoris, rectum, uterus, cervix, fallopian tubes and/or vagina. Though reconstruction is an option, many women report significantly reduced sensitivity and difficulties with arousal and orgasm.

Some of these challenges may be long-lasting, but there are treatment solutions that can help. Regardless of whether or not you experience pain of discomfort during sex, experimenting with the following strategies should help you to better understand your unique sexual response and heighten your experience of pleasure:

Get Creative! We often get stuck in the intercourse-model of sex and forget about all the other hot ways we can enjoy sex play: oral sex, fingering, vulva massage, rubbing-off, fantasy, vibrating massage and dirty talk all have the potential to cultivate intimacy and lead to mind-blowing orgasms. In fact, many of these so-called alternative forms of sex are more likely to bring you to climax than penile-vaginal intercourse.

The latest research shows that women are far more likely to experience orgasm when we engage in a variety of sex acts (not just intercourse) and that we’re more orgasmic alone than with a partner. Hooray for solo sex! However, orgasm is not the end-all-be-all of sex, as many women report that connection to a partner can be more satisfying than orgasm itself.

Whatever your fancy or relationship status, start exploring all the hot ways you can enjoy sex without the pressure or narrow focus of intercourse itself. As you become more relaxed and in tune with your body, this may facilitate the relaxation necessary to explore penetrative sex.

Explore Your Entire Body. Treatment can impact sexual response in the genitals, but pleasure and orgasm are ultimately driven by your brain. Take a break from playing with what’s between your legs and explore the rest of your body. Women can enjoy orgasms from stimulating various areas of our bodies and some can even reach orgasm through fantasy alone!

Get Wet and Wild. Using lubricant for sex play changes everything! It allows us to slip, slide and twirl away in new ways that would be dangerous or painful without the supplementary wetness provided by a good quality lube. Silicone and water-based products are condom-safe and can help make external and internal stimulation more pleasurable

In addition to using a lubricant during sex play, experts recommend using a vaginal moisturizer internally if you’re experiencing chronic dryness. Using a dropper, apply 1.5 mL into your vagina at night and tweak the amount depending on how much your absorb overnight (i.e. if it seeps out onto your sheets, try using a little less). Many experts recommend Blossom Organics Moisturizing Lubricant which you can find at your local sex-positive store or online.

Get Aroused! Many women experience pain or discomfort during sex play because we’re simply not ready for penetrative sex. The body and mind require foreplay to get the juices flowing beforeinsertion of any object into the vagina. If you’re not feeling in the mood, don’t force it. Use fantasy (it’s not cheating to think about your dream guy), kissing, massage and deep breathing to relax and enjoy the pleasurable sensations of your body — pleasure isn’t always sexual. As you become more aroused and relaxed, you can learn to contract and release your pelvic floor muscles to improve sexual response and facilitate penetration, if desired.

Change Positions. If your experience tenderness or discomfort in one position, have fun experimenting with new ones! Grab a few extra pillow to help prop up your hips, neck, shoulders or legs until you find angles that work for you. Choose positions in which you can control the speed, pressure and depth by being on top or using your hands to guide your partner’s hips. In the process of finding more comfortable positions, you’ll likely discover new hot spots that feel good as well as new vantage points from which to enjoy the sexy view.

Learn About Dilators. Talk to your health care provider about vaginal dilators or exercisers — tubes of varying sizes used to stretch the vagina and help women learn to relax the surrounding muscles. Used with a water-based lubricant, dilators are often used after radiation or surgery. They differ from vibrators or dildos in that they are not designed specifically for sexual pleasure, although some people will combine vaginal exercises/stretching with self-stimulation.

Talk to Your Health Care Provider. Talking about sex with anyone can be daunting, but these uncomfortable conversations are worth it. You have a right to ask questions and get answers about your body. And you have a right to be a sexual woman — however you may choose to define this.

Ask your health care practitioner about your options including topical hormone creams, non-hormonal moisturizers, dilators, pelvic floor physical therapy and counseling with sexual health professionals. You may also want to explore treatment options with complementary holistic practitioners including those with backgrounds in acupuncture, naturopathy, homeopathy and herbal medicine.

Talk to Your Partners. Whether you’re single, dating or in a relationship, you should only do things that feel good for you and silence in response to pain is simply not an option. Nor is making excuses to avoid sex, as this often leads to avoiding affection and intimacy altogether. If you’re not in the mood for sex (for any reason at all), be honest. Forgoing all physical affection is much more serious than forgoing sex, so be straightforward about what you’re experiencing in both your body and mind.

You have a right to be sexual and enjoy a high quality of life and though a cancer diagnosis can create new and intimidating sexual challenges, they are worth tackling. Sex is intrinsically connected with intimacy, relationships and communication and everyone encounters sexual problems. Overcoming these issues and enjoying sex again is entirely possible with a little patience, an open-mind and a huge helping of self-love.