Sex and Pain

How do porcupines make love?

Very carefully—exactly like humans in physical pain.

With all the talk about tantra, BDSM, and the latest exotic position, too many bloggers, so-called sex coaches, and popular magazines are encouraging regular people to create their own personal Sex Olympics. But even if people are uninhibited, are in a good relationship, and have good sexual “function” (their plumbing works the way they want it to), there can be another obstacle to enjoyable sex.

It’s very un-sexy. It’s physical pain.

For starters, the pain can be genital: vaginismus, a herpes outbreak, post-menopausal atrophied tissue, a urinary tract infection. There can be pain in one or both partners attempting intercourse without sufficient lubrication—common in couples rushing to avoid erection problems, or when there’s a desire discrepancy.

But from head to toe, the rest of the body is vulnerable to pain that can interfere with sex.

When I was being trained (while dinosaurs roamed the Earth), we learned about the sexual parts of the body: the genitalia, nipples, anus, mouth. Throw in the ears and neck if you’re liberal.

Now, as a 60-something-year-old, I have a different view of the sexual parts of the body: they are the lower back, the knees, the neck, the hips, the elbows. Yes, any weight-bearing joint becomes a sexual body part when it hurts. Most people even use their ankles during sex; we only realize that when our ankle hurts.

Smartphone and computer use have led to an epidemic of carpal tunnel syndrome. And even without these devilish devices, our precious hands become arthritic with time.

When hands or wrists hurt, the quality of sex goes down. We want to caress, to squeeze, to push or pull. Our hands are the way we connect with a partner’s breasts, back, legs, face, and everywhere else. And the grabbing that’s instinctive during passion can hurt, disrupting the passion.

Many years ago I spoke at a conference of hand injury professionals at Stanford University. “Ever notice how especially cranky hand injury patients are?” One hundred fifty physical therapists nodded in agreement. “And how many of you ask your hand injury patients about masturbation, maybe brainstorming comfortable and safe ways they can do it during their recovery?” One hundred fifty physical therapists were dead silent. “Why do you suppose these patients are so cranky?” I asked.

* * *

One obvious way that pain interferes with sex is the disruption. You’re cruising along, and then you feel stabbed or burned unexpectedly. Pain jars you out of your reverie, your bliss, that treasured world where nothing matters. It disrupts your sense of timelessness, your connection to your partner, perhaps your journey toward orgasm.

Pain makes us protective. We turn our body to avoid it, favor one limb or one side over another. To prevent pain, we have to be conscious of that body part every second. While sex is about letting go, pain is about vigilance. The two are almost impossible to reconcile.

Then there’s the emotional impact of pain (and the fear of pain). While hurting (and adapting the sex to the pain) we don’t feel young, we don’t feel graceful. We fear we’ll never have pain-free sex ever again. We miss our former body intensely. The grief can be unexpected, suddenly flooding over us just as someone is caressing us or saying we’re beautiful. A partner’s desire for us can be terribly bittersweet when the body they crave is a body that continually betrays us.

We can’t allow pain to end our sex lives. But what can people in pain do to make sex more possible, more enjoyable?

• Stretch first. Just two minutes of stretching wherever it hurts will make it hurt less during sex. This is especially true if you have early-morning sex.
• Start slowly. Like an experienced jogger or biker, let your body get into a rhythm slowly.
• Prepare for sex with a hot shower or bath, perhaps some ibuprofen.
• Tell your partner honestly what positions or activities are painful, and try alternatives together. When you discover what works best, make those your go-to sexual activities.
• Feel free to cry as you let go of some of your old favorite sexual positions or activities.

If sex hurts, stop—or at least slow down. Since you’re already in bed together, there’s almost certainly something great you can do that hurts less. And it’s far easier to discover it or do it with your partner’s cooperation, rather than doing it secretly, hoping he or she doesn’t find out.

Physical pain: not sexy. Maybe the end of sex the way it used to be. But not the end of sex.

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