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Coping with sexual pain

An article published recently in The Journal of Sexual Medicine found that, for women who experience vulvo-vaginal pain, women's and their partners' acceptance of the pain was associated with better sexual functioning and sexual satisfaction. As I tweeted a link to this article, part of my brain was going, "Wait, what??? Accept vaginal pain and have sex in spite of it? Isn't that the worst kind of suck-it-up, anti-feminist approach to women's sexual concerns that you've ever heard?" But before you lose faith in me completely, hear me out... Acceptance is a concept that comes up a lot in my work. I'm a fan of a mindfulness-based approach to therapy called Acceptance and Commitment Therapy, which says that we can accept the difficult parts of our experience, and live a life that we value and desire in spite of those difficulties. We don't have to be free from physical or emotional pain before we embark on our lives. We can all acknowledge that life can be difficult. All of us will experience pain or loss. Some of us, through nature or nurture or both, will have experiences of sadness or fear or pain to an inordinate degree. Though I certainly believe it's helpful and kind to ourselves to try to mitigate our suffering as much as possible, I also know that many of us will never be completely comfortable, completely free of the demons that plague us. However, our culture is one of great optimism. In many ways, we are told that we can find a complete solution to any problem of living if we only try hard enough -- eat right, think positive, go to therapy, meditate enough, get the right treatment... Certainly it's true that our problems can be mitigated and managed, and it's good to do so. I don't believe in suffering for the sake of suffering. What is problematic is when we believe that we can't move forward UNTIL our problems are completely solved. "I can't ask anyone out until I feel more self-confident." "I can't be sexual with my partner again until I'm sure I won't lose my erection." "I have to wait until my pain is gone before I think about sex again." These are all really understandable thoughts! And certainly each person gets to decide when s/he is ready to tackle issues like this. At the same time, life is short and it is possible for us to wait too long for perfect conditions. So how does this relate back to vaginal pain and sex? Many women with pelvic pain find that they shut down their sexuality completely. "If I start cuddling or making out with my partner, they'll want to go further and I know I can't, so I don't want to lead them on." "I feel so frustrated and weird because of this that I don't even want to think about myself sexually, it just brings up a lot of bad feelings." "I just feel like I shouldn't be thinking about sex while this is going on." If you experience sexual pain and really want nothing to do with sex for a while, this is totally understandable. You don't have to push yourself to want something that you actually don't. However, for many women with vaginal pain, sex and sexuality are valued parts of life that feel closed off because of the pain. If you fall into this category of really missing that part of life and wishing the pain would go away so you could have it back, is it possible to accept the pain as part of your experience and find ways to be sexual anyway? Could it be okay if your sex life looks a little different than it used to? If this is sounding good to you, you might consider making some lists: Make a list of conditions that allow you to feel sexual as you are now. Maybe it's wearing no undies or watching a hot movie or getting a massage from a completely supportive and understanding partner. Make a list of ways that your body is sexy and sexually responsive and hot, just as you are now, and even if you experience pain sometimes. Make a list of sexual activities that you can do alone or with a partner that feel good and don't make the pain worse. Hope this helps you in having the best sex life you can!

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