pelvic pain & intimacy

From age eleven on, when I bled for the first time, my cycle has been intense at best and horrible at worst. I had and at times still have killer cramps, causing me to vomit, faint or spend three days per month curled up in bed.

Only recently I have been diagnosed with endometriosis and its sister adenomyosis, after dealing with the effects of these conditions for almost thirty years. 
Therefore, I know first-hand how much they can affect daily life. I also know that it’s not only the pain and fatigue that has a major influence on your life when you’re struggling with pelvic pain. Chronic pain affects your relationships too, as well as your sex life. 

What is pelvic pain?

If you have pain in the area below your belly button and above your legs, this is known as pelvic pain. While pelvic pain can occur because of, for example, appendicitis or a hernia, most often it’s used to describe pain in the region of women's internal reproductive organs.

For most women, this is a sign of a physical condition, such as endometriosis, adenomyosis, or pelvic inflammatory disease (PID). Other women may experience pain as a result of emotional factors. 

For some, this pain may be intense, stabbing, or throbbing in nature, while for others, it may be mild and like a dull ache.
Especially with endometriosis, adenomyosis, menopause, and PID, the pelvic pain you’re experiencing can be chronic, which means that the pain is present on most days for six months or more. This is also often the case when you have experienced physical or emotional abuse. 

Ways to support yourself

I always recommend to talk to your doctor or gynecologist if you’re suffering from pelvic pain. When you do, it is important to make sure you have a doctor you feel seen and heard by. 
Take the time to discuss some solutions to the pain you’re experiencing. Options usually range from hormonal treatment to surgery. 

Additionally, working with a somatic therapist or intimacy coach can provide support.
As I am both a somatic therapist and an intimacy coach, I'm here to support you. 

Healing from trauma

A somatic therapist has an embodied approach to support you in healing from trauma. They’ll also support you in finding more pleasure in everyday life, and to deal with the consequences of pelvic pain.

These consequences can be very diverse. Having chronic pain is stressful enough in itself, but it can also have a negative influence on your relationship(s).
For example, your partner might not understand the pain you’re experiencing, and might respond hurt or angry when you have to cancel yet another appointment. 
Maybe you’re finding it difficult to feel and express your capacity and boundaries, as they might change from day to day, or because you have developed a habit of pushing yourself beyond them in order to not miss yet another day at work. 

In these cases – and in many more – a somatic therapist can help you get in touch with yourself first, to process your own disappointment about the pain and its consequences, to find out what your capacity is and where your boundaries are, and how to communicate in a way that’s honest and that will lead to more intimacy. Both with yourself, as well as with the ones close to you. 

Where a somatic therapist might focus more on supporting you as you heal from trauma, an intimacy coach will add their knowledge of sexuality. 
This is incredibly helpful, as pelvic pain will often lead to pain during sex.

Ways to approach pain during sex
 
The clinical term for pain during sex is dyspareunia, and its characteristics can vary greatly from person to person. Sometimes, the pain is only there upon initial penetration and will go away quickly, but at other times, you might experience it during thrusting and the pain might last for days post-intercourse.

Dyspareunia doesn't always occur every time you have sex. For some, it only occurs every so often or only in certain positions. Just as dyspareunia can vary, it can also be treated in a variety of ways. 

You could for example try experimenting with having sex at different times of the month. When you do, keep track of your cycle and the common symptoms you experience. You might find that certain times of the month you experience less pain during intercourse.
Use plenty of lubrication if you experience vaginal dryness too.

Different sex positions and depth of penetration can result in different levels of pain too.
Most women with pelvic pain find the missionary position, for example, to be more painful due to the way the pelvis is tilted and the deep penetration that results. Try out different positions and notice if there are any in which you don’t experience pain.
Always make sure you're fully aroused before starting penetration.

Of course, sex doesn’t have to mean penetration. Oral sex and mutual masturbation are amazing ways to have sex without penetration.

Relax the pelvic muscles

Aside from these options, pelvic floor therapy might be helpful. Most women with pelvic pain involuntarily tighten the pelvic floor, which can cause further pain. Learning to relax the pelvic muscles is important when you’re experiencing pelvic pain. 
You might find that having a yoga practice helps with this too.

Communicate openly

To create more intimacy with your partner, it’s important to have open and honest conversations with them. 

When you’re working with an intimacy coach, they’ll be able to support you in having these vulnerable conversations, in which you might discuss all that comes up when you’re experiencing pelvic pain, such as your need to love and be loved, your fear of intercourse, your fear of intimacy that may lead to intercourse, your feelings of guilt about not being able to have intercourse, or your fear of losing the relationship.

At the same time you’ll learn to hold space for your partner, as they share for example their frustrations about not being able to have intercourse with you, their fear of hurting you, and fear of being rejected.

Even though this might not immediately take your physical pain away, it will help you to feel closer to your partner, and to feel seen and supported.