Relationships & painful sex

Feeling stressed, self-conscious about your body, depressed or anxious about intimacy can make sex uncomfortable, and even painful.

Sometimes dyspareunia (painful sex) begins as a physical problem, but then has a flow-on effect to your psychological wellbeing and relationships, causing stress and anxiety.

A vicious cycle can develop where past experiences of painful sex cause anticipatory fear of more pain. This fear creates stress, tension and reduces libido and arousal and as a result, sex becomes painful. For some women their past experiences may include sexual or emotional abuse, which can a be a trigger for experiencing painful sex, even in good relationships with an understanding partner.

For women approaching menopause who are experiencing sexual problems in a relationship, it is helpful to sort out how much is due to the physical symptoms of menopause rather than other sexual issues. It can be difficult to know if menopause influences your relationship with your partner, or if the relationship you have with your partner influences your experience of menopause.

There are many ways two people can be sexual, or sensual, with each other that do not involve vaginal penetrative sex. Think of all the things you did before you had sex for the first time. We sometimes call this ‘outercourse‘, and refers to kissing, hugging, fondling, touching etc.


The right treatment depends on the cause of the pain, but almost all treatment options will include a combination of individual and couples sexual and relationship counselling. If you are in a relationship, encourage your partner to be involved in your treatment, particularly the counselling sessions. Women and their partners often experience feelings of rejection, confusion, helplessness and frustration and the sooner these feelings are discussed the better the outcome for all concerned.

It can also help if both partners read relevant books and seek out other resources together. It’s okay (and a good idea!) to have some fun with sexual exploration. Sometimes couples get into a ‘routine’ for sex that’s no longer working for one or both partners. Self-help books can be easily bought over the internet, so there’s no need to be shy.

For single women, dyspareunia can prevent them from approaching partners or entering new relationships. Talking to a health care professional about your feelings can help to stop the negative pain cycle.

Relationships & libido

It is quite common for women to experience a decline in spontaneous sexual desire with age, or when you have been in a long-term relationship.

Chronic low libido can sneak up on you. Initially, you may feel like it’s just another dip in your sexual interest and manage it the way you have in the past; explaining it away as a normal response to the stresses of life. But, if low libido has been happening for a long time and it is distressing, or causing relationship disharmony, you should examine your real reasons for not wanting to have sex. Is it about short-term or recent events, or is it beginning to look like a way of life? Is it a way of life you want or is it distressing you? How does it impact on your partner?

For couples, differences in sexual desire can create significant problems. A pattern of avoidance and resentment can build up especially if sex is initiated by one partner and refused by the other over and over again. The partner with lower libido may feel bothered by sexual overtures and the partner with higher libido may feel frustrated, rejected and unloved. Some couples stop being affectionate and loving with each other and negative feelings become more and more overwhelming. These difficult feelings, if not talked through, can impact negatively on the relationship.

What can you do about desire discrepancy?

Solving the problem of desire difference in a relationship can be challenging. There is no magic wand (or pill, potion or cream) that will create sexual desire. And it’s not about just having sex whenever your partner wants.

The exercises below assume you have the building blocks of a workable relationship and the ability to work together on this issue. There are many things that may turn someone off sex. It’s not possible to discuss them all on a webpage. It is important to understand that if there is conflict or abuse in your relationship; it may not be possible to solve a sexual problem. Sometimes a sexual problem is a symptom of an unhealthy relationship.

Good sex can give a well-grounded relationship a really positive boost, but it won’t solve serious relationship problems. Relationship counselling might be an important first step in building trust and communication before working on a sexual problem.

More complicated personal reasons can also underlie low libido, so seek counselling if you think this is the case.

What is good about sex for you?
Make a list of all the things that are:

  • enjoyable
  • positive
  • beneficial
  • worthwhile

about sex for you

For example:

  • I enjoy the feeling of sexual arousal
  • I like the touching, the feel of my partner’s skin next to mine
  • I sleep well afterwards
  • I enjoy seeing my partner experience pleasure
  • My partner and I feel closer emotionally

Anything at all that’s good about sex needs to go on the list. Don’t worry about any bad things that counter the positives at this point. They will go into their own list and be dealt with separately.

This list of good things about sex is part of your motivation for having sex. If you have good reasons for having sex, you can use these reasons to examine and influence sexual desire, and sometimes have ‘decision driven’ sex, rather than ‘desire driven’ sex.
What reduces your interest in sex?
Think about all your reasons for not wanting to have sex and write them down too. You don’t need to show anyone your list so be honest (with yourself).

For example:

  • I am too tired (a common reason)
  • I am too stressed (also common)
  • I am bored with our routine
  • Sex is painful
  • I don’t get aroused like I used to
  • It is not very pleasurable
  • I feel self-conscious about my body
  • I can never orgasm
  • My partner needs to attend to personal hygiene

Try to be explicit about what it is that’s putting you off so you have something to work with. If your reasons don’t seem very concrete think about the feelings you have during sex or when your partner approaches you sexually. Do you feel:

  • pressured
  • guilty
  • manipulated
  • grief
  • shame
  • embarrassment
Feelings like this will be off-putting, so recognising and understanding them is a first step towards getting them out of the bedroom.


Stress is part of life. It may be related to day-to-day ‘busyness’ with too much to do, and never enough time.  Or it may be a more serious and recent event such as job loss, illness or death of a loved one.

It is not always reasonable for some people to feel like having sex around the time of serious stress.  But if normal day-to-day stress is getting on top of you, it’s probably worth considering some strategies that might help you get on top of it.

Some people want more sex at difficult or sad times; to help them relax, as a comfort or a distraction, or to feel alive and joyful. Everyone is different, especially when it comes to sex.

Think about the sort of things that make you feel tense or stressed and not sexual:

  • Are they things that are going to go away?
  • What can you do to change them?
  • Are they serious crises?
  • Are they part of your life that you can’t or don’t want to change?
  • How can your partner help to change them?

Can you make a decision to give yourself some time each day where you will make the effort to relax and not focus on the stressful things?

Letting go of stress may not be easy, but if you can find a way to relax, it may give you the energy and the focus you need to enjoy life and maybe sex as well.
Pain during sex
Physical pain is a good reason not to desire sex.

If you anticipate pain during sex, you will be anxious and this will reduce libido and arousal. Talk about the pain with your partner so they know how you are feeling.

You should not experience pain during sex so don’t ignore it if you do.  See our webpages on painful sex for more information.
Talking with your partner

Frightening as it can seem, consider having an open discussion with your partner about how you feel. If you’ve been avoiding sex this can be especially difficult. But if you do it well, it will build intimacy and help you to manage your sexual relationship more honestly.

Be kind

  • This is a sensitive issue to discuss for both of you, acknowledge that at the start of the conversation
  • Avoid saying anything hurtful or making accusations
  • Frame the discussion positively, for example: ‘I really like it when you….’ Instead of ‘I hate it when you….’ And ‘Could we try this instead of that’.
  • Be aware your partner may not have thought about this the way you have and may be surprised or react defensively
  • Try to take responsibility for your part of the relationship (be honest about your reactions and responses – how would you feel in your partner’s shoes?)
  • Remain focused on solutions

Choose your time

  • Talk when you have the privacy, the time and the energy (don’t just surprise your partner with a conversation like this at the end of a long day)
  • Talk when you are feeling positive about making changes


  • Find out what it’s like for your partner when you refuse sex
  • How can you do it better without it feeling like a rejection?

Be positive & stay focused on solutions

  • If tiredness is overwhelming, can you schedule a time for sex? It may not seem romantic, but not being tired or pressed for time might be more practical. Sometimes this means a change in routines, or getting a baby-sitter, or keeping the bedroom door closed so that small children can’t just wander in.
  • If sex is painful – can you talk with your doctor together about possible reasons?
  • Would you benefit from local oestrogen replacement?
  • Are you aroused enough or could you:
    • spend more time on foreplay
    • try some new strategies
    • read some erotic literature, or watch an erotic film together
    • explore other sexual activities besides intercourse (massage is a good place to start)
    • buy some new lingerie, light a few candles, add some soft music
    • use a vibrator together (sex-toys can be bought online)
    • try a lubricant (this can be bought in the supermarket)

Be conscious of both your limitations

  • Don’t expect miracles – the discussion may not go exactly how you hope
  • If your partner isn’t a big talker you may need to use actions to get things to change – for example, show them how you would like to be touched, gently guide their hand to where you want to it to be
  • Challenge your own shyness if it’s holding you back
  • Feeling uncomfortable initiating new sexual practices is not unusual, but may be worth it in the long-term

The aim of this exercise is not to have you swinging from the chandelier every night of the week. It’s to enhance honesty, intimacy, fun and pleasure in your relationship and hopefully help you manage differences in sexual desire instead of using excuses to avoid the issue.

It’s also not to encourage you to have sex when you don’t want to. Use it as a pathway to understanding each other and finding a middle ground that is more satisfying to both of you.

Don’t forget that it will take ongoing commitment and revisiting the discussion to keep it working in the long-term.  And if you get stuck, talk to a trained sex therapist.

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