National Vulvodynia Association

Overcoming Challenges in Your Intimate Relationship

Chronic pain, and especially vulvodynia, can disrupt your intimate relationship. You may not be able to engage in frequent sexual intercourse, but that doesn’t mean your sexual relationship is over. In fact, avoiding all sexual activity can be self-defeating if it leads to a loss of desire in either partner. It is possible to create a satisfying intimate relationship with your partner even when you suffer from vulvodynia.

Start Talking About It

Communication is key to a healthy sex life for all couples, but many people are uncomfortable having conversations about sex or assume that their partners already know their preferences. How can you know what your partner likes without asking? Talking becomes even more important when your intimate life is challenged by a chronic pain condition. Discussing your concerns and fears, or what’s painful or pleasurable, will lay the groundwork for a satisfying sexual relationship. At first, these conversations may make you uncomfortable, but it will get easier with practice.

Here are some suggestions for facilitating a productive conversation about sex. (16)

• Timing and Location: It’s very important to set the time and location of your conversation beforehand. Although every relationship is different, in general, you should avoid springing this type of conversation on your partner. Let him/her know in advance that you’d like to set aside time to talk about your intimate relationship. Do not have this conversation while intimate, during a romantic date, or before a social engagement.
• Write Down Your Feelings: Writing down what you want to say beforehand is a good way to clarify your feelings. It can also help you practice the best way to express what you’re feeling.
• Create Safety and Show Respect: In order to disclose very private feelings, both of you need to feel safe. Since the conversation will likely involve a discussion of novel intimate activities to try, you should agree not to embarrass or laugh at each other. If he/she takes the risk of exposing private sexual desires, be respectful and consider that kind of sharing a compliment.
• Listen Without Interrupting: Learning not to interrupt isn’t easy, but it’s very important to intimate communication. Agree not to interrupt. If you make a mistake, apologize and focus on listening until your partner is finished speaking. If it is difficult for either of you to stop interrupting, choose a random object and give it to the partner who is speaking. When finished, he/she hands the object to the other partner. Be sure to jot down points you want to respond to while your partner is speaking.
• Make “I” Statements: Try to avoid telling your partner how he/she feels or thinks. Talk about your feelings, by starting sentences with the word “I.” For example, say “I feel uncomfortable when you…” rather than, “You make me uncomfortable when you…”  By speaking in the first person, it doesn’t sound like you’re blaming your partner.
• Be Specific and Ask Questions: Try to avoid making sweeping statements such as, “You always do that,” or, “I’ll never be able to do that.”  Be as specific as you can in your descriptions. If your partner makes general statements, request clarification and ask questions to improve your understanding.
• Time-Outs: Before you start talking, agree that either of you can ask for an intermission or to end the conversation. You should also agree to resume the conversation at a later time.
• Agree on Confidentiality: Since discussing your sexuality is such a private matter, agree beforehand on the confidentiality limits of your conversation. For example, is it okay for your partner to share this conversation with his brother or best friend? Respect the agreed-upon restrictions and don’t break confidentiality.
• Schedule Another Time to Talk: Conversations about sexual intimacy should be an ongoing process. It’s unlikely that you will completely resolve an issue, or even cover all aspects of it, in one sitting. Before you end your conversation, decide upon another time to sit down and talk.

Now that you’ve learned basic communication ground-rules, here are some issues you may choose to discuss with your partner:

• Satisfaction with Intimate Relationship: How satisfied were both of you with your sexual relationship prior to developing vulvodynia?  Were there conflicts that predated your vulvodynia or did both of you have a high level of satisfaction with your intimate relationship?  How has vulvodynia changed your sex life?  For example, have you become fearful that sexual activity will increase your pain? Is the pain causing you to avoid intimacy?  Does your partner fear hurting you during sexual activity or feel rejected because you don’t initiate sex? Are you now the sole initiator because you’re the one in pain? How do these changes make you and your partner feel?
• Painful or Pleasurable: It’s important to teach your partner which vulvar areas elicit pain when touched. You can do that yourself or your partner can accompany you to your next medical appointment and your doctor can identify the areas. Which parts of your body and vulvovaginal area give you pleasure when touched? In addition to location, which sexual activities give you pain or pleasure?  Which sexual positions do you find most comfortable and enjoyable?
• What Does Your Partner Enjoy? If you haven’t already done so, ask your partner what he/she finds pleasurable. A simple aid for this exercise is a foreplay map.  In this exercise, you label body parts in the order you’d like them to be touched. You also label body parts in the order you think your partner likes to be touched. Your partner does the same exercise and the two of you compare the results.
• Redefine What Intimacy Means: People vary a great deal in their sexual attitudes and practices, so it is important to remember that ‘normal’ is whatever gives you and your partner pleasure. Intimacy doesn’t necessarily equal intercourse. You should never feel obligated to have painful penetrative intercourse, especially since it can lead to an association between sex and pain. There are a variety of non-penetrative sexual activities that provide mutual pleasure and help to maintain intimacy. Books such as Betty Dodson’s Sex for One, and Klein and Robbins’ Let Me Count the Ways: Discovering Great Sex Without Intercourse, discuss these alternatives. Your partner may be more open-minded than you think and trying new sexual practices may even add some excitement to your relationship.
• Plan Ahead for Pain Flares: It is common for flare-ups to occur, leading to extended periods of time when sexual intercourse is out of the question. It’s very helpful for you and your partner to develop a plan for dealing with this situation ahead of time. During these times, you can agree to certain sexual closeness or non-sexual ways of expressing intimacy, such as cuddling or snuggling. Discussing how to handle the situation ahead of time helps to lessen feelings of rejection and prevent misunderstandings.
• Other Gestures of Affection: Make a list of non-sexual gestures your partner does that make you feel loved and valued. Examples might include attending doctor’s visits with you, holding your hand or bringing you flowers. Ask your partner to make a list as well and then exchange your lists. Both partners should try to pick one item from the list to do each day. These small gestures can go a long way in maintaining intimacy in your relationship.
• Counseling: For some couples, longstanding relationship issues may predate the development of vulvodynia or the condition may impact your relationship so dramatically that you need to consult a therapist. Other couples may cope quite well, but still want to seek the advice of a trained therapist. Discuss whether you think visiting a sex or couples therapist would be of benefit. Remember that you are not the first couple to face the challenge of redefining your sexual relationship. To find a knowledgeable therapist or counselor in your area, ask your health care provider for a referral. You can also access the NVA referral list by going to the following link https://www.nva.org/for-patients/health-care-provider-list/ and/or visit the web sites of professional organizations, such as the American Association of Sexuality Educators, Counselors and Therapists (www.aasect.org). Before making an appointment, contact a few different therapists and ask about their experience dealing with couples facing sexual intimacy issues related to chronic pain.

More Suggestions for Keeping Sexual Intimacy Alive

Both a vulvodynia sufferer and her partner can lose interest in sex while learning to cope with the condition, at least for a period of time. Upon diagnosis, most couples’ priority is finding a treatment that will alleviate the pain, rather than dealing with sexual issues. Here are some suggestions to help you maintain intimacy in your relationship.

• Schedule a Time for Closeness: Many couples believe that sexual intimacy should occur on the spur of the moment, without planning. As a relationship progresses, even without vulvodynia, spontaneity often dissipates due to work responsibilities, children and other commitments. Most couples find that they need to schedule time for closeness. Plan ahead and make a ‘date’ with your partner that works for both of you. Schedule some relaxed time together that enables you to slowly begin your rediscovery process.
• Keep Track of Sexual Thoughts: If vulvodynia has lessened your desire, try keeping track of your sexual thoughts in a diary. Every day for several weeks, take a diary with you wherever you go.  When you have a sexual thought or feeling, no matter how fleeting, write it down. Note the time of day, whether you are alone or with someone, and what you did about it. Sometimes just keeping track of sexual thoughts can increase desire. You may discover situations that increase arousal and can try to recreate them with your partner.
• Exploration and Foreplay: Create a relaxing environment by lighting candles or playing soft music. If it’s been a long time since you’ve been intimate, it’s a good idea to set some limits. For example, you can agree to engage in a touching session that avoids the vulvovaginal area. Your goal is to feel relaxed and simply enjoy sensual pleasure by exploring each other’s bodies. This session may include petting, caressing, fondling, stroking, kissing and massaging. Foreplay is not only a prelude to sexual intercourse. Focus on what feels good to you and tell your partner what you enjoy. Ahead of time, you can explore your capacity to enjoy sexual pleasure through self-stimulation. By touching your own body, you can figure out how to enjoy sex in spite of having vulvodynia and then share what you learn with your partner.
• Intercourse: If you decide to engage in penetrative intercourse, take it slowly. Perhaps you can try using a finger first to gauge how it will feel. Choose a time of day when you experience the least amount of pain. Use a lot of lubrication to eliminate friction and make sure you are fully aroused prior to penetration. Choose a position that reduces pressure on the sensitive vulvar areas and ask your partner to limit thrusting time. If helpful, support yourself with a pillow. The use of a topical anesthetic, e.g., lidocaine, prior to intercourse helps to relieve the discomfort of penetration. Let your partner know what causes pain and show him/her other ways to touch you that aren’t painful.
• Reintroduce Spontaneity: Once your pain is controlled, consider offering your partner a ‘window of wellness’ during which he/she can initiate intimacy. This may help to revive the spontaneity that has been lost and lets your partner know that you haven’t lost interest.