Dyspareunia = catchall medical term for “painful intercourse”.
For some of the below conditions, I mean non-penetrative sex in addition to intercourse, and some involve vulva pain in additional to vagina pain.
PS: This list is not exhaustive and is provided for informational and educational purposes only. It’s not intended as medical advice and should not be a substitute for a visit or a consultation with a healthcare provider.
1. Less than ideal arousal
During sexual arousal, the vagina expands in length and width, while the cervix retracts. Increased blood flow to the genitals (vagina, labia, clitoris) increases sensitivity.
If this physiological process of arousal hasn’t fully transpired before the stimulation and friction of sex begin, ouch feelings can occur. Ouch being the technical term, of course.
2. Less than ideal lubrication
The blood flooding the labia/clit/vagina during arousal phenomenon (vasocongestion) is also responsible for vaginal lubrication. Plasma from the increased blood seeps through the vaginal walls, and this is the primary source of vagina lube.
Whether because arousal/vasocongestion was not enough, or if it’s due to other reasons, not having enough lube to reduce friction in the vagina or around the vulva is painful.
Remember going down a plastic water slide as a kid but there wasn’t enough water and your ass cheeks squealed on the way down, leaving your skin behind? Yeah, it’s like that.
Decreasing estrogen due to menopause make the tissues in your vagina thinner, and the friction on the fine skin can cause pain. Reduced lubrication production can also be a factor during menopause- see above.
From STIs like Chlamydia and Trichomoniasis to UTIs and your garden variety yeast infections, many different infections can cause vaginal and/or vulvar itching, burning, or stabbing pains. Yay!
Vaginas can get angry at certain condoms, lubes, and tampons, and vulvas can get wrathful at some soaps and body washes.
2/3 of folks with endometriosis have some sort of sexual function dissatisfaction, including dyspareunia. It is especially wide spread in those who have endometrial tissue that has replanted itself around the vaginal canal and the pain is often described as sharp and severe.
The intersection of gynecological and gastroenterological pain sensitivity is a thing. I don’t fully understand it, nor does it seem the medical research community, but the correlation is there.
Cysts on the ovaries can crowd the pelvic area and cause pain in the vagina during the rigors of sex, not to mention the hormonal impacts- see above.
I put my hand up to your face, your eyes blink in a protective reflex.
Vaginismus is I put my hand up to your vaginal opening, and it blinks in a protective reflex.
An involuntary muscle spasm, vaginismus makes insertion of a penis, finger, toy, tampon, or gynecological tool damn near impossible, and extremely painful if attempted anyway. It can be caused from trauma, past painful vaginal experiences (so pain begets pain), or nothing at all.
A chronic pain of the vulva around the opening of the vagina with no identifiable cause, in my experience it feels like a knife blade in your vag and it’s horrible.
It’s something I struggled with several years ago, and it was awful. Tampons were impossible. I needed a pediatric speculum for gynecological exams and I still winced. Penetrative sex was bloody and tear-filled.
This was around 2009 or so, and thankfully I had a sex-positive Ob/Gyn who took my complaints seriously and treated me successfully. No more vulvodynia.
And I never heard anyone else talk about it until the past year, and suddenly I’ve met DOZENS of folks who are experiencing chronic vulva pain that has either been diagnosed as vulvodynia, or hasn’t been examined yet but sounds a whole lot like vulvodynia to me.
My guess about the uptick is there's more comfort with talking about vaginas these days and less shame about it.
But talking about it is just the first hurdle. The medical community has been slow to show priority about understanding this condition- where it comes from, why, and how to treat it more effectively.
A rudimentary Google Scholar search yields just 9,000 returns for “vulvodynia”. Comparatively, “erectile dysfunction” yields 208,000, and ED doesn’t feel like one’s penis is being stabbed, so that seems fair, but I digress.
SO WHAT TO DO ABOUT THE VAGINA OUCH?
Make an appointment with your gynecologist. Advocate for yourself. Don’t accept a half-assed answer from the MD or any minimizing of what you are experiencing.
Get tested or ask your doc about pain treatment during an STI outbreak.
Try different positions.
Try different condoms and vulva-friendly body wash.
I’m going to say it again because it bears repeating: USE LUBE!
Talk to your partner. Again, advocate for yourself and what you need (more kissing, sex acts other than penetration, more gentle touches, whatever it may be).
Make an appointment with your favorite sexologist and sexual wellness coach to strategize sexual technique, communication with partner(s) and/or doctors, and emotional management approaches to work through the process.
HERE’S WHAT NOT TO DO:
Yes, these may be explanations, but ultimately sexual activity should NOT hurt, and it doesn’t have to.
I admit I once thought positive affirmations were trite, but I got turned on to them when I was given a journal with daily prompts, one of which was writing a daily affirmation. I jotted down things like “I put on sunscreen every day” and “I am patient” and darn it if I didn’t start remembering to put on sunscreen, and somehow found extra patience when feeling frustrated! I began applying it to my business goals, and that’s been working like a charm too.
I’ve since read up and geeked out on the brain science of positive affirmations and now I’m a total convert. Here is what I learned, along with a list of 27 positive sexuality affirmations I created to set you on a path to feeling (and being!) sexuality confident and satisfied:
So evidently our brains change! In actual real, physical ways. So cool!
Our behaviors, environment, thoughts, and emotions can cause the brain to rewire itself, even in adulthood when neural pathways are well-developed, and the key to this, is repetition. Thinking “I am full of sexual energy. I am full of sexual energy. I am full of sexual energy” to ourselves on repeat can actually change our brain to HAVE MORE SEXUAL ENERGY! So there is validity to “fake it til you make it”. Whoa.
Reticular Activating System (RAS)
This is the part of the brain that makes you see sky blue Mazda Miatas everywhere after you decided you want to buy a sky blue Mazda Miata, or makes you notice 3 different people using a certain word the day after you just learned that word.
Apparently our brains receive a shit ton of information from our senses that we don’t need and it gets filtered out of our immediate consciousness. Until we tell our brain that this certain piece of information is actually needed, and then it’s brought to the forefront by our RAS.
So writing “I put on sunscreen every day” makes me more likely to notice the bottle of sunscreen on the counter that I used to walk by on the way out the door. And writing “My genitals are healthy and normal” can make it easier to notice and see opportunities to find beauty and goodness in your genitals where you used to see shame.
Humans strive for psychological consistency, and cognitive dissonance is the discomfort that occurs when we hold two contracting, inconsistent values, beliefs, or behaviors. And because of our distaste for this dissonance, human can do some impressive mental gymnastics and herculean behavioral changes to get consistency again.
This can be great. If you’re saying to yourself “Telling my partner what I want during sex is natural and easy for me”, and your brain is rewiring itself and adopting this as fact (cognition), but you don’t feel confident speaking up for what you want and in fact you’re not telling your partner what you desire (feeling, behavior), there’s a dissonance.
And to resolve it, one of two things can happen- you can believe you’re a liar, a hard pill to swallow, or you can start telling your partner what you want during sex to make your story true and have consistency between thought and action.
Such a powerful tool for sexual behavior change!
The problem is, this can majorly backfire.
There was a study finding that for some people, positive affirmations did change their thinking or behavior. But for other people, it made them feel worse because they resolved their cognitive dissonance by more deeply believing that their negative beliefs were true and that the positive affirmations were a lie instead of the other way around.
The truth is many people resolve cognitive dissonance in toxic ways. Here’s an infuriating example you may recognize:
Belief 1: I’m a good judge of character, and I know Joe Smith to be a good guy.
Belief 2: Sexual assault is bad.
Well when Joe Smith is accused of sexual assault, there’s cognitive dissonance and that psychological discomfort can be resolved in one of two ways:
Changing Belief 1 (“Joe Smith is not a good guy, I judged wrong on this one”) or-
Changing Belief 2 (“I am a good judge of character, so Joe Smith is a good guy, and therefore...” and then convincing themselves sexual assault isn’t that bad, or 14 isn’t that young, or the victim is lying, or deserved it somehow.
Take home message from this research: positive affirmations can help, especially already positive people, when they are part of a broader intervention strategy (therapy, coaching, mindfulness practice) rather than as a stand-alone self-help tool to make sure the change is going in the right direction.
So, given all that, here are my suggestions for making the best use of my list of 27 positive affirmations for sexual confidence:
-Pick 5 or so affirmations that really resonate with you and say them in your head, out loud, or write them down REPEATEDLY. Several times in a row, several times a day, for several days.
-Frame them as positives and in the present tense (I’ve done this work for you) because “I will” or “I want to” aren’t as powerful as “I am” in activating RAS, or so I’ve read.
-Use these in conjunction with other sexual and personal growth work, such as a therapist or sexual wellness coach, like me!
Without further ado:
1. Sexual pleasure is a beautiful gift that I deserve to receive.
2. I explore and embrace my sexual desires.
3. I am sexually generous.
4. I am full of sexual energy.
5. I am grateful for my body and the sexual pleasure it provides me.
6. I exude sexual confidence
7. I am in full control of my sexual thoughts, feelings, and behaviors.
8. I live, love, and engage in sexual behaviors according to my values.
9. I communicate successfully with my romantic and sexual partner(s).
10. Telling my partner what I want during sex is natural and easy for me.
11. My bed is a peaceful sanctuary where I feel safe and satisfied.
12. Sexual arousal is a fun process that happens easily for me.
13. I have intense and frequent orgasms that satisfy my body and mind.
14. My genitals are healthy and normal.
15. My genitals function exactly as I want them to and bring intense pleasure to myself and my partner(s).
16. My sex life is exciting and it makes me feel happy to be alive.
17. I develop and maintain meaningful relationships.
18. I am worthy of love and kindness from others.
19. I accept rejection from a potential sexual partner with respect and humility.
20. I am patient and compassionate about my partner(s)’ sexual insecurities.
21. I am a worthwhile, full-fledged human being whether or not I’m currently in a relationship.
22. I practice empathy and compassion to myself and all living beings.
23. I have a strong sense of purpose in life.
24. Exploring my body and growing into sexual wellness is a priority in my life.
25. I pay attention and listen to what my body needs.
26. I am confident and comfortable in my sexual and relationship identities.
27. I am sexually and emotionally thriving.
After 10 years in business as a self-employed sexologist, I decided to press pause and dedicate 6 whole months to reevaluating and reinventing my entire life. Today I’m thrilled to finally relaunch the 96 improvements, updates, and changes I’ve made to the work that I do and the way that I do it (yes, literally 96!!) So what are some of these changes you can expect from me?
Some of the changes are obvious
If you’re a long time customer or follower, you probably noticed:
- New logos and a bright new color palette that represent my revitalized excitement for sexuality and all the joy it entails.
- Sexual wellness coaching! This is a big one! After years of clients requesting 1:1 work with me, I decided to say yes to this. Read all about my philosophy and approach to coaching here!
- A self-scheduling calendar that lets you book sex ed classes (and coaching sessions) with me online yourself. You no longer have to email me back and forth to choose a date, time and topic! Hey, 21st century!
- A whole new approach to blogging and social media that is less “a day in the life of a sexologist” and more tools to help you grow sexually like:
- Inspirational and educational short-reads
- Sex in 60 Seconds videos
- Sex Trivia Tuesday (on Facebook and Instagram)
Some Changes Are Less Obvious At First Glance But Still Awesome.
- Classes are now charged per person instead of a flat rate.
- A focus on serving and making a name and community for myself in the San Diego area, retiring national speaking tours.
- An online store with a “Dr. Jill Picks” section, a handy quiz for beginners that helps you choose the best sex toy for your body (coming soon), and individual recommendations from me via email for a personalized and educational shopping experience.
- More free stuff- at classes, in your sex toy shipment, in your mailbox on your birthday!
- Sex Ed 101 is totally revamped and is now efficiently covers over three dozen sexuality topics for a true “crash course” experience. I love how it’s turned out!
BUT! THE BIGGEST AND MOST IMPORTANT CHANGE IS NOT ABOUT COACHING OR WEBSITES OR LOGOS OR BLOG POSTS.
It’s how I show up to this work and this business not just as a sexologist, but as a human being.
It’s about a mission to help you learn to feel good- sexually and emotionally, AND ACTUALLY PRACTICING THAT FOR MYSELF TOO!
It’s having a healthy relationship with this business, and setting the intention to approach my work from a place of personal wellness and thriving.
It’s setting professional boundaries and being self-compassionate.
I spent my entire 20s angry- ranting and writing and arguing about rape, female genital mutilation, misogyny, and sexual degradation on Facebook and online communities and in-person classes for literally HOURS A DAY, for YEARS. I became a public figure around this, and would wake up to an inbox full of news articles and emails about the latest sexual atrocity on the planet.
I opened my heart to giving help and advice to any and every one at any and every time of day. I wanted to, felt obligated to- and was naïve and idealistic enough to believe I could- change the entire world and everyone in it. Even after having a panic attack at the supermarket when my phone buzzed, and I checked it to find a private Instagram message from someone describing a particularly gruesome sexual assault they just experienced in graphic detail, I couldn’t figure out until this relaunch why I was completely burned out, depressed, and in therapy for PTSD.
This relaunch is about practicing self-compassion. It’s learning and accepting that it's not my job to change the entire world, I cannot change the entire world, AND THAT’S OK.
It’s knowing I still have a lot to offer and can still make a big impact by being the change I want to see with the people in my life- my family, my friends, my clients, my followers, knowing that it ripples out. It’s realizing that essentially running an unofficial 24/7 rape crisis hotline by myself out of my house with no funds, no compensation, and no emotional support was not a kind or compassionate thing I did to myself, my mental health, or my business.
I use to feel personally responsible for every mile of the beach, feel distraught when I inevitably couldn't help all the thousands of starfish, all the while cursing the tide for putting them in this position and fighting with the man for getting in my way. Relaunching is about becoming the young woman instead- making a difference on an individual level while letting herself enjoy the sunshine as she does.
It’s about never forgetting that sex can be weaponized and sexuality can be ugly, but remembering that it’s not always. It’s coming to understand that focusing 10% of my work on the ugly and 90% on the pleasure and love and connection and life-affirming aspects of sexuality instead of the other way around is not frivolous. Pleasure and connection are important and valuable.
This relaunch is about setting firm boundaries. It’s learning to say “no” to things I don’t want to do. That don’t feel good. That don’t serve my new business vision of personal wellness and thriving.
It’s saying no, I will not drive round trip from Pennsylvania to Alabama and put myself up in hotel to teach a sex ed class for $300! (a thing I actually did.)
It’s saying no, I will not write for your site, teach the sexuality unit to your students, or consult with your pharmaceutical company’s marketing team about a new erection drug for free, and learning to not feel guilty about it. It’s saying no, I don’t give individual sex advice via email or social media messages, and learning to resist the need to explain myself.
It’s acknowledging that earning a *just* salary that is commensurate with my advanced education, decade of experience, and high quality of work is not greedy.
It’s meditating every morning. And just letting shit go.
It's finding another amazing, supportive, badass self-employed woman to work with every day because the loneliness of working in isolation in an empty house does NOT make me thrive! And thriving is the #1 most important thing- so I can show up at my best to help you thrive, sexually and emotionally. Thanks for reading.