Sex Therapist Q&A

We live in a culture that is saturated with sexual images, yet it is pitifully devoid of real sexual education for young people, which translates into a poor foundation for adult relationships. Uninformed teens grow into adults who may spend years, even decades, basing relationships on the minimal or incorrect information they accumulated as youngsters. Today's emphasis on abstinence-only education leaves many couples without basic knowledge about how their bodies work or what to expect in a relationship. Much of your own suffering -- as well as your husband's -- might have been prevented had you acquired comprehensive information about sexual health and pleasure. Nevertheless, I'm so glad you wrote now! You've described a complex situation, but there are two points that stand out: First, no one should ever have sex that is painful or even uncomfortable. Pain is a symptom that something is amiss and needs attention. And having sex because someone else insists is a surefire way to feel disempowered, which can erase whatever authentic desire you might otherwise have felt. If you were having sex you didn't want, then you were certainly insufficiently aroused and lubricated, which could have caused sexual intercourse to be painful. In addition, certain medical conditions also make intercourse -- and sometimes even gentle sexual touch -- painful. Given your background, the precise cause of your pain can only be determined by a thorough sexual history and physical exam.

I would urge you to see a doctor, but, this time, be sure to see someone who is well-trained in the practice of sexual medicine and comfortable discussing the extent of her expertise working with patients who have sexual pain conditions. Anyone who is reluctant to have this conversation with you or doesn't supply satisfactory answers is not the right doctor.

The second key point is this: Many people think that sexual desire is supposed to hit like a bolt from the blue; that a woman should merely look across the room at her partner and feel overcome with sexual urgency. If she doesn't feel that way, she may imagine that there is something wrong with her or with her relationship. The reality is quite different. Many people -- especially women in long-term relationships -- feel desire only after they have experienced sexual pleasure and arousal. So, a long, lovely kissing session, or the right kind of caresses, or the mental stimulation of an erotic movie or conversation, could initiate the arousal that leads to a desire for more. However, building up arousal to the point where you are ready for intercourse -- physically and emotionally -- can be a slow process. Many women simmer "on low" for a long time before their heat begins to rise. Along the way, any disruption can turn the flame down and leave her cold. A partner who rushes, the experience of pain, even a major mental distraction can snuff out the fire. Anybody who has had only a few poor sexual experiences may conclude she is just not very sexual, when, in fact, it is pretty healthy not to feel sexual under circumstances that are uninspiring, counter-erotic or unpleasant!

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