Sexual pleasure and intimacy are integral aspects of our overall well-being, and experiencing pain during sex can be distressing and confusing. As a Certified Sex Coach, my role is to guide individuals through their sexual journey, providing support and strategies to address challenges like painful sex. Unfortunately, painful sex, or dyspareunia, is one of the most common concerns that clients bring to consultation sessions. Coaching individuals who are experiencing painful sex requires a comprehensive understanding of the connection between mental and physiological experiences of pain—as well as the shortcomings of medical professionals to address these in a holistic way.

It’s also important, early on in the sex coaching process, to dispel myths about the experience of painful sex. For example, it’s important to understand that painful sex has nothing to do with how attracted you are to your partner. There may be other inaccurate things your clients believe about their condition that you’ll need to address when they come up.

In this article, we will explore how to coach someone who experiences pain during sex, offer guidance on speaking to partners about painful sex, emphasize the importance of medical self-advocacy, and highlight the benefits of working collaboratively with sexological bodyworkers and pelvic floor specialists.

Understanding the Mind-Body Connection in the Experience of Pain

Pain during sexual activities can have complex causes that involve both physical and psychological factors. To effectively address and help individuals with this issue, coaches need to consider the interplay between the mind and body.

In order to achieve this comprehensive understanding in a holistic way, understanding the following is crucial:

  1. Physiological factors:  Understanding the physiological aspects of pain helps coaches rule out or address these underlying physical causes, which may require medical intervention or specialized treatments. These physiological factors include infections, hormonal imbalances, pelvic floor dysfunction, vaginal dryness, scar tissue, endometriosis, or medical conditions such as Lichens Vulvar Sclerosis.
  2. Psychological Factors: The experience of pain during sex can also be influenced by psychological and emotional factors. Past traumatic experiences, relationship issues, stress, anxiety, body image concerns, or negative beliefs about sex can initiate pain, contribute to pain, or make it worse. Sadly, people often overlook or exaggerate how mental issues can affect pain during sex. This leads to an incomplete understanding of the problem. Either scenario leaves the client far away from relief.
  3. Mind-Body Connection: One example of the interplay between the mind and body is the way anxiety and fear can lead to muscle tension and cause pain during sexual activity. Individuals may find themselves in a loop as experiencing pain can then create psychological distress and then anticipation of pain and so on.

 When we look at both the physical and mental aspects of pain from a holistic perspective, the work we do with a client can be more fruitful.

The First Steps in Coaching Individuals Experiencing Painful Sex

When working with individuals experiencing painful sexual encounters, you first need to create a safe and non-judgmental space for them to share their concerns and fears. Begin by acknowledging their pain and reassuring them that their experiences are valid. 

Many times, clients will arrive to sessions having been told by doctors and partners that “it’s all in your head,” “you just need to relax,” or “it can’t be as bad as you are acting.” Simply acknowledging their pain can be healing in itself. It also sets the stage for the assessment process and the creation of an action plan.

Helping your client understand that painful sex is a common issue with various underlying causes and that it is not their fault is a foundational step in this process. 

Throughout the intake process, it’ll be important to identify what kind of pain they are having. The different types of pain they may be experiencing include:

  • Primary pain—pain since first becoming sexually active
  • Secondary pain—develops after experiencing pain-free sex
  • Complete pain—pain that’s present every time they have sex
  • Situational pain—when the pain only happens at certain times

Next, you need to inquire if the pain is entry pain (intraorbital or superficial dyspareunia), deep pain (collision dyspareunia), or a combination of both. 

It’s crucial to understand the type of sexual pain your client is experiencing as this will inform the action plan you create with your client.  Whether your client experiences primary, secondary, or situational pain for example, reveals clues to the origins, blockages, or contributing factors of their dyspareunia.  This will allow you to ground your client’s experience in a way that supports the mitigation of the pain itself and then the journey back towards pleasure.

How Sex Coaching Can Help Clients with a Sexual Pain Diagnosis

If your client has already received a diagnosis like one of the following: vaginal atrophy, vaginismus, vaginal infections, endometriosis, pelvic inflammatory disease, lichens vulvar sclerosis, STIs, or vulvodynia, you’ll likely be receiving a client that has conflicting feelings about their diagnosis. On the one hand, they may feel relieved they finally have a diagnosis, but on the other hand, they may feel that this has simply led to more questions.

If your client has vaginismus, defined as spasms of the vaginal muscles caused by the fear of being hurt or prior trauma, they could greatly benefit from sex coaching that works to understand the origins of this fear. An appropriate action plan could help the client reconnect with their body and reclaim their pleasure through somatic practices and education around their physiology. Referrals to sexological bodyworkers, pelvic floor therapists, and certified cannabis coaches can be a great addition to the work.

Another frustrating diagnosis can be vulvodynia, which is pain that lasts longer than three months and has no clear cause with sensations that may include burning, stinging, stabbing, itching, rawness, and throbbing. As a Certified Sex Coach, you can support your client by helping them navigate the potential contributing factors of inflammation, hormones, nerve damage, weakened pelvic floor muscles, or long-term reactions to past vaginal infections. You can also act as an advocate for them if they are having difficulties communicating with their medical team.

Unfortunately, many clients experiencing painful sex will reach a point where they feel that sex coaching is their “last attempt,” after years of suffering and bearing through pain in order to have some semblance of a sex life. In these cases, you can be there to reframe sex and pleasure in a way that acknowledges their experience and opens a pathway toward healing and understanding.

Guidance on Speaking to Partners about Painful Sex

An important part of your action plan for clients who are struggling with painful sex is talking with their partners. And the guidance you provide your clients on how to have those conversations needs to go beyond simply encouraging them to have open and honest conversations with their partners. 

You need to emphasize to your clients that pain during sex is not a reflection of their attraction or love. There’s so much societal confusion about sex and love that many people think a lack of attraction or love must be at the heart of their sexual discomfort. Unfortunately, a client’s partner may even accuse them of lacking attraction when they learn that their partner is experiencing pain. In turn, your client may withhold their experience, which further disconnects them from their bodies and interferes with them honoring and validating their physical experience.

In the action plan, you’ll guide your client in using “I” statements to express feelings and needs, which fosters a collaborative approach between partners. You can also help them understand that both parties may be experiencing their own emotions such as concern, guilt, or frustration. You can teach them both how to hold space for those emotions.  

It’ll be important to discover your client’s understanding of consent and provide them resources about consent to ensure that they have a strong foundation upon which to have these delicate conversations Partners need to discuss and establish common language around consent in order to enable them both to feel more safe in the conversations around pain. Both need to feel comfortable expressing their needs.

For this, I highly recommend the Tea model of consent to get started. While your client might feel like they are beyond consent talks with their partner since they are already engaging in sex, I find that exploring exercises found in Betty Martin’s Wheel of Consent model to be crucial in allowing us to recover the ability to notice what we want and to set clear boundaries. 

Additionally, it’ll be important for you to give your client space to practice with dialogue in the safe container of your sessions to express when they may need to pause, stop, or renegotiate what is happening in the sexual experience. This is essential because sometimes individuals experiencing pain during sex feel paralyzed and unable to speak up. Or they may try and bear through it for lack of a way to express their needs because they fear hurting their partner’s feelings.

Respecting Boundaries: No Need to Force Through It

You need to emphasize to clients that they should never force themselves through painful sex. Encourage them to listen to their bodies and prioritize their well-being and comfort. This is an essential element of self-care that will help them learn they deserve to experience pleasure rather than pain.

Your client needs to learn that it’s okay to assert their boundaries around what they will or will not do sexually. Assure them that consent is an ongoing process, and they have the right to say no or pause sexual activities if they experience pain no matter how long they have been with their partner(s). You may need to offer quite a bit of guidance on self-care and boundaries to help your clients unlearn certain habits and beliefs.

As their medical team assesses and provides medical action plans, as a Certified Sex Coach, you can help your client explore alternative ways to experience pleasure and intimacy that do not involve penetration. This could end up being a time of amazing experimentation, exploration, creativity, and a feast of erogenous zones!

Coaching Clients to Be Their Own Advocates

As a sex coach, you can empower your clients to be their own advocates when seeking medical help for painful sex. You can do this by encouraging them to document their symptoms, including the location, intensity, and duration of pain. You can provide them with resources and information about pelvic floor health, sexual health clinics, and sex-positive healthcare providers. Helping your client prepare a list of questions to ask their medical team ensures they feel empowered and informed during their appointments.

The Benefits of Working Collaboratively with Other Providers

As a Certified Sex Coach at Sex Coach U, you are trained in a powerful talk-only modality that informs the sex coaching process by addressing the five parts of the sexual self. The MEBES© Signature System looks at the Mind, Emotion, Body (or Behavior), Energy, and Spirit of the client and where they may feel blocked in relation to the sexual concern which, in this case, is pain during sex. 

Throughout the coaching process, you may find that your client would benefit greatly from also working with another provider. This is why it’s important to have a list of providers such as sexological bodyworkers, pelvic floor therapists, and rolfers to refer out to. 

While referring your client to a trusted body-based practitioner can be an excellent way to support your client and move your work forward, I highly recommend exploring the option of working collaboratively with these providers. This is why, in the process of building your local and virtual network of resources, I recommend reaching out to these providers to establish a relationship so they can understand the work that you do as a Certified Sex Coach. This is what truly leads to a comprehensive approach to sexual pain.

Coaching individuals experiencing painful sex requires a compassionate and holistic approach. By creating a safe and non-judgmental space, acknowledging their pain, and dispelling myths, Certified Sex Coaches can guide their clients toward healing and understanding. 

When supporting individuals with sexual discomfort, if we understand the different types of pain and their potential causes, we can design tailored strategies and referrals to specialized professionals. Effective communication with partners is essential because it emphasizes that painful sex is not a reflection of attraction or love but the result of a combination of factors.

Encouraging clients to respect their boundaries and prioritize their well-being reinforces the importance of consent and self-care. Additionally, empowering clients to be their own advocates in seeking medical help and providing them with resources enhances their agency and informed decision-making. 

As sex coaches, there is so much we can do to support individuals on their journey toward reclaiming pleasure and healing through the collaborative process of sex coaching.