“How will I ever be able to have intercourse?”

If you’ve struggled with pain during sex or other types of pelvic or sexual pain it’s likely that this question is very familiar to you — anxiety around intercourse is normal in these situations.  (Unless of course you’ve been pushing all thoughts of sex and intimacy out of your mind since your symptoms began.)

The idea of intercourse or any type of penetration may send your brain into a tailspin of worry and catastrophic thinking, and you into a full-blown panic.

If so, you are not alone!  Women and men who’ve struggled with pelvic pain, especially pain during or after sex commonly experience anxiety when they think about attempting intercourse again, or sometimes physical intimacy at all (which of course might lead to intercourse).

This anxiety around intercourse can come up whether you’re still in a lot of pain, or your symptoms are virtually gone and you’ve been successfully using dilators for some time…or any time in between.

And unfortunately the more anxious you feel, the more stimulated your nervous system is, the more likely it is that your muscles will contract, and the more difficult it will be to actually have or enjoy sex at all.

Which is why I want to share with you my 5 most effective strategies for overcoming anxiety around intercourse that’s been getting in your way.  So that you can not only start having and enjoying intercourse with your partner (if that’s what you want right now), but more importantly so that you can reclaim your connection with your body and sexuality, and heal any deeper issues that may be contributing to your pain!

Understanding Anxiety and Where It Comes From

Before I give you the steps to overcoming anxiety around intercourse (or anything else) it is important to understand what causes anxiety in the first place.

Many people think of anxiety as an emotion.  But it’s actually not an emotion; it’s a mental and physiological response to repressed emotion and comes from a combination of stressful thinking and the body’s natural response to the suppressed emotional energy.

Let’s take a closer look at how each of these factor into anxiety around intercourse.

Stressful Thinking  

Stressful thinking is a huge contributor to anxiety, and when it comes to having intercourse after you’ve had pelvic pain, it can include thoughts like, “What if it hurts.  What if all the pain comes back.  If I don’t have sex I’ll continue letting my partner down.  I’ll never be able to have intercourse.  That’s not fair to my partner.  He/she is going to leave me.  I’m broken/defective /not good enough and deserve to be alone.”

Thoughts like these trigger the sympathetic nervous system (aka the Fight or Flight response) which releases a whole host of stress hormones and neurotransmitters that contribute to increased tension, decreased blood flow, and pain – and more importantly creates that feeling of full blown anxiety or panic in your body.

To relieve anxiety from your thinking it’s important to start noticing and working with the thoughts that are coming up when you either think about or attempt to have intercourse, or penetration of any kind.  To learn more about how to effectively work with these thoughts once you’ve identified them please see my post How To Think More Positively When You’re In Pain.

Getting a handle on your thinking will significantly reduce the anxiety.  Just ignoring those thoughts or trying to stop thinking them IS NOT ENOUGH. You’ve got to identify and work with them in order to reverse the effect they are having on your body and nervous system.

Suppressed Emotion.

The second big contributor to anxiety is suppressed emotion.  And when it comes to feelings of anxiety around returning to intercourse – there is a very long list of potential sources of suppressed emotion!  I’ll go over some of the possibilities in a moment but first I want to give you a brief summary of how suppressed emotion contributes to anxiety.

Emotions are energy that is meant to move through the body.  If we were going to measure them we’d measure them in hertz (like music).  When we have emotions from current or past issues in our lives that we are unconsciously suppressing then that energy gets stuck and held in our body.

According to Dr. John Sarno, author of The Mindbody Prescription, when emotional energy is held in the body, the brain/nervous system registers that something is wrong.  Stuck energy, tensed muscles, and shallow breathing all trigger the sympathetic nervous system response (there’s that fight or flight response again), and contribute to the feelings of anxiety in our body.

So, when we have unresolved issues around sex, intimacy or our relationship – issues that may have started before our pain did – they can play a huge role in not only creating anxiety when we think about having intercourse, but in causing pelvic pain in the first place.

Why?  Because even if we’ve physically healed our body, many of those same issues, and the emotions related to them, can still be present, and will be unconsciously (or sometimes consciously) triggered when we start thinking about or attempting to have sex.

So, not only do we have all the worry and stressful thinking around possibly triggering pain again, we may also have those unresolved emotions getting stirred up.

Women and men can hold a lot of emotion in their pelvis as the result of negative past experiences around sex or sexuality or past traumas (sexual or medical).  And it doesn’t usually take something we would consider to be a big trauma (like sexual abuse or medical trauma) to create the unresolved emotion that can trigger anxiety and pain.

Some of the issues I have seen contribute to pelvic pain or anxiety around intercourse both for myself and my clients are:

• Unresolved relationship issues with your partner.  When we don’t have sufficient emotional intimacy and connection with our partners to create a sense of trust and safety, we can carry a lot of mental, physical, and emotional tension – all of which can contribute to anxiety before and during sex.
• Feelings of shame around sex and intimacy that can prevent us from speaking up and asking for what the want – or setting boundaries around what we don’t want  – before or during sex.
• Not giving ourselves full permission to engage in and enjoy sexual pleasure as a healthy, positive thing in our lives.  (Cultural beliefs around sexuality make this particularly difficult for women and a common thread I see in women who are struggling with pelvic pain)
• Negative beliefs about sex and intimacy from our family, religion, or culture.  For example:  “Sex is dirty.  Good girls don’t enjoy sex. It’s a sin to have sex before you’re married.” etc.
• Feelings of duty or obligation around having intercourse in the first place.  (Believe it or not I have had women tell me that their priest or doctor has told them that it was their duty to have sex a certain number of times per week with their husbands!)
• Previous trauma that we may think we’re “over” but that we haven’t fully processed, felt, and healed the effects of.  This can include but is not limited to childhood (or any) sexual abuse, rape, medical trauma, past physical injury/trauma, negative early sexual experiences, or negative messages around our bodies and sexuality.

In order to live successful lives according to our own or society’s standards we unconsciously bury these things and all of the emotions that go along with them….and all of this gets held in the muscles in our pelvic floor!

It’s no wonder the idea of having intercourse, even if we have addressed the physical issues and relieved the physical pain, can create anxiety!  Especially when we approach it with a lack of awareness and disconnection from ourselves.

5 Steps to Overcoming Anxiety Around Intercourse

Now that you have an idea of what may be contributing to this, I’m going to give you some very effective strategies to work help you start overcoming anxiety around intercourse.

1)    Observe Your Mind 

First, get out a paper and pen the next time you feel anxious and write down all the thoughts that are going through your mind.  Dig a little.  Don’t just write down the thoughts you’re initially aware of, breathe into your low belly, get curious and start to uncover the thoughts that are running in the background behind the most obvious thoughts.  Once you’ve identified the thinking that’s contributing to your anxiety work with it using the steps outlined here.

2)    Slow Down/ Take Baby Steps

In order to get past the anxiety of doing anything that has caused or increased your pain in the past (walking, sitting, touching your vulva, inserting dilators, or having intercourse) it is really important to slow down, connect to your body and take one baby step at a time.

SLOWING WAY DOWN, breathing gently into your low belly, and taking baby steps will allow you to be aware of all of the sensations in your body whether they are physical sensations (like muscle tension or pain) or emotional sensations (like heaviness, contraction, or holding your breath) before you take the next step.  Staying tuned into your body and emotions and only taking baby steps forward will help create a sense of safety and allow you to relax and become aware of any deeper issues that may come up for you.

3)    Honor Yourself – Honor Your Body

Have an agreement with yourself and your partner ahead of time that you are going to honor the sensations in your body and not push yourself past any discomfort (mental, physical or emotional).

Notice that I did not say not to push yourself past pain.  Of course you don’t want to do anything that causes pain but I want you to stop, breathe, and honor your body WAY before you feel any pain.  You are going to be your own best friend and honor ALL of your body’s signals.  That means not only not doing anything that causes pain or discomfort, but also ONLY doing those things that feel really GOOD.  If you have no idea what feels good than slow down even more and be patient and curious enough to find out.

You’re going to let your body lead this process and TRUST that your body knows what you need.  So discomfort means, “Stop, breathe, and see if you can find another way – or not yet.” and pleasure means, “Yes more of that please”.  It may take a leap of faith to listen to your body at this level, but in my experience it’s the only way to move forward towards having intercourse again.  The anxiety isn’t going to go away if you push.

4)    Start with Self Pleasuring

It’s a lot easier to go really slow and stay tuned in and aware or yourself mentally, emotionally, and physically when you are by yourself.  Practicing on your own you’ll be more in control of your experience and more able to stop and observe your thoughts or allow your emotions. It will give you the chance to really connect to what’s going on for you and be there for yourself.  You’ll get the chance to explore and learn about your body and what feels really good to you, including with using techniques like breast massage and breathwork to help open up energy flow and create safety and ease in your body.  When you’re able to ENJOY penetration on your own you’ll be much more likely to be able to enjoy intercourse, without anxiety, with your partner.

 

5)    Work Through the Deeper Issues

Work through any issues that come up around your relationship with your partner or sex and intimacy in general, including any past trauma.  Your body will stop you from doing something repeatedly that isn’t in your best interests and pain and anxiety are both effective ways to do that.  If there are deeper issues in your relationship or your life that are preventing you from being fully present and authentic, and feeling emotionally safe during intercourse start to pay attention to those and give them the attention they need.  You may want to seek out support from a qualified coach or therapist to help you.

These steps are not meant to be a quick fix (though I have seen them significantly reduce anxiety around intercourse fairly quickly).  All together, they are a lasting solution.  They will help you deeply connect to yourself, access your body’s guidance, and ultimately relieve the anxiety you may be having around returning to intercourse, or physical intimacy at all.  Give yourself time to practice and soon you’ll be enjoying not only intercourse, but the deeper connection with your own body and sexuality that you deserve.

Article originally appeared on Pelvic Health and Rehabilitation Center’s blog