Tag Archives: couples

Painful Sex: Best Therapy Practices for Women and Couples

Women who experience painful penetrative sex due to Provoked Vestibulodynia (PVD), Vulvodynia  and other forms of Pelvic Pain may have suffered in silence for years. They may have thought that the pain was due to being new to intercourse and that it would subside. Or perhaps they may have mentioned it to a gynecologist, only to be told that there was no evidence of any diagnosis, or that they had a bacterial infection and prescribed a medication that didn’t help. For some women who had painful sex that was intolerable, they may have avoided going to a gynecologist for their entire adult life.

Women we see at Center for Love and Sex who are in heterosexual relationships where penetrative sex is an expected part of the sexual repertoire over time develop tremendous shame, anxiety and fear of any sexual encounter if they feel it will lead to intercourse. Their partners may gradually avoid initiating sex due to the obvious reason of not wanting to cause their partner/spouse pain but in addition, of wanting to avoid being turned down which they experience as outright rejection, lack of desirability and at times shame.

As a consequence to the painful sex, some male partners/husbands may develop their own sexual disorder like erectile dysfunction or premature/uncontrolled ejaculation due to the anxiety that develops around their penetration hurting their partner. Couples like this tend to self refer to a CLS therapists when sexual avoidance has gone on for some time and couple is in crisis or fear of losing their sex life altogether. The physical ailment causes intra-personal and interpersonal challenges that have to be addressed in therapy. Many times these women can treat and heal their pain when working with a pelvic pain physical therapist.

When I mention pelvic floor physical therapists to friends and even other therapists, they have never heard that this specialty even exists.  As a systemic sex therapist, I frequently see women and couples who present with painful sex and collaborate with pelvic floor PTs to coordinate treatment in a holistic manner. I have had general therapists refer some of these cases to me after seeing clients for many months or years assuming the pain was a somatic outcome of early trauma.

It is critical for all therapists to understand the structure of the pelvis and causes of pain so that they know how to support, advocate and refer their client to the right doctors and pelvic floor PTs so that they can move ahead quickly with a treatment protocol that addresses their particular issue. It is also important for pelvic floor PTs to understand the consequences the pain has had on the client’s primary relationships, her Sex Esteem®, and shame level around discussing the specifics of her condition so that they can collaborate with the therapist. I will often assign homework assignments that will echo or support the exercises being assigned by the pelvic floor physical therapist.

Amy Stein Co Presenter

In my upcoming webinar for therapists, sex therapists and physical therapists titled The Collaborative Clinical Care Model Between Therapists and Pelvic Floor Physical Therapists Involving Sexual Pain, I’ll be collaborating with Amy Stein, DPT Founder and Director of Beyond Basics, a specialty PT practice in NYC and the author of Heal Pelvic Pain, a self-help book for people dealing with painful sex, urination and other physical activities involving the pelvis. I invite you to spread the word about the webinar which will be live and take place on Monday February 6th from 12:30-2:30 PM EST and is geared for professionals.

For those of you reading this who suffer from any sort of pain during sexual activity, I invite you to contact my practice, Center for Love and Sex via email sari@saricooper.com or coordinator@saricooper.com to discuss your situation and set up an appointment for an in person session or a coaching session if you’re outside of the NYC region.

Feel Too Awkward to Tell Your Tinder Dating Story? You Could Use some Sex Esteem®

It’s wedding season, and I felt fortunate to attend a wedding of a man and woman who had met on Tinder. Each person that got up to make a speech at the rehearsal dinner and at the wedding mentioned this detail in their toast to the bride and groom. It made me feel surprised and yet rejoiced that this particular couple felt no embarrassment nor any discomfort that they had met up (a few years back now) on what was then known as more of a hook-up app. They did not feel repentant, naughty or shady about their initial desire to meet someone for some playful fun.

However as a sex therapist, I treat single people who are dating, newish couples and long-term committed couples, and several clients have discussed their feeling awkward when their friends or family ask how they met their new significant other. Does it seem better at that very minute to conjure up a romantic or at the very least a quirky, serendipitous story rather than admitting that you matched with a click or a swipe?
Not only have over 15% of US adults used online dating sites or dating apps, but the numbers of users and success stories increases each year for all ages.

Girl texting on the phone in a restaurantSince 2013, the number of 18 to 24 year olds on these sites has almost tripled, while it has doubled for Americans between 55 and 64 . So, if meeting online is so common these days, why can it sometimes be uncomfortable for some people to admit how they met?

The media in our culture still encourages fairy tale romances, seen in so many romcoms or series in which a young man sweeps a young woman off her feet, or a woman just has to look at another woman at a party and they fall in love (or lust as the case may be) instantly. In a show like Transparent, or Girlfriends’ Guide to Divorce , two characters make eye contact from across the room and know they have to have each other . But we know that this isn’t the only way people meet. Perhaps swiping right or clicking ‘like’ is’ the new fairytale romance that we are just waiting to see in movies and television. When over one third of singles have used a website or app to meet others, it is time to rethink our idea of romantic introductions

Despite online dating’s popularity, there is some stigma around it. A recent study found that 23% of adults agree that “people who use online dating sites are desperate” . Although this percentage has decreased since 2005, ideas like this are discouraging for those who already fear the judgement from others as they reveal their true story of how they met.Male and female legs during a date As a therapist who often sees single clients who are dating, I often hear people express embarrassment when they start seeing someone and their parents or friends start asking more questions about where they met. The exception to this pattern are gay couples who are more comfortable with meeting men on apps like Grindr for a hookup which may or may not lead to a relationship.

When I inquire further, I discover they think people will think the relationship is not a “real” one and that it doesn’t have much hope for a long-term union because it started online. There is also the belief that others will judge them for shopping for hookups and trying to dress it up as a “date” when they’re speaking of it. People often believe that they should be embarrassed about having some relationships which are more about a sexual connection than an emotional/romantic union. These thoughts and feelings reflect more on American society, and religious/cultural beliefs than it does about human sexuality and the interest people have to have casual sex without a monogamous contract. If the understanding is clear and transparent, and both parties are sober and consensual and hopefully have discussed safer sex precautions, it is their prerogative on how they meet and connect with a partner.

Online dating app conceptHowever, when a couple meet on an app and then have the relationship develop into a long-term committed relationship, I encourage them to accept the relationship’s origin with pride and encourage them to explore more deeply the reasons behind their reluctance to share including internalized shame, anxiety of being shunned or criticized and the worry their relationship will not be respected.

I let them know that over 54 million people are utilizing sites like Match.com, EHarmony, and apps like Hinge and Bumble, and that many other like them are sharing their modern day love stories. In so doing they are changing the way the public may see the ‘hookup’ apps such as Tinder and like my friends who married earlier this summer,  beginning to embrace the potential beauty and power of online dating.

A recent heterosexual couple who came in to address their flagging sex life told me: “Her parents would die if they knew she found me on Tinder” and “ My parents won’t take our engagement seriously if they knew how we met and they’re helping to pay for the wedding”. If you are nervous to answer when someone asks you how you met, I am empathic since you are part of a generation of innovators who still have to explain Instagram and Snapchat to your parents. My advice to you is to use your Sex Esteem®, which is the combination of Couple in love kissing laughing having funCuriosity+Confidence+Clarity+Communication+Creativity.  I explored the idea of their shame in sharing their story is partly the same shame that was contributing to the less frequent sex in their relationship.

In addition to therapy, my practice provides Sex Esteem® classes and coaching which empowers people to tell others about the origins of their relationship without fear or shame. (There are some cultures in which the knowledge pre-marital and/or gay sex could have grave consequences so I help clients make well-thought out decisions when it comes to sharing this information). They also empower people to articulate the sex they desire from their partner in clear, calm way that allows for a partner to hear without defensiveness or hurt.

BLD022897 If you tell a listener in a confident and authentic manner what allowed the two of you to become more serious after initially being attracted to their physical appearance it is not different than your relative seeing a person they were attracted to at a disco or at a friend’s party. Relating it to situations of their generation that may have seemed illicit or less “serious” by their parents allows them to identify with the erotic and emotional feelings that are centuries old. Rather than focusing on the fact that you met online, tell a story about the moment you knew this connection had legs to become a committed relationship.

Man on smart phone - young business man in airportThe focus does not have to be about your online profile or how many people you swiped through to find her (unless you want it to be!). Instead, talk about the first time you laughed together, the reason why you were embarrassingly late to dinner, or how you hit it off when you both ordered the salad without the olives.

I invite you to become empowered. You met online because you took the initiative to find someone right for you who has similar interests, passions, and hobbies. You knew what you wanted in someone, and you went out and found the right person. Who says you have to wait for destiny? You found them. Own and celebrate your Sex Esteem®!