Sex, Pain & A Return To Intimacy

I started to write this blog piece on my way back from a trip back in December. My partner and I had only been home for a few hours when the Franklin Fire started and we had to evacuate. Fortunately, we did not lose our home in that fire, but I did lose track of this piece. The following month brought the Palisades Fire and the loss of our home. When I started back to work after those first crazy few weeks, Tabu asked me to do an Office Hours focusing on “What We Wish Our Partners Knew.” Friends, it brought me full-circle. 

The following is what I had started to write. I share this in all of its rawness as I was writing in a place of frustration with my own body and its abilities. Even those of us who teach  sexual wellness have our own struggles. For many of us, that is our very catalyst to teach. We want to facilitate and drive these hard conversations. 

“I have to tell you that I have struggled with painful sex since chemotherapy sent me into early menopause, stripping my body of all of its moisture. Nights like last night are so hard on my self esteem and also my relationship. We went on this awesome date night last night and wow! I was feeling so excited. We had so much fun, got all cute and saw our favorite artist in concert. Great night. AND my libido came to the party! I was feeling good.

But then… we. forgot. lube. How?! No idea. Total buzzkill. I had to explain to my partner that my vagina was sadly off-limits. 

Did we still have fun? Yes. Was I able to participate the way I wanted to and to be fully satisfied, no. And god I am sick of this. 

Just like a lot of you, I struggle to communicate how uncomfortable this can be for me. Last night I described the sensation while lube-less as “a million tiny paper cuts”. Talk about a buzz-kill for us both. 

I also struggle to make my partner feel comfortable with using toys and tools during intimacy. That these are not a replacement in any way for tongue, fingers or penis. Rather these tools are ways to relax and stimulate me with friction-less touch and penetration prep. I keep trying to communicate that the power he wields in using these should be sexy, hot and bold. 

Does anyone have a really great and empowering way to introduce this? 

I am encouraged that my plan towards sexual wellness and a return of my libido is working. But, like most, I am impatient. I love sex! I want it back! I want this issue to be a distant memory and to have the thorn in the side of my relationship gone. 

Friends, please know that even those of us who teach about these topics professionally. struggle too sometimes. Conversations about pain and our needs are hard. They just are.”

Where do you even get started?

Knowing Thyself.

Two of the most frequent questions I get in Office Hours are 1) How do I get started with intimacy later in life after a long hiatus? 2) How do I achieve orgasm later in life and 3) how do I avoid discomfort with penetration?

My answer is always the same. Start with finding self pleasure. This doesn’t have to even be genital stimulation. It could be mood setting, self massage and sensual touch. Find what makes you feel good and to get in the mood. I am also a big fan of audio-porn. I personally am a subscriber to www.bloomstories.com, but there are many non-paid options such as www.girlonthenet.com. When you’re ready to graduate to genital stimulation, external stimulation may be the first step. Most people don't know how large the clitoris actually is. The legs of the clitoris extend beneath the labia and many women find a lot of pleasure in stimulation beyond the clitoral "glands", i.e. the little nub we all think about. I love The Tabu Pearl as well as The Pelvic People Kiwi. 

Once you are ready for penetration, you may want to start with a dilator kit to begin to gain confidence in penetration and to stretch and relax the muscles of the vaginal canal. Moving on, the Tabu Nuri is a great choice. Pelvic Floor Physical Therapy (PFPT)  can be very useful for learning techniques as well, Cognitive Behavioral Therapy (CBT) can also be very useful to learn strategies to help manage fears and anxiety that may proceed intimacy. 

Finding orgasm may be different now. You may need more stimulation. You may need more revving up. This may be mental or physical, You may also need changes of position, which is where a positioning pillow could be put to good use. 

Partner Communication.

Once you learn yourself again, it is much easier to communicate your needs to your partner. Although, as previously established, this can be a difficult conversation. Seeing a sex therapist can do wonders for this communication. I refer patients to this treatment option often. The Center for Healthy Sex has become my go-to resource in Los Angeles. If you live elsewhere, search for a sex therapist near you or consider virtual care.

The Next Layer.

Medications 

•  Vaginal estrogen. It is a fact, not opinion, that this is safe for almost everyone. Even most cancer-survivors and women with a family history of cancer can use this as it is not systemic like HRT. Applying topical estrogen to our vulva and inside of our vaginas helps our tissues directly in those areas to strengthen and repair. We are replenishing estrogen to these tissues that so badly need it so they can be closer to the firm and plump tissues we had when estrogen was plentiful in our bodies. Forgive the analogy, but it's kinda like watering our flowers. This can be a cream or an insert or both. I use both.

• Testosterone as part of HRT: Estradiol can make tissues feel a lot more comfortable and help with pain. However, it won’t give us our libidos back nor help us to orgasm better. These are two of the many reasons why I personally use a compounded testosterone cream as part of my HRT regiment. 

• Vyleesi: This is a medication for low-libido that I am just starting to use under the direction of my OBGYN. I have no review yet, as this is new to my plan of care. But I will report back!

  
  

My favorite tools. 

My go-to’s for intervaginal treatment: 

• Tabu Nuri Wand: For those of you who have watched Grace and Frankie, this wand is the real deal. Designed for post-menopausal women with pelvic pain, this wand is flexible, light weight and features heat and vibration settings to promote blood flow and comfort as you relax and stimulate your intervaginal muscles. Need to start smaller? I recommend the Vwell Spectrum Dilator Kit often, as it features the smallest dilator on the market, small incremental advancement options and a great price point. 

External stimulation:

• If you are not ready for penetration or would like a gentle re-entry to intimacy vulvar pain, start here! My favorite tools are the Tabu Pearl and The Pelvic People Kiwi.  These are also great as an added layer of stimulation for finding that elusive orgasm.

Positioning.

• For both pleasure and pain management, positioning can be key. I have the Tabu Prim Positioning Pillow handy as it both looks nice as a throw pillow (hats off to Tabu for that design feature!) and works so well for positioning. 

Deep vaginal pain, be gone!

• For increasing confidence for both her and him, The Pelvic People Ohnut helps prevent deep-collision pain. This makes everyone more confident and sex more fun!

More than an honorable mention: Light-Therapy. 

• The Fringe Heals Light Therapy Pelvic Wand is my personal favorite. I worked on the design team for this tool and have a lot more to say about light therapies! Watch for much more to come in an upcoming blog. 

Let’s talk about lube. 

• If sex is painful and/or if your tissues are dry you need lube. Get a really good water based product for use with tools and/or if you are using a condom. I use Tabu Aureum lube, as it both feels really nice and also has an ingredient list that reads like a face-serum. And I like to treat my vaginal tissues like I treat my face: with a lot of kindness. I also keep a bottle of silicone based lubricant on my nightstand for sex. It doesn’t dry out and stays slick which is best for me. My preferred brand is Über Lube. Please be mindful that silicone lube will not play well with your silicone tools: it will make them feel rough over time which is clearly not desirable. If you like to use coconut oil, make sure that you have a back-up birth control option to condoms. And it's a no-no for silicon tools too as oils break down silicon. And lastly, if this is your preferred lubricant, keep clean coconut oil in your bedroom. Using your cooking oil as bedroom oil is just an infection waiting to happen so please just…don’t. 

Please watch the February 2025 Office Hours that I taught with Tabu entitled “What We Wish Our Partners Knew”. I hope that this blog as well as the Office Hours video impresses on you that this has nothing to do with our attraction to our partners or dissatisfaction. This is all just problem solving in the bedroom to deal with the trials and tribulations of our changing hormones. And the desire to help ourselves so that we can continue to enjoy a healthy sex life at any age! 

Remember that knowing thyself and being able to communicate with your partner is key. And this goes both ways, guys, for any of your that may be reading this. And I am more than happy to have ongoing conversations on this topic if any one of your readers is looking for help - don't be shy in reaching out. Let's break the stigma!