Book Review: 'Sex Without Pain' by Heather Jeffcoat, DPT
This book is a “how to” resource that is a simple to follow, step-by-step guide designed to put you on the path to healing and pain-free intercourse.
Heather Jeffcoat, DPT is the founder of Fusion Wellness & Femina Physical Therapy, and the author of Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve. This book is primarily a “how to” resource. The author describes it as:
“a simple to follow, step-by-step guide designed to put you on the path to healing and pain-free intercourse.”
Designed specifically for people who are unable to access pelvic floor physical therapy, it provides a treatment guide through self-assessment, dilator techniques, and stretches for the pelvic floor. Heather is not only an expert in her field, but a caring and affirmative educator about all things sexual and pelvic health.
You can hear more from Heather about her book and pelvic health, specifically causes and treatment options for painful sex in Episode 8 of the Permission for Pleasure Podcast.
Receive 20% off a PDF download of Heather’s book at SexWithoutPainBook.com using code PLEASURE20
Pain and Sex
Painful sex is never normal. Take a step toward finding out what is going on with your body. You do NOT have to give up on sex!
Painful sex is never normal.
Due to the lack of education about sex, and years of hearing half-truths, many women think pain with sex is typical or normal. They believe that pain might just be part of what every woman experiences with sex.
False.
If you are experiencing painful penetration, the three reasons I address here are potential causes that have solutions that you can take control over right now.
However, if these more common causes don’t seem to be the issue, then I encourage you to seek help from your medical provider. Preferably, start with an OB/GYN doctor or a Pelvic Floor Physical Therapist. A qualified healthcare provider can assess more involved issues causing dyspareunia. Dyspareunia is the medical term for genital pain that occurs just before, during or after intercourse. Though certainly not an exhaustive list, a few examples of conditions that might cause pain would be: hormonal changes that decrease lubrication and elasticity of the vagina; ovarian cysts; fibroids; endometriosis; skin irritation or inflammation; infection; or vaginismus.
There are solutions, and I strongly encourage you to seek the help.
Tips on talking about sexual health with your healthcare provider HERE.
Three Common Causes
1. Not enough “arousal” time before penetration
Women’s bodies require sufficient time for arousal in order to get to a place of desiring anything entering their vagina. Allowing time for increased arousal will give your vagina and vulva the time they need to lubricate. This also increases blood flow which allows your vagina to soften and lengthen. All of these arousal responses help ensure that you don’t feel pain during sex.
Take your time!
2. Not enough lubrication before penetration
Lubrication is absolutely necessary for penetrative sex not to result in pain. Some women’s bodies produce a lot of natural lubricant, and some don’t. Both are normal! It is important to understand how your own body functions and if you naturally lubricate enough for pleasure or if you need added lubrication. Many women need or desire more lube than they produce -- sometimes all the time, and sometimes at varying seasons in their lives. Some possible causes of decreased lubrication might be: hormonal changes, medications, menopause, postpartum or breastfeeding, and aging.
There are many lube options available, read about them HERE.
3. Positioning
If certain sex positions are painful for you then by all means, STOP using that position or figure out ways to modify that position so it doesn’t hurt. Often a certain position may be uncomfortable because penetration is too hard or too deep. An easy adjustment for this is to try positions where you are in charge of how deep and how hard. Women sometimes find that positions where they are on top allows them this kind of control. There are also options to customize penetration depth with devices such as Ohnut rings.
Gently try different positions and evaluate what works or doesn’t work for you.
What usually happens if someone has pain with sex?
They stop desiring it and ultimately stop having it altogether. Communication with your partner is crucial in working through pain with sex. Be honest with them. Talk about what is going on with your body and what you want to do about it. Take a step toward breaking the silence.
You do NOT have to give up on sex!
Learn more on the Permission for Pleasure Podcast
Pelvic Health and Painful Sex
* links are not sponsored content, but if you want to try Ohnut mentioned above, they offer my community 15% with code CINDY
All About Lube
Adding a personal lubricant into your sex life is not just for when you need a little “extra,” but can enhance your sexual activity and make it feel “extra!”
Picture going down a water slide without enough water … It is not comfortable, or fun! Adequate water is needed for the slide to be slippery and cut down on the friction between it - and you! Lubrication is a lot like that.
Whatever you have heard and believed about sex, women and lubrication – throw it out the window and let’s start fresh with the basics. Sex can involve your body parts rubbing or moving against another surface or partner’s body parts. This results in friction. When there is too much friction it can cause discomfort, micro-tears of the skin, or pain. Adequate lubrication reduces the friction.
Reducing friction can also increase pleasure.
This means that adding a personal lubricant into your sex life is not just for when your body needs more moisture to avoid discomfort, but it can also make the sex you’re having slicker, longer lasting and more enjoyable. It can be an enhancement for your sexual activity.
Before you read further, let’s be clear - the cultural myth that a woman getting “wet” is the indicator that she is turned on and aroused is simply not evidenced-based. The best indicator to determine if a woman is aroused is - listening to her words - letting you know she is. Also, a lack of lubrication does not indicate a lack of arousal or desire for sex. These two facts are important for you and a partner to understand.
Lubrication is part of the sexual response cycle.
With arousal, there is increased blood flow to the genitals which begins the lubrication process. Women are all different, but typically need 11-20+ minutes of warming up activities (foreplay) to reach full arousal. A woman’s lubrication can vary day to day and from partner to partner. Women naturally lubricate in varying amounts.
Experiencing times of vaginal dryness is not an “old lady” issue.
There are many reasons why any woman of any age might not produce sufficient vaginal lubrication to allow for pleasurable sex. It may occur on and off in a woman’s life or it may be the nature of the way your individual body works all of the time. Certainly, a woman’s hormonal shifts in life can be a significant factor.
It is normal to experience times of increased dryness after birthing a baby or while breastfeeding. It is well known and documented that menopausal changes and aging can result in vaginal dryness and lack of lubrication. Other factors can affect lubrication as well. Stress, alcohol, medication side effects, dehydration, and skin irritation are a few known culprits.
Touching your genitals when they are dry, is not usually pleasurable!
So, whether for solo play and exploration or for partnered sex, lube is a good thing to have on hand. For the times you and your partner may be having a quickie - lube is most certainly recommended due to the decrease in time for arousal.
Despite what you may have seen on TV or in movies - saliva is not good lube. It isn’t slippery and has no staying power because it evaporates quickly. It can also transmit STI’s and unwanted bacteria from one partner to another.
Using lube with protective barriers like condoms is highly encouraged. It decreases friction that can cause discomfort as well as reduces condom breakage. Pick a lube based on its compatibility with the type of condoms you regularly use. Additionally, a good lubricant is essential for anal play or anal sex. The anus does not self-lubricate at all and penetration of any kind without lube can result in tissue trauma and pain.
BASIC categories of lube:
It is best to think through each type and possibly try a few to determine what will work best for you and your partner. I highly recommend you test out the lube on skin other than your vulva or vagina first to determine any sensitivity. The underside of your arm works well, dab some on there and wait a day to see if you tolerate the lube without irritation. Always check labels, the fewer ingredients - the better.
Silicone based lube:
Generally well-tolerated, non-irritating, and unlikely to cause allergic reactions. Safe to use with condoms. Not usually compatible to use with silicone toys. A little goes a long way, slippery not runny, and stays where you put it. Long lasting, and doesn’t evaporate. Suggestion: Uberlube.
Water-based lube:
Thinner consistency and dries up quickly which may require reapplication. Often a good choice for those with sensitive skin. Check ingredients and steer clear of parabens, fragrances and glycerin. Easy cleanup. Safe with latex condoms and silicone toys. Suggestions: Coconu, Good Clean Love Almost Naked, Okanagan Joy.
Oil based lube:
Thicker consistency and can play multiple roles as a friction reducer as well as great for skin-on-skin contact and sensual massage. Be careful with ingredients - may cause irritation/infection in some women. Not safe with latex condoms. Suggestion: Coconu
Food Oils:
None are recommended for vaginal lubrication. Though many people tell me they use coconut oil with good results and no ill effects. Food oils can speed up growth of bacteria and yeast in the vagina. They don’t flush out of your system easily. Oil causes condom breakage - do not use with condoms. Suggestion: Coconut oil
Petroleum-based lubricants (Vaseline, mineral oil)
These products should not be used internally and are not recommended. They can irritate and promote bacterial growth that can lead to infections. Never use with condoms or other latex barriers because they cause breakage.
More Options:
Hybrid lubes: a mix of water based with some silicone that provides a longer-lasting benefit with easier clean up. Suggestion: Good Clean Love
Lubes infused with CBD or hemp. Suggestions: Coconu, Foria, GoLove
Edible or flavored lubes
To try UberLube use code CINDY for 15% off
To try Coconu use my affiliate link and code Pleasure for 15% off
To try Okanagan Joy use my discount code CINDY15
*AFFILIATE LINKS AND RECOMMENDATIONS: I may earn a small commission when readers purchase products through my affiliate links. This doesn't affect which products are included. I choose products carefully, and anything I recommend on my website is recommended for its quality, performance, and overall reputation, regardless of any affiliate relationship.
5 Podcasts (and a TED Talk) Worth Listening To (2018)
A few ideas for learning something new about sexual health.
I listen to MANY podcasts, interviews, and talks on sex and sexuality - looking for great resources to share with my community of learners. As 2018 wraps up, I have gathered up a few of the best for you!
1. “Am I 'Normal?’ and Other Questions with Sex Educator Emily Nagoski” | Bad Yogi Podcast
This interview has something for ALL ages and seasons of life. Definitely worth your time! If you want to know more about Nagoski's book Come As You Are, you can read my book review here.
2. Physical Therapy + Peeing During Sex | Girl Boner Radio
Host August McLaughlin interviews Heather Jeffcoat, DPT about pelvic floor health, sexual pain conditions, urinary leaking, menopause, postpartum, urinating during sex and how physical therapy can help transgender individuals post genital reconstruction surgery -- just to name a few. Especially good information about painful sex.
3. Sunscreen Lessons (Ep. 26) | Whine Down with Jana Kramer
This podcast features therapist and intimacy expert Dr. Leslie Gustafson and her therapist husband Doug. This conversation was like listening in on a therapy session. Thought provoking, honest and delving into relationship sex dynamics in an unscripted session. Worth a listen.
4. More Sex, Less Pain with Heather Jeffcoat | Sex with Emily on Sirius XM
To learn more about pelvic floor health, listen to this Q&A by physical therapist and author of "Sex without Pain" Heather Jeffcoat on the Sex with Emily podcast. Ladies, our pelvic floor is made up of 12 muscles and pelvic floor physical therapy is literally changing women's lives for the better. I wrote a blog about pain and sex you can read here.
5. Leaning Into The Squirm: How to Talk to Your Kids About Bodies, Sex and Sexuality (Ep. 99) | Sorta Awesome
Listen to a great discussion with counselor Leann Gardner about “Leaning Into The Squirm: How to Talk to Your Kids About Bodies, Sex and Sexuality” on the Sorta Awesome podcast. I want parents to feel confident to be their child's primary sex educator!
BONUS: "What young women believe about their own sexual pleasure" TED talk by Peggy Orenstein
I read Peggy Orenstein’s book, Girls & Sex this year and found her TED talk to be a good representation of her interviews and findings. I especially recommend this for parents/grandparents of girls in middle school through college. Good insight into why comprehensive sex education is crucial.
