Genital Pain and Intimacy

Q: "I have vulvodynia and other chronic pain conditions and I don't spend a lot of time with my bits because pain, and effort, and it's just... not very fun, or appealing? But I'm dating someone who's very sexual, and I like doing things with them and the way my body feels when things get steamy, and it's clear that they're up for doing more but are letting me set the pace.





I don't really know how to... introduce them to my genitals? I can tell them the things that will definitely feel *bad*, but I can't really tell them what feels *good* because I genuinely don't know, and I get really self-conscious in the moment. The last few partners I've had have either been super anxious about inadvertently hurting me (which then made me super anxious), or I've felt like I needed to push through the pain because it was probably inevitable and I didn't want it to stop us from having a good time. My pain levels have also gotten worse since the last time I negotiated intimacy like this, so I'm extra nervous about trying again two years later.





I'd appreciate any advice you can offer!"





A: Thanks for your question. I have some ideas for your situation. In terms of how to talk about your genitals, I would suggest having this discussion in a relaxed non-sexual setting. That way, you both can have a good discussion and your partner can ask questions and you can brainstorm together and talk about your wants, desires, do’s, and don't’s. Having a safeword or gesture helps during sex. Safewords can be anything and when either of you needs to pause or stop. You can just say it instead of worrying about explaining what you are feeling at the moment. Reassure your partner that they are not hurting you rather this is just how your body works. You have every right to say stop when you need to, you shouldn’t force yourself through the pain for your partner's sake, because I guarantee your partner wouldn’t want you to either, sex is all about the journey of mutual pleasure. Also if this is appealing for you, experiment with masturbation. See what feels good/neutral and what doesn't, and take it slow, don’t try to force anything. Then when you are with a person you can tell them what you’ve experienced as pleasurable. Also, note there are SO many different ways to have sex that aren’t centered on genitalia or penetration. The body has so many ergonous zones for you to experience pleasure and even orgasms for some people!

Trauma and Sex

Q: “ (cw childhood sexual assault mention)


Hi, I have CFS/ME and fibromyalgia, but I also have chronic vaginal neuropathic pain following a not so successful genital upcycling surgery five years ago (I'm trans). I also have a csa history and consequent C-PTSD. I definitely have a sexuality but I'm afraid to express it in company, because I don't know how to work with fear of physical pain from being touched. Do you have any suggestions/recommendations for how to work with stuff like this? It's ruined a number of relationships over the years, and made me functionally asexual with others.”
A: Thanks for your question. I would suggest playing with sex that does not involve your genitals. That could mean making out, exploring the many other erogenous zones of your body, massage (which is also great for your fibromyalgia), using toys on your partner or your self (in areas that feel pleasurable -which could be anything from your nipples, neck, back of your knees, feet, etc! Everyones different).






In terms of your fatigue, telling your partner exactly how to get themselves off is a great way to be intimately involved without physically exerting yourself. You still have the control and can lie next to your partner while they are having fun. Also talking to your partners about how you need to take it slow is a good idea. You don’t have to go into why you need time to become comfortable, or why you might need to stop sometimes, but just explain that this is a part of being with you. There are many different ways one can have sex and feel intimate with their partner, so just keep an open mind, have patience, and communicate!

Chronic Fatigue and Surgeries & Maintaining Sexual Intimacy in a Relationship

Q: “My partner and I haven’t had sex for a long time - months, maybe even 6 months to a year because of all of my recent surgeries and chronic fatigue. How can I make sure we are meeting each other’s needs, even when I feel horrible?”




A: Thanks for the question. I have a few ideas. Mutual masturbation is a good way to get off but you don’t have to exert a lot of energy. If you don’t have the energy or ability to get off yourself, you can instruct your partner exactly how you want them to get themselves off. This way you are exerting less energy but are still involved. Talking dirty is also a great low energy way to still connect with your partner and make them feel sexy. You don’t even need to act on what you say to them. Lastly, talk to your partner and explain how you feel. Ask them what they need to feel fulfilled and maybe brainstorm together more creative ways to create sexual intimacy.

Porn with people with disabilites

Q: “Any recs on porn or porn stars, sites, or films who are disabled, without being fetishized? Generally looking to watch some great porn, with people who happen to have visible disabilities.”

A: Unfortunately there is not a lot of quality representation of people with disabilities in the porn industry. As you mentioned, most porn that does have PwDs fetishizes them. The only example that comes to mind is this video featuring a gay quadriplegic porn star. There so needs to be more porn that features people of all abilities! There is a lot of demeaning and degrading porn with PwDs, there needs to more realistic and empowering porn so we can see ourselves enjoying sex and get off on that!

Talking about bladder control with potential partners

Q: "I have a spinal cord injury and as a result have no bladder control, which becomes a big source of personal anxiety anticipating potential intimate encounters. I do not use a personal mobility aid, so there's less physical marker of disability, which makes any conversation or experiences a surprise for potential partners. Any tips on how to bring up the bladder control issue before entering the bedroom, communication tips if there's leakage during, and products to make the experience less messy/more pleasant?"

A: Thanks for this question. I know this is a sensitive topic and not an easy one to bring up with potential partners. I would say before you get intimate sit down with them and discuss all aspects of what you like in bed and what could happen. Talking about it in a matter of fact way helps the other person feel more comfortable. Talking about what your partner likes in bed and whatever else might come up also helps shift the focus from being only about you to being about your potential experiences together. This conversation beforehand will help you communicate if it happens during sex, and just be open laughing it off, cause all sex is messy! As for products to make the experience better, putting a towel under you will help your anxiety about possible leakage. Also, hospital pads are a great and cheap way to minimize mess as you can just throw them away afterward.

Spasticity and Orgasms

Q: "I have mild spastic Cerebral Palsy and I’m afraid to orgasm because I’m worried it might be painful. Do you have any advice?"





A: Yes! This is a common concern for people with CP. For folks who don’t know, spasticity causes muscles to be really tight and spasm - this can lead to pain! When people orgasm, most often their muscles get tight (this is true for anyone, not just people with CP). So, for those with CP, we have to be creative! Here are tips to help you enjoy your orgasms. Get into a comfortable position. This might mean bending your legs so they don’t push against whatever is surrounding you or what you are lying on. Using pillows to brace the impact of your muscles tightening can be really helpful as well. Also if you take anti-spastic medication, maybe time your fun around when you take your medication so your muscles are more relaxed. Also, and I know many people think the goal of sex and masturbation is to orgasm, but it’s not! Sex is a journey and it’s all about pleasure. So just explore your body and try different things and most of all, have fun!

How do I support my girlfriend when she is talking to me about her depression?

Q: “My girlfriend has depression and I have rheumatoid arthritis, vitamin deficiencies, and symptoms of Hashimoto's and hypothyroidism (need further evaluation, high likelihood though, parents and grandparents have it). Whenever I talk about my physical struggles, she either doesn’t say anything and listens while she holds my hand, or says the most perfect things. I feel good talking about it with her and she just so darn good with words I feel better and understood. What she does is enough and I am so so so thankful to have her. Whenever she talks about her depression, I get quiet and uncomfortable. I’m uncomfortable because I don’t know what to say her. I do listen and let her talk and make sure I’m not talking over her, but I want to say something back to her. Sometimes I’m really really trying to listen but I get too into my own head about what I’m going to say to her and I feel guilty for not listening. I want her to know that I am there for her. I want to say more things other than “I love you,” “that sucks,” “I’m sorry,” “i don’t know what to say,” “I’m glad you’re getting the help you need” “oh.” What other things can I say and how do I feel less uncomfortable when she talks about depression?”




A: Thanks for such a good question. I have a few suggestions. I would say to have a talk with your girlfriend when she is feeling okay about what she would like you to do to make her feel more supported. You can even say that you want to say and do more when she is struggling with depression, but you don’t always know what to say. Also saying that your quietness does not mean you are uninterested or not wanting to talk about her depression will help. Discussing how perfectly she supports you and voicing that you want to do the same for her might be a good way to open up this conversation. I can not give you other things to say to help her feel better because everyone is different and depression doesn’t work like that. But hopefully just having this conversation will give you a better idea of what would make her feel supported when she needs it. You don’t have to overthink saying the right thing all the time, sometimes just being there and showing that you are physically and emotionally present and not freak out by her struggles will make her feel comfortable just voicing these things to you. I would also recommend doing your own research on what exactly depression is, because there are a lot of misconceptions, and many people will take other people’s depression personally or think they need to somehow “fix it”. But having this conversation, doing your own research, and just simply being there for your partner can make a huge difference. You sound like such a caring person that she will definitely appreciate this conversation.