To improve difficulties with penetration, it is important to:
- Have sex only when you want to
- Feel safe in your sexual relations
- Understand and Meet your own conditions for good sex (for example having privacy, feeling relaxed, not feeling rushed, pressured, tired or distracted, feeling able to trust a partner)
- Learn to recognise when you are tense and identify techniques and ways to relax and overcome this
- Use self-exploration to identify the kind of stimulation you like and focus on this stimulation during partnered sexual activity
- Be able to enjoy having sex rather than worrying about your performance or what you look like
- Feel confident to communicate and negotiate about sex with your sexual partners
When pain is felt only on deep penetration, it is important to exclude a medical cause for the pain by having an assessment with a medical doctor. Once you have excluded a medical cause for the pain, it may be helpful to avoid certain positions, for example being penetrated from behind (when penetration may be deeper and may involve contact with the cervix). If you suspect this is the cause of pain for you, you may wish to try the following positions to see if they are more comfortable:
- being on top, where you can control the depth of penetration;
- being on your back and raising your legs high;
- or being on your back with your legs together (usually you’ll need to have your legs apart for your partner to enter, then put your legs together, with your partner’s legs on the outside of yours).
The vagina’s production of natural lubricant can be affected by a range of factors (for example: pregnancy, breastfeeding, the menopausal transition and certain medications). If your vagina feels dry, you can try to make sex more comfortable by getting more turned on before penetrative sex and/or by using a lubricant (lube), which you can buy at any chemist or sex shop. Lots of people find that lube makes intimate touching more pleasurable.
Lifestyle factors
A healthy lifestyle helps to reduce stress levels and improve cardiovascular health. In turn, this can enhance arousal and support sexual functioning. A healthy lifestyle can be supported by:
- Getting enough sleep
- Eating well
- Exercising regularly
- Stopping smoking
- Limiting the use of alcohol and recreational drugs
Visit nhs.uk/live-well for help and advice around maintaining a healthy lifestyle.
We know that there are three key elements that enable sex to go as well as possible: psychological arousal, physical touch, and being in the moment. These are known as the Conditions for Good Sex (Gurney, 2020).
Psychological arousal refers to how much of what is happening you find sexually arousing and turns you on. This can include how attracted you feel to your sexual partner(s), things in the environment (like lighting, sounds), the context (time of day, your role in the sexual experience), and also sexual fantasy and types of porn.
Physical touch refers to the types of physical stimulation that your body needs to feel sexually aroused. This can include the types of pressures your body needs, the speed and location of touch, the types of sex you enjoy and whether you enjoy using sex toys and/or lubricant (‘lube’).
Being in the moment refers to how much you are able to be in the present moment (rather than caught up in other thoughts or worries) and how much you’re able to focus on the physical sensations and psychologically arousing stimulation. This also includes how much you’re able to feel relaxed. Later in this booklet we have included suggestions about using mindfulness to increase being in the present moment.
The closer each of these elements are to our ideal conditions, the better the sexual experience will be. If we have high psychological arousal (are aroused and turned on), are receiving the types of physical touch we find pleasurable and are able to be in the present moment (and not distracted by other thoughts or worries) we have met the conditions we need in order for sex to go well.
Knowing your own conditions for good sex can help you to:
- understand what you need for sex to be its most enjoyable
- understand what might be disrupting the arousal process
- understand how these conditions might have changed or been impacted by sexual difficulties
It is not usually necessary for all of your conditions for good sex to be met throughout every sexual experience for the experience to be enjoyable. However, understanding your own conditions, and talking about them with sexual partners, can help to include more of your conditions more of the time.
Our pelvic floor muscles are like ‘a bowl of muscle’ underneath the pelvis. They provide support for the pelvic organs and help control when we go to the toilet. They also help to increase blood flow to your genitals which aids arousal and increases pleasure. Contractions of these muscles also help produce sensations at orgasm.
The image below shows where your pelvic floor muscles are on your body. You can feel your pelvic floor muscles by contracting your anus as though you’re trying to stop a bowel movement, then imagine a zip closing forwards an upwards as if you’re trying to stop the flow of urine at the same time.
Sometimes, the muscles of the pelvic floor can become tight or tense. There are many reasons why this happens, for example injury during surgery or childbirth, a history of sexual trauma, feeling anxious about sex for any reason, or just the anticipation of penetration. This tension can cause pain or discomfort during sexual activity, and reduce pleasure.
Pelvic floor relaxation exercises improve your awareness of when these muscles are tense or relaxed. Ensuring our pelvic floor muscles are relaxed helps sex to be enjoyable and not uncomfortable or painful.
To practise pelvic floor relaxation, you can use a technique called ‘Sniff, Flop and Drop’.
- Sniff - take a soft and deep breath in through the nose over three seconds. Keep your shoulders relaxed and your chest still.
- Flop - keep your stomach soft while breathing in. This should mean that the abdomen ‘flops’ or fills all the way out on the in-breath.
- Drop – allow your pelvic floor to drop or release also during the in-breath.
You might find it easier to close your eyes while doing the exercises to really focus on the sensation of the pelvic floor relaxing, of ‘dropping away’. You can then take this skill into sexual situations, consciously relaxing your muscles in the sexual moment.
Earlier in this booklet we explained the importance of being in the present moment to fully enjoy sex. ‘Mindfulness’ has its roots within a wider set of Buddhist spiritual teachings and practices, the benefits of which have been known to Asian communities for centuries. More recently, a secular version of mindfulness practice has been adopted by Western cultures. Mindfulness practice can enhance our connection to the present moment, which can help improve a range of difficulties, including sexual ones.
When we get caught up with critical thoughts or trying to change things, this takes us away from the present. An important part of mindfulness is paying attention to your present experience without evaluating it. This means not judging the experience that you are having, just noticing it with curiosity and openness.
There are many ways to practise mindfulness. For example you could:
- Go on a walk and use all your senses to notice your present moment experience – the different things (like colours and textures) you can see, the smells and the sounds. Rather than ‘listing’ the things you notice, this is about really experiencing them in depth and detail.
- Sit in comfortable position, with your feet on the floor and your back straight but relaxed. Spend some time focusing on your breath as you inhale and exhale, focusing your awareness on the natural rhythm of your breathing.
It is completely normal for your mind to wander. When you notice this has happened, gently bring the focus of your attention back to the present moment.
It can take time to increase your ability to be mindful. You can start by practising for 10 minutes each day as you get more confident. Building up your day to day mindfulness skills can help you stay more present during sexual situations. Everyone responds differently to mindfulness practice, however. As with all suggestions in this booklet, only do what feels right for you and stop if anything causes you pain or feels distressing.