Learning to Stop Anticipating Pain
If you’ve been stressed for a long time, you’ve had a rough month, semester, year or if you’ve had a rough marriage or childhood, your pelvic floor muscles will stay in a chronic state of tension. Without getting treatment of some sort for this, the muscles will likely stay this way. Having sex with a pelvic floor that is always tight can make sex uncomfortable. When sex is consistently uncomfortable, then the anticipation that sex will be uncomfortable will feed into this mental loop. Then you are stuck in a pattern of A) I’m not really enjoying sex B) I should probably have sex to maintain this relationship/please my partner/out of obligation/etc. C) Penetration is about to happen and I know this is going to hurt E) The anticipation of the pain causes an additional reflexive tightening of the pelvic floor muscles F) Sex hurts again. This cycle can be broken. But, your brain has to be part of the process of unwinding the pelvic floor muscles.
One of the biggest exercises to get out of this catch-22 uses a dilator. This is a long tube shaped item of varying materials with varying girths. Some are bendable, some are hard. The girth is what matters the most because girth is the issue that can cause the most discomfort with penetration.
Dilators have a really bad wrap. When people tell me they’ve used a dilator before it makes me want to roll my eyes. Rarely do I think dilators are used correctly. 95% of the time, dilators have one roll for me. And that role focuses on the brain.
My personal story is that I got married when I was 22. I was a virgin. I had sex and it hurt. It hurt way more than I thought it would. It hurt more than my friends say it did. It hurt more than fiction and non-fiction said it would. It hurt more than it should have. Now, I was definitely dreading sex. At my wedding friends came up and said “You are going to have sex tonight!”. I was not looking forward to it. I anticipated the socially acceptable amount of pain that apparently most women experience the first time they have sex and I was nervous about it. My anticipation was not only met, but exceeded. Yes, the first time I had sex it certainly exceeded my expectations with life-altering and mind-numbing pain. Allow me to get graphic. I bled. I bled everywhere. The next day I got on a 10-hour plane ride to Hawaii. I bled on the plane. Sitting was painful. I bled all over Hawaii. I wasn’t comfortable going in the ocean because I was bleeding. I couldn’t have sex on my honeymoon because of the pain and the blood. I bled for seven full days. My first time having sex wasn’t beautiful. It was traumatic, painful, unexpected and I never wanted to repeat that process again.
Then real married life began. I moved to a new city away from friends and family. I attempted sex a few more times, but the experience was still really difficult for me. When I got to the gynecologist’s office to figure out why I was hurting so much with sex, he did an exam. He was an Asian man of about 45 (at that time, more than twice my age). After his exam he looked up at me and said “There is nothing wrong with you. There is plenty of space for a penis. If you want to keep that ring on your finger, I suggest you try to put this dilator in every day. I have no doubts you can get this whole thing in.” The dilator was massive.
Yeah, he was callous. But, he did have dilators in his office which looking back, is pretty unique.
Every day at four I would turn on Oprah (I still love Oprah – get over it) and lie on the ground to insert the dilator. It felt like a big, slow stretch, deep inside. A weird feeling. An unnerving sensation, but not painful. Mind you, I didn’t really have a relationship with my genitals at that time. I grew up being told not to have sex before marriage and not to use a tampon because it would mean I was no longer a virgin. I first used a tampon at the age of 20 (and didn’t know I could urinate with a tampon in). So, this sensation of a slow stretch in my vagina was weird.
Guess what. Sex still hurt. It hurt a lot. We weren’t even technically to have penetration – there was too much pain. And…I didn’t keep that ring on my finger. But, that wasn’t because of the sex or lack thereof.
Enough about me, let’s talk about how dilators should be used. They should be used with guidance, with strict rules and with results. I am extremely firm about how I issue a dilator program. Sometimes the first “dilator” I issue is just a long-stemmed q-tip. I never hand someone a massive dilator and say “get this in”. I know that it will never translate to enjoyable sex.
Rule One: Start with a very doable girth. If you are already having truly penetrative sex then I usually go with a dilator size that is considerably smaller than their partner’s size. I start with a size that isn’t intimidating to the naked eye. What we are trying to do is build confidence and calm and success.
Rule Two: Use lubrication. Use a lubrication that doesn’t cause irritation. I typically recommend using coconut oil because it is anti-microbial, gets the job done great and it is easy to purchase.
Rule Three: Make sure that you are in a comfortable location without worry of someone walking in. Make sure that you are mentally relaxed. Make sure that you are not sexually aroused. This one is really important. It might seem that the process of using a dilator may be easier if you are aroused, but the reality is that this would completely defeat the point. The dilator program is the work. This is the work that re-trains your brain that vaginal penetration does not equate to discomfort. If you can experience that inserting a dilator when you are not aroused is completely manageable and doesn’t solicit discomfort, then when you are sexually aroused you will have even that much more confidence that the experience will be enjoyable and not painful. The dilator program is a rehabilitation program, not a sexual activity. It is a rehabilitation program for improving later sexual activity.
Rule Four: If discomfort is quantified on a scale of 0 through 10, then 0 would mean no discomfort and 10 would mean that you would go to the hospital. Never allow this discomfort to go beyond a 2 out of 10. Once discomfort exceeds a 2, then you must not move the dilator anymore. Keep the dilator exactly where it is and start doing diaphragmatic breathing and relax your anus. 2 is the magic number.
Rule Five: Ten minutes, three times a week. Use of your dilator from beginning to end should not take more than ten minutes and it is very successful when done three times a week. While there may be some research that suggests using the dilator for much longer than this and using it every day, the reality is that research doesn’t always sit nicely in real life. If doing the dilator program takes longer than ten minutes and you have to do it every day, it is much more likely that you will not regularly do your dilator program. Carving out ten minutes is achievable three times a week. Carving out 30 minutes every day is not. Using the dilator doesn’t just require that you insert the dilator, it requires that you find the time to be alone without children screaming in the background, without feeling rushed because you have to start cooking a meal, without worry that someone is about to walk in.
That leaves us with 2: 10: 3
Never more than 2 discomfort, never more than 10 minutes a day and never more than 3 times a week.
Was that a long prologue to the whole program? Maybe. But, if you don’t understand the background of the program, it won’t be nearly as effective.