chronic genital pain and painful sex – a heart felt discussion

By Kai, Bodysex therapist and sex educator

When I talk about genital and pelvic pain it comes from personal experience and a professional relationship around the subject. It is often heartfelt and mixed with many emotions. I find sharing my journey helps others to talk openly about their experiences. it allows people to approach me that might not.


My problems with genital and pelvic pain started some time ago. The first time I experienced testicular and groin pain was when I had an inguinal hernia – quite common. Although my hernia sac was larger than normal protruding from my inguinal canal into my scrotum. Like many inguinal hernia surgical repairs, surgical mesh was used. Postoperatively for the next few years, I would experience chronic right sided groin pain radiating into my testicle.

Years later I started to experience debilitating testicular pain (on the other side). An ultrasound revealed a large grade three varicocele in my left testicle. Varicoceles are large abnormal scrotal veins. Similar to other varices within the body. Except these varices occur near the pampiniform plexus. A tightly packed area full of nerves, arteries, veins, lymphatic vessels, the vas deferens and spermatic cord. This happens to stem down into a super sensitive erogenous zone “my scrotum”.

The solution to this problem was of course surgery! Which involves ligating (suturing and cutting) multiple veins to prevent blood flow and allow the vessel to die off. Urological surgeons are never quite sure which is the offending vessel, so they ligate as many visible vessels hoping they get the right one. Post-surgery my scrotum was the size of a tennis ball (and heavily weighted). I was unable to effectively walk properly for a month. I ended up with a hydrocele (small amount of fluid around my testicle). My balls and penis were off limits and definitely affected my relationship with my partner at the time. Following recovery, the pain returned (in fact I don’t think it had ever actually gone). This is now called a recurrent varicocele.

Never let a healthcare professional touch your genitals until you have discussed your feelings around them or with someone like myself first.

Self-loving was often uncomfortable and orgasm not always achievable because of the physical and emotional response to the whole saga. The pain was often excruciating compared to the pain experienced prior to surgery and now affected my left inguinal canal and left lower abdomen. The Urologist suggested having varicocele embolization. A procedure where an interventional radiologist places metal coils to obstruct the blood flow in the veins that could be responsible for the pain. I had this procedure two times. Again, recurrence both times.

Following these experiences, my testicle and pelvis felt like an angry mess. Every time I had a surgical procedure the relationship between my mind-body and genitals changed. Love making with myself changed. I thought at the time, how could medical science do so much damage to the fundamental pleasures I had with myself? Years later I studied clinical science – I became acutely aware of the research practices and disparities around medical and surgical procedures, pharmacotherapy, medical products and psychology.  More so the lack of evidence involving many of them.

In short multiple surgical procedures have left me with two-ten-centimeter scars bilaterally across my pubic symphysis. 12 metal coils in situ permanently. Scar tissue and adhesions around the coils. Recurrent varicocele with inflammatory responses and surgical mesh on the other side. Prior to surgery, I was always able to contract and lift both testicles during pelvic floor exercises with ease. This is also called the cremaster reflex (involuntary or voluntary) Post surgery I could no longer contract my left testicle and the reflex had diminished.

So, take it from me I understand the full range of emotions that occur from chronic genital pain and genital surgery. My personal journey is one of the reasons I work with people and genitals, “because I get it”. Our genitals are attached to a full range of emotions in life. Pleasure, pain, sensitivity, anxiety, enjoyment, happiness and life’s truly pleasure “the orgasm”. Our genitals reflect a state of health and erotic wellbeing.

Many of us will go through various forms of physical and emotional genital pain in life. Nearly three in four women will experience pain during intercourse (which makes my mission so important). There are no statistics for men – but I guarantee that penile and scrotal pain exists. One of the biggest reasons for painful sex apart from pathological causes is that we rush into erotic play with lovers. We don’t communicate enough about what feels good and what doesn’t feel good. We often don’t experience enough foreplay, so our genitals and bodies are not sufficiently aroused. The majority of cues and education around sex comes from wham-bam porn. Lovers are quick to act out porn scenarios, before learning each other’s genitals and bodies. Many penis owners don’t know how to use their penis in a capacity of gentle lovemaking – more on this some other time.

It’s important to self-sooth genitals when it comes to chronic genital pain.

Painful sexual experiences (pathological cause or not) develop conscious and unconscious somatic markers. These markers are either associated with positive or negative outcomes from the sexual experiences in your life (physical or emotional pain). For example, you may have felt significant pain from a penis during sexual intercourse. You didn’t tell your lover at the time. Consciously you may not think about this past sexual experience. But your body and unconscious mind hold this mark.

Such negative sexual experiences can result in a continuous loop. For example, fear around anything to do with the penis, anything going near or being inserted into your vagina or anus. Most likely you will recall emotions around that experience. Unfortunately, this can play havoc during erotic moments with yourself or lover – inflicting a state of flight or fight response. In this scenario you might withdraw, your heart rate increases, muscle tone in your genitals, anus, pelvis and other parts of your body become tense. You might experience a full range of emotions but have no idea why you are feeling this way. Literally, thinking back to the painful sexual experience can also result in unintended genital pain – you don’t need a physical sensory experience. Those who have experienced chronic genital and pelvic pain will try to avoid erotic interactions with themselves and lovers. Such experiences become internal alarms. The body learns to react and respond in a negative manner.

There is no doubt that genital pain adversely impacts relationships. Lovers often don’t know how to respond to situations of pain. Likewise, those experiencing the pain don’t know how to respond to their lover. Often both lovers will just shut down emotionally and physically. Our erotic capacity is the make-up of “glue” that holds relationships together. This can easily break down. Especially if you have poor erotic awareness and communication with your lover. Communication finesse is always required for pleasurable sexual experiences.

The other thing I want to touch upon is the grief and loss around genitals. It’s really important to acknowledge and work through this. Chronic genital pain can be from a loss of genital function or loss of genital organs. For example, a vulva/vagina owner may have a hysterectomy and lose their internal sex organs. A penis owner might lose a testicle or prostate. Trauma or cancer can result in the loss of a significant portion of genital tissue or nerves. Loss and grief can also stem from sexual assault or abuse. In essence, you lose a whole range of things asscoiated with genitals – the ability to self-pleasure, receive pleasure, create life, feel body and genital arousal. Unlike other situations of loss and grief, our genitals are intricately linked socially, culturally, physiologically, somatically, emotionally, in our personal erotic themes and sexualities. A sensitivity is required to work through these links and complexities to deal with this.

The nerve structure around genitals is vastly extensive and complex. Genital anatomy (shape) and structure differ for everyone. So, does the pain response to these structural dynamics.

I have personally experienced the health care system in relation to chronic genital pain. I am also witness to my client’s experiences at attempting to heal in the same system. The system is not designed for sexual healing, or bodysex therapy (body-based), learning around such healing. I am mindful of the capabilities and limitations that specific healthcare professionals (surgical specialists, psychologists, counsellors and physiotherapists) have when it comes to genital pain. However, these professionals are limited in how they work with the genitals, genital pain and the body (including the time they can spend with you). Safe touch  (bodysex therapy) experiences and sexual healing are not part of this system. Professionals can also exacerbate chronic genital pain responses. Recall back when I was discussing “somatic markers”. You can experience further emotional and physical pain responses when it comes to surgery, physical forms of therapy and clinical procedures – that’s because you’re still healing sexually. Your mind-body and genitals are still in a state of flight or fight response. Adding further insult to the healing process. Many patients get to a point with their specialist and have exhausted all options. There is nothing more to they can do. Wrong! I bridge the gap when it comes to sexual healing and learning. For example:

  • Physical and emotional components around the genitals and the body.
  • Discuss genitals and your sex life openly with real understanding and compassion.
  • Allow opportunities for safe touch and self-touch (genital and body experiences) in a capacity of learning, personal healing and managing pain.
  • Knowledge around sexuality and sexual lifestyles.

People who have had genital surgery relinquish control of their body and genitals to the surgeon’s knife. It can feel terrifying, intrusive and can result is a sense of erotic loss.

I have a very good understanding of genital anatomy, body-mind restrictions that occur with genital pain responses and how to work with these. Including the pathophysiology around scar tissue, nerve damage, inflammation, surgical procedures and drugs used to treat pain. In my personal journey, I have used a variety of tools to manage genital pain. I have also taught clients similar tools. Here are some areas that clients work through with me:

  • Learning how to communicate with your lover.
  • Learning how to be present and feel into your body.
  • How to have different types of erotic experiences with yourself and lover.
  • How to slow down and enjoy slow sex experiences.
  • How to manage physical and emotional pain using meditation.
  • Learning about genital anatomy including genital mapping.
  • How to relax your body using mindfulness – and breath.
  • How to self-massage, feel genital and pelvic restrictions from scar tissue.
  • How to change pain responses into possible pleasures.
  • Feeling into touch and genital responses from touch/massage.
  • Learning about your somatic markers.
  • Genital art and modelling therapy
  • Recommending different types of lubrication for genital dryness and sexual activity. Plus, much more.

People might be skeptical about mindful approaches and the work I do with genitals. Henri Astier has suffered from chronic pelvic pain. In this recent BBC article, he talks openly about how mindfulness helped him manage his pain. This is a great article and will give you some insight into how I work with similar clients or maybe even yourself. For me personally and professionally, the learning around genital pain doesn’t stop. Likewise my clients are learning things about themselves they have never felt before.

Been told that your pain experiences aren’t real? You are the best person to understand your body and its responses.

If your someone who suffers from genital pain the first step is to open up about your concerns. The second hurdle create an awareness around your genitals and body. This might mean moving from a position of shame, pain, and embarrassment, to a position of feeling and developing a new relationship with your body and mind. Breaking the negative loop in chronic genital pain is a journey. It takes time and patience to heal. You need to be gentle with yourself. It’s important to find health care professionals that are going to be compassionate and have the same level of patience with you on this journey. There is much more about genital pain states and painful sex that I do not have the time to reflect here. Please connect with me if you would like to explore my professional services.

further reading

How does vaginal stimulation produce pleasure, pain, and analgesia? link here

The Effects of Massage Therapy on Pain Management in the Acute Care Setting. link here

Clinical Holistic Medicine: Holistic Sexology and Acupressure Through the Vagina (Hippocratic Pelvic Massage). link here