Ask the experts: Pain during sex - We're having issues in bed and my partner won't talk about it

Many people reach adulthood with either no information about healthy sexuality or negative and fearful ideas, Verity and Nic say. Photo / 123RF

Dear Verity & Nic,

I recently told my partner that the reason I have been avoiding sex is that it hurts. He was shocked and angry and then had difficulty performing the next time we tried. Now he won't go near me and won't talk about it. We haven't had sex for over six months and I'm worried he's going to find someone else. I wish I had kept my mouth shut. We have a great relationship in every other way. We have been living together for three years and were talking marriage and kids. How do I get things back to where they were? - Karla

Dear Karla,

It is tough when being honest with your partner seems to make things worse. We wish talking about your sexual pain had gone better for you, but please don't regret raising it. There are far too many women experiencing pain during sex and suffering in silence. In many cases, when couples present with different levels of wanting sex, pain or lack of pleasure lies behind the partner saying "no" to sex.

It's no coincidence that, in hetero couples, the person having painful or unpleasant sex is usually female. Frequently the man doesn't know because his partner has protected him from this knowledge. So many women believe that painful sex is inevitable and that sex is something they do for men, not for their own pleasure.

Many people come into adulthood with either no information about healthy sexuality or negative and fearful ideas. For many women, this vacuum is filled by conventional gender role expectations, including; self-sacrifice, being pleasing and thinking they have to earn love by "giving sex". This may be changing; there is certainly more of a discussion around entitlement to pleasure among younger women, but negotiating that in a relationship with another is still highly problematic for many women.

So there may be many reasons you had not previously raised that sex was painful for you. Perhaps you did not know why it was painful or that there was probably something you and your partner could do about that. Pain during sex can stem from many things; you and your partner not waiting until you are fully aroused before moving to intercourse, chronic infections, skin conditions, dryness due to certain medications or cancer treatment. Pain may also result from tensing of your pelvic muscles due to past painful sex, a history of sexual assault or feeling unsafe in some way with your current partner, including emotionally.

You may also not have raised the issue of your sexual pain because it is hard to talk about sex, and no one has taught you how. It is perhaps one of the most frequent interventions we make in our practice with couples to get them talking together about sex. You may fear the pain stems from some kind of lack in you. Some women believe they are not "sexy enough" or not "into" sex enough if they are not getting aroused and experiencing a lot of pleasure.

Other women fear making their partners feel like "bad lovers" or hurting their feelings, so they pretend everything is alright. This fear is not an unreasonable concern. Many men believe they should magically "know what to do" in bed. The porn they usually get in place of good sex education fosters that belief. Your partner may feel he "should" have known you were experiencing pain; he may see it as an indictment of him as a man and a lover that, not only were you not enjoying sex, it was painful for you.

He maybe also feel appalled that you have been in any way physically hurt by him, let alone during sex. If he is decent, this idea will be shocking and abhorrent to him. Sadly, it is not unusual for men who feel shame, guilt, or embarrassment to show anger rather than express those vulnerable emotions directly. This anger is no more helpful than his shutting down. Shame is also a likely response to his inability to "perform". Yet, if he was anxious about not hurting you, it's entirely understandable that he lost his erection. Shame and anxiety are usually passion killers.

In terms of the way ahead, you have been courageous and raised a touchy subject with your partner, you have started the ball rolling, but communication has now broken down. If you and your partner are going to have a viable future together with the marriage and family you envisaged, you must learn how to have difficult conversations well. We encourage you both to take this crisis as an opportunity to grow and develop better relationship skills.

Psychologists Verity Thom and Nic Beets are specialist relationship and sex therapists. Photo / Dean Purcell

We recommend you make a bid to get your partner to re-engage with you about all this. Reach out with some compassion that he may be feeling distraught and hurt. Perhaps speak about how much you value the relationship and want to build a great sex life with him and that you believe that if you and he work together, this is possible. Write him a letter if you think having time to reflect would help him respond well. It might be helpful to talk about how common sexual challenges are for couples. Most of us will experience three or more serious sexual issues in our lifetime.

To ease you both into a more relaxed, realistic and informed space about sexual matters, you could do some reading together like Emily Nagoski's "Come As You Are" or David Schnarch's "Resurrecting Sex" (which is a bit old but still has many good ideas in it). There are also many good podcasts and Ted Talks (including by Emily Nagoski) about the ingredients for a good sexual partnership you could listen to or watch together.

If your partner is unwilling or unable to step out from his hurt and stop being angry and shut down, it may be time to seek professional help from a trained relationship therapist (make sure they are willing to talk about sex; sadly, not all of them are!). It is reasonable for you to expect him to do the hard work of tolerating being open rather than defensive or angry. If you can't get him to talk or go to therapy, then we would encourage you to reconsider the wisdom of marrying him and having children when he can't settle himself to talk about tricky things.

The good news is these kinds of issues are often the gateway to new intimacy and connection. It is possible to learn how to work as a team to take your sex life and your relationship to a new and more rewarding level.

• Verity & Nic are psychologists and family therapists who have specialised in relationship and sex therapy for more than 25 years. They have been working on their own relationship for more than 40 years and have two adult children.