What Happens to Relationships When Sex Hurts

In her 18 years as a sex therapist in Orange County, California, Stephanie Buehler has come to recognize a certain tense, fraught dynamic in couples when a female partner has vulvodynia. The chronic-pain condition affects female genitalia, sometimes manifesting itself in generalized pain throughout the vulva and sometimes in localized pain that can be provoked through vaginal penetration. Either way, vulvodynia can make sex extremely painful.

Often, “these couples have stopped having any kind of physical contact. Usually they’ve stopped being affectionate,” Buehler told me. Particularly in mixed-sex couples, she’s found that “sometimes it’s because the woman is afraid that if there’s any physical contact, he’s going to get aroused and she’s going to have to say, ‘I’m not interested.’ Or it’s because he doesn’t want to burden her with his needs.” Not every couple whose love life has been affected by vulvodynia fits that description, Buehler noted: “Sex is not the be-all, end-all for every couple.” But many, she’s found, are frustrated by the loss of a way to communicate their love to each other. Sometimes a partner, especially a male partner, feels rejected, believing the female partner is exaggerating the pain she feels during sex as a way to brush him off. Sometimes the female partner feels guilt or frustration because