If talking about bladder issues can be difficult for some IC patients, then talking about sex and IC is surely even more difficult. While sex is often a taboo topic, finding ways to manage intimacy and IC can be difficult for patients dealing with pelvic pain. When even the pressure of a loose elastic waistband is too uncomfortable at times, it’s hard to imagine intimacy being desirable, let alone pleasurable.
Dr. Rachel Rubin, one of only a few physicians with fellowship training in sexual medicine for all genders, said intimacy shouldn’t be painful. No, she doesn’t just have her head in the sand and not understand IC patients. Instead, she has some suggestions for how intimacy and IC can co-exist in a pleasurable way. It might take a bit of trial and error, but it’s possible.
Redefine Intimacy
Though most people think of physical intimacy as being sexual intercourse with penetration, Rubin said doesn’t have to always be the case for everyone, especially those with pelvic pain.
“One of the major important things is that intimacy can and should look a lot of different ways,” she said. “It does not have to just equal pain-producing penetration. Sometimes you have to think outside of the box for intimacy and pleasure.”
Research suggests that 65% of IC patients can enjoy foreplay and orgasm without pain. With that being the case, IC’ers have found outercourse often the most pleasurable form of intimacy for them.
Learn What Works
Figuring out what feels good and what doesn’t is also important. Rubin said most doctors don’t ask patients whether they can have an orgasm or if any stimulation feels good. She mentioned clitoral stimulation can be pleasurable for women with pelvic pain.
“Find the things that don’t hurt and don’t cause pain,” Rubin said. “If anything is pleasurable, then do that. Continue to have intimacy that feels good as opposed to painful intimacy.”
Rubin pointed out that playing on your own can help you figure out what’s going to work and what’s not. Dr. Heather Howard of the Center for Sexual Health and Rehabilitation offers a free guide for couples about how to best map out what feels good together.
“You can’t predict and give overarching advice of what works for everybody,” Rubin said. “Sadly nothing works for everybody.”
So, patients and their partners can do some careful experimenting (and hopefully have fun along the way!) to figure out what works best.
Communicate about Intimacy
Though we’re talking about physical intimacy and IC, verbal communication also plays an important role. Talking about sex can be hard for couples.
“Nobody taught us in middle school sex ed class how to talk about sex at all, let alone when there is pain,” Rubin pointed out, saying couples may have to practice getting better at communication about sex.
She suggested having conversations about sex when fully dressed both beforehand and afterward. Talk about what worked and what didn’t. Be considerate of your partner’s feelings on both sides of the equation. It’s easy for a partner to feel rejected and dejected after being turned down too often by a patient in pain — even if he or she understands the pain. Pelvic pain patients, on the other hand, can feel pressured to do things even when they hurt to make their partner happy. Talking about it helps.
One of the challenges partners of IC patients often face is knowing whether it’s a good time for sex or not. Talk about this together and how to manage this. Maybe come up with a signal to indicate whether you’re OK with intimacy that day. For example, you could keep a pillow on your bed that you flip one way when you don’t feel up to sex and the opposite way when you do. These sorts of strategies can help keep some spontaneity in your relationship.
Pick the Right Products
Vaginal skin is very delicate and sensitive. Finding the right products is important when working to avoid pain with intimacy. Many IC patients say lubrication is helpful. But finding the right lubrication is vital. Rubin said a water or silicone based lubricant is usually best. She also warned to be careful of chemical-filled products at the drugstore and avoid warming gels, which can irritate the vulva.
“You’ve got to experiment a little bit,” Rubin said. “Try [the lubricant] on other parts of your skin to see if it irritates.”
Along with lubrication, Rubin suggested devices designed for sexual arousal or pleasure can often be helpful in conjunction with your partner.
“Devices are wonderful for all bodies and all sexual organs,” she said. “But not every device works for every person. Finding a device that would work well for you is a little bit of a trial and error.”
Rubin said technology has created lots of products to aid with orgasm and arousal for both genders. She views these as any other tool used to improve our bodies like hearing aids or glasses. As such, Rubin suggested looking for more high-end products with good reviews. She also mentioned a few places to start shopping if you’re new to this: Amazon (look at the reviews), Dame, Lelo and Womanizer.
“Intimacy should not be painful and miserable,” Rubin said. “Find activities that bring you joy and pleasure and fun.”
For more resources and information on intimacy and IC, be sure to check out the IC Network’s Intimacy and Sex for IC Patients section.
