Tips For Supporting A Partner When Going Through Health Struggles Such As Endometriosis And Painful Sex… In The Bedroom And Beyond
By Holly Dixon
“I feel guilty because I cannot provide what I should to him. He always thinks that I don’t like him or I don’t love him because I don’t want to have sex with him. I keep explaining to him that it always hurts... It is really, really so painful that I do not enjoy sex but I have to because I don’t want to damage our relationship. That’s what’s tough” (Emily, a participant in Butt & Chelsa, 2007).
Emily’s statement above reflects how torn many women who suffer from painful sex (aka dyspareunia) feel when navigating issues of sexual intimacy with their partners. It also illustrates how a women’s dyspareunia can influence her partner, contributing to feelings of rejection or disconnection if not managed well. (The “should” in her first sentence also reflects societal expectations about what men’s and women’s roles are during sex (snore), but that’s a conversation for another day…)
How can couples stay strong, close, and affectionate throughout health struggles like endometriosis and dyspareunia? One way is to work on providing really responsive and tailored support. Below are 5 research-backed tips to help you do this well.
PROVIDE EMPATHY AND ENCOURAGEMENT. What you do and say matters immensely. Pain and pleasure are experienced in the brain and can be influenced by interpersonal interactions. Women who experience vulvar pain report that having an understanding partner was the most helpful component in learning to cope with their pain. Whereas, if a woman perceives their partner to be disappointed, angry, invalidating of their experience, or frustrated with them, it actually intensifies their pain, and increases their risk of psychological distress.
How do you provide validating, empathic, understanding responses? You really listen (not just wait until they’ve finished talking before you talk), you affirm their experience with verbal and non-verbal cues (e.g., “I hear you”), and you ask questions that show you’re curious and invested in being there and supporting them (e.g., “tell me more”, “how does that affect you?”, “can you tell me what that’s like for you?”). Providing an empathic and validating response is also helped by an ability to catch yourself if/when the tendency to provide unsolicited advice arises, or when your own ‘stuff’ (e.g., biases, fears, expectations) means you’re not able to be present and responsive to your partner in the way they need.
But it’s not all about providing attention and empathy (known as ‘solicitous’ support). There’s also a role for ‘facilitative’ support (basically, encouragement and support to cope). In fact, studies show that women’s sexual function improves on days when her partner provides greater facilitative and lower solicitous support during sex, whereas women report poorer sexual functioning on days when their partner provides solicitous support during sex (Rosen et al., 2014). Yup, you read that right: Attention and concerned responses to a partner’s pain during sex can actually lead to decreased sexual functioning and satisfaction. For clarity, solicitous responses during sex are often like: “oh, you’re in pain, let’s stop” whereas facilitative responses are like: “Oh, you’re so amazing, it feels so good, and you’re coping so well”. Here’s why: Attention and sympathy can draw attention to the pain. They pair (in our brain) the idea that sex goes with pain, and thus we should avoid both penetrative and nonpenetrative sexual activity altogether. So, while it’s important to show your concern, and provide validation and empathy, I suggest that you also provide encouragement and champion their adaptive attempts at coping, especially when you’re in the bedroom.
BE OPEN TO REDEFINING WHAT SEX AND INTIMACY MEAN TO YOU AS A COUPLE. Society makes out that ‘real’ heterosexual sex is spur-of-the-moment, tear-each-other’s-clothes-off-and-shag-on-the-kitchen-counter-until-you-both-mutually-orgasm sex. This viewpoint is problematic for several reasons. First, it doesn’t acknowledge the fact that women need their desire to be triggered (i.e. they can’t just launch into it from nothing), women need to feel safe, and the majority of women are not able to orgasm through vaginal penetration alone (i.e. without any stimulation of the clitoris), let alone orgasm in time with their partner. It also doesn’t make space for a multitude of other ways to be sexually intimate, including getting it on with foreplay, massage, intimate talking, laughing, listening to or watching sexy things, slowing things down, doing everything-but-penetrative-sex, and co-masturbation.
One of the things that may be particularly useful to you as a couple is to define what sex and intimacy mean to you, and what speeds up vs slow down desire. Ask yourself: What environmental conditions and psychological and physical states help turn on my desire vs turn it off? With this deeper understanding of the things that help vs hinder desire, you’ll be better able to play around with different ways of being intimate (both sexually and non-sexually) that meet both of your needs for closeness, connection, and pleasure. Perhaps you can explore different kinds of foreplay, play around with co-masturbation, slow things down, or explore the effect of gentle massages (this latter option reminds me of the pleasure Philippe, a man with quadriplegia, felt when receiving sensual touch to the ears in the 2011 French film “The Intouchables”). It’s likely that societal narratives of sex will need to be cast to the side, and instead, you’ll need to create your own narrative of sexual intimacy that works for you.
UNDERSTAND THAT THERE IS MUTUAL VULNERABILITY. Seeing your partner struggle with health issues like endometriosis and dyspareunia can be hard: There’s the pain of seeing them in pain, there can be feelings of helplessness, and feelings of rejection and disconnection when your needs for intimacy (sexual or nonsexual) aren’t catered to. As one partner said: “The only thing that’s hard for me is [that] I don’t think she always understands how hard it is” (Butt & Chelsa, 2007). Be aware that when you start to feel helpless or worn down, you’re more likely to express invalidating responses to your partner’s pain (Cano, Leong, Williams, May, & Lutz, 2012), which can snowball and lead to even more challenging issues in your relationship. You probably have a limit on how much support you can provide, and when you can provide it. Make sure you nurture your own needs and seek support from others too, otherwise you’re at risk of losing yourself.
PROVIDE INVISIBLE SUPPORT. This one is a bit obvious but needs to be included. If/when your partner is too weak or in pain to do their share of the household responsibilities, be open to doing them without complaint or resentment. This comes back to the first point: if a woman perceives you to be resentful, it intensifies their pain and increases their risk of distress. You can be angry and frustrated that they experience this pain, but please curb the impulse to get angry with them because the pain affects their capabilities.
OUR ILLNESS VS YOUR ILLNESS. In relationships, we are always mutually influencing each other all the time. When one person is ill, the other person is affected. Instead of seeing the illness or pain as a challenge for just one person, try to see and talk about it as a challenge for the relationship. Doing this is like jumping in the car your partner is driving while trying to dodge incoming challenges, as opposed to sitting in the grandstand watching them do it themselves. You’ll play a much more active role in navigating how to cope with the challenges and maintain the relationship, which will likely increase your ability to stay strong, close, and affectionate throughout the illness.
Getting support right can be a bit of a delicate balance. You might stumble around for a while not quite knowing what to do or say, it might be hard to transform an impulse to express anger at them into expressing anger at the illness, and it might be hard to recognise your own needs and be open about them. The best thing you can do is get in the car and ride this through alongside each other. The more you’re able to be present enough to see and meet your partner’s needs, the more you’ll be able to navigate this challenging space together.
Holly is the brains behind the social venture "Togetherly", researching and writing about all things from relationships to wellbeing. Holly is doing a PhD in relationship psychology and is on a mission to help people have healthier, happier relationships. Read more of Holly's research and findings at Togetherly.