Who wants to do something they don’t enjoy? Especially when it comes to sex.

Ideally, sex feels more than enjoyable…like, downright pleasurable. But with so many stigmas, expectations and misinformation about how it should feel, getting there physically and mentally can feel like an impossible-to-reach standard. And typically, your healthcare provider may be the last person you want to talk to about it.

Here’s the thing, though: I love talking about sex and pleasure! It’s my favorite part of the job. And because sex looks a little different throughout our lives, it’s never a one-and-done conversation. As you and your body change, so does what feels good. This is why establishing it as a part of your ongoing health check-ins can be greatly beneficial.

While I get that it’s a hard thing to bring up with your doctor or nurse-midwife, know that we won’t pass judgment. And better yet, we’ll help find solutions to make sure your sex life is what you want it to be, and feels how you want it to, as well.

How sexual pleasure is related to sexual health

First, let me say that sexual pleasure is good for your health. There’s a strong psychological tie between the two. If something doesn’t feel good, your body won’t want to do it, and will likely have a physical response in opposition. Desire will decrease. And after time, that lack of desire or physical block becomes a learned response.

We see this often in those who have a history of trauma. It can also be true in those who continue to have unpleasant sexual experiences. The body affects the mind; the mind affects the body. This is why your provider wants to help you reach a good place with sex and pleasure.

How to ask your doctor about sex

Though sex and pleasure are absolutely worthwhile topics to bring up to your provider, it can understandably still feel embarrassing to do so. Our society has stigmatized sex, making it a taboo topic, even in a healthcare setting.

So if you feel shy, or uncomfortable, know that there are no rules for why you ask a question.

  • You don’t need to have a medical issue. Sex doesn’t need to hurt to bring it up.
  • You can ask how to increase your pleasure. We have tips to help!
  • You can focus on your emotions. We can talk about how sex makes you feel.

There are no rules for how you ask either. Try starting with:

  • I am having problems with dryness or pain with sex.
  • I’m not having sex as often as I’d like.
  • My periods are really affecting my sex life.
  • I want to have an orgasm/I’ve never had an orgasm. What can I do?
  • How can I regain sexual pleasure?
  • I have a low sex drive. What can I do?

Your provider may start the conversation in certain appointments, too. I like to ask people if they are sexually active and how things feel during their annual wellness visits and postpartum visits, or if I know they’ve experienced any major life changes. Again, while what we discuss does not have to be medical, it’s especially important to tell your provider if sex hurts since it can indicate a larger medical issue.

Things that may affect sexual pleasure

Before looking at the types of things that can affect sexual pleasure, it’s important to understand why sexual pleasure is too often devalued and ignored, especially for those with vaginas.

  1. Socialization – Those who identify as women have been socialized not to prioritize their own pleasure. In the media, porn, books and even in conversation, female pleasure is shown as secondary, or not necessary at all.
  2. Education – Our sexual education doesn’t include anatomical education, where the many incredible facets and pleasure capabilities of the vagina and vulva are fully explained and explored.
  3. Normalization – We’ve been shown an unrealistic picture of what pleasure looks like for most people with vaginas. This leads to a belief that orgasms should be achieved quickly, consistently and usually by penetration. Or, pleasure is portrayed only by an association with sex versus the touch that can come before it. Worse, we’re told pain during sex is expected.

Everyone has a right to feel pleasure during sex, and your provider may start the conversation with three reasons you might not be now.

Pain/discomfort – If you feel pain or discomfort during sex, the first thing we’ll do with your permission is take a swab to check for bacterial vaginitis and STIs, both of which are treatable. If the cause is more tissue-related, we’ll talk about lubrication. If it’s more of a muscle pain or related to postpartum, a pelvic floor physical therapist is a valuable resource.

Vaginal dryness – People mistakenly assume there needs to be a great deal of discomfort to add lube during sex, but there is no downside to adding it at any time. This is especially true during postpartum or lactation when estrogen levels are super decreased, and during perimenopause and menopause. You can also talk to your provider about a vaginal estrogen prescription.

Anatomy awareness – Because we’re all socialized to think certain sexual experiences are “normal,” and without a baseline knowledge of how our bodies work, we often never learn what brings our individual selves pleasure. The clitoris, for example, has thousands of nerve endings, making it a key zone for sexual stimulation. The vulva, vagina, and clitoris may also swell when sexually aroused, making them more sensitive to touch. Your provider can provide foundational knowledge of where everything is and how it can all beautifully work together.

Knowing our own anatomy takes time and patience—and a willingness to discover what feels good. So whether you’re hoping to achieve orgasm, or simply want to enjoy the different types of pleasure that can lead up to it, experiment on your own or with a willing partner.

Decreased desire – If sex feels more like a chore, pleasure will be the last thing on your mind during it. Several things can cause this—life, right?—so figure out what’s on your mind. Whether it’s a flailing connection with your partner, romantic interruptions, persistent stress, not having your needs met or any of the other reasons above, your provider is open to talking these things through so you can find your rhythm.

Your sex life throughout life

There is no age limit to great sex. But it’s important to recognize that our priorities in life shift. Some days (or months) we’ll choose sleep over sex. Others, we’ll be perfectly happy staying up all night with our partner—or ourselves. Interest in sex, how it feels and what feels good will also change, but remember that when bodies settle into new normals, they always recalibrate. And there are ways to help this along.

Adolescence – Hormones are raging, and this is the period of discovery and exploration. Remember birth control options and STI protection.

Reproductive years – Life is stressful and constantly changing. Pregnancy and young children may enter the mix. All of this change impacts desire, which will ebb and flow. Roll with it.

Postpartum – Things may not feel the same after giving birth. Sleep is scarce, low estrogen affects vaginal dryness, there’s likely soreness and increased discomfort and desire can be at an all-time low. This is temporary!

Perimenopause – As estrogen dips, so does desire. Arousal is also likely harder to find. Medications, time and experimentation can help achieve a new (still pleasurable) normal.

Menopause – Physical and hormonal changes abound, affecting both the body and mind. Arousal may take longer to achieve, which makes this a great time for experimentation. Learn about your new body like you did during adolescence.

Remember your provider is there for you during all stages of your sexual health—and pleasure plays a big part in that. While talking and commiserating with friends about a less-than-ideal sex life can be a great resource, they likely have experienced the same socialization, education and normalization around sex and pleasure, which is why it can be good to get a fresh perspective. So, let’s talk about sex! <Find a WHA provider>

Helpful resources:

  • Come Together and Come As You Are by Emily Nagoski, PhD
  • Becoming Cliterate by Laurie Mintz, PhD
  • Sex Talks by Vanessa Marin, LMFT
  • Mating in Captivity by Esther Perel
  • Let’s Talk About Down There by Jennifer Lincoln, MD
  • The Menopause Manifesto and The Vagina Bible by Jen Gunter, MD
  • Pleasure Activism: The Politics of Feeling Good by Adrienne Maree Brown