If you’ve experienced unwanted pain during sex, you’re far from alone. Take it from psychologist Dr. Nazanin Moali, who knows a great deal about it from personal and professional experience.
We recently explored her own journey with sexual pain, as well as takeaways and insights for anyone struggling, for this week’s Girl Boner Radio episode.
Stream the episode on Apple Podcasts/iTunes, Spotify, iHeartRadio or below! Or read on for a lightly edited transcript.
“From Painful Sex to Vibrancy: Dr. Nazanin Moali’s Story”
a lightly edited Girl Boner Radio transcript
Dr. Moali:
I grew up in Iran in a really—during a challenging time. It was post Islamic Revolution. And during the war, I grew up with a family that they’re open minded. My mom is an author. But because of what happened during the revolution, she was in a very deep depression. So she was almost absent during my childhood years.
August (narration):
That’s Dr. Nazanin Moali. She told me that because of her mom’s struggles and near absence, she didn’t really get any information about sex or sexuality. She did come upon an erotica series her mother owned, though. She was intrigued—but also, perplexed.
Dr. Moali:
Growing up in a country that was more conservative, I got lots of negative messaging around sex and sex before marriage and even sexuality for women. So it was very confusing.
On one hand, I was getting this access to this very tasteful erotic material, and I was getting very negative messaging around sex at school and society. So it was definitely very confusing.
August:
Is there or was there at the time any formal sex ed class in Iran?
Dr. Moali:
No, unfortunately. It’s an extreme, abstinent-based approach, right? The idea is, you don’t want to even think about sex before my age. And you hear all of these horror stories about what can happen if you masturbate, what can happen if you have premarital sex. And I was such a good student that I was internalizing all of those messaging, which was tough, and it was conflicting for me.
August (narration):
Masturbation, she learned, is perverted and bad for your health. You would go to hell for doing it. And “good girls?” They don’t even think about sex.
Dr. Moali:
It was just so confusing. Because you discover your body. It’s pleasurable. On the other hand, you feel like why? Why am I thinking about this? So that was really tough.
From early on, I was connected with my sexuality. I was kind of like, I discovered there’s part of me that’s free, and I want to have sex. And I kind of valued that part of me. But there was this other messaging that was going on that good girls they don’t think about sex. This is perverted.
August (narration):
She moved here, to the United States, as a teenager, where she tried to separate herself from those negative ideas.
Dr. Moali:
At that time I was very disconnected with my body. I was thinking about, Okay, these are the messages. I’m just gonna put it away, and I’m gonna be whoever I am now. And I was always kind of conflicted about this part of me.
August (narration):
Dr. Moali is now a psychologist, published researcher and the host of the Sexology Podcast, in addition to a similar Farsi podcast. Much of her work focuses on helping people improve their sex lives and restore or achieve passionate connections—a far cry from what she learned about early on.
Those mixed messages she received about sex aren’t what led her into this work, though—well, at least not directly. She told me she was in grad school for psychology when she started experiencing sexual challenges.
Dr. Moali:
And what happened was—I was in a relationship—and out of the blue, sex became painful.
When I first notice it, it was at the point of penetration. And it was really, really painful. It almost felt like my entire body was clamming up. It was just so shocking and surprising for me, because that wasn’t an issue that I had before.
Granted that I didn’t know that sex shouldn’t be painful at all. So I’m thinking, reflecting back, I wonder there were times that sex was uncomfortable or mildly painful, and I was assuming that was enough. And being disconnected with my body, I didn’t may perhaps notice it when it was very extreme. And almost at some point, penetration was impossible.
August (narration):
That happens a lot, by the way, especially for people with a vulva. I’ve heard from several folks who said that another woman—their mother, a sister, an aunt—told them that discomfort and pain are just part of sex. But unless pain is part of a kink or turn on, something you want and experience pleasure from, sex should never cause pain.
For Dr. Moali, painful penetration and feeling unable to even have sex affected a lot more than sex itself.
Dr. Moali:
It transformed how I was perceiving myself. Because I was thinking, Oh, god. I’m someone that likes sex. It’s part of my identity. And my body kind of tells me “no.”
And you know, when you have bad experiences around, kind of sexual encounters, your desire get impacted. Because if you’re going with maybe once or twice, if you have bad experiences, that’s okay. Everyone at times struggle, but if you continue to have pain during sex and you’re trying to muscle through it, because you think that if you, if you do that, that’s going to go away, that really impacts your desire to want to have sex.
It was impacting my identity. It was impacting my relationship. What happens is that time when you’re struggling in the bedroom, if we’re not really tackling the issue, it’s gonna bleed out of the bedroom. So we started having tons of conflicts outside the bedroom. And that also impacted our relationship.
You know, I was confused. I was sad. At the beginning, I was, I wasn’t even bringing it up that much. With my partner, I was like, No, I’m just gonna pretend this is not happening. And he noticed. Of course he noticed. He was like, “Honey, what’s happening?” And then I started to search for solutions.
August (narration):
Soon, she realized she was far from alone in her lack-of-information about sex. Even her trusted gynecologist seemed unaware. Rather than addressing her symptoms in a comprehensive way, he gave her relationship advice.
Dr. Moali:
And he said, “Honey, perhaps you don’t want to be with him anymore.” And I was confused. I was like, I’m with this person for all this years. Why now?
So when then I went to another person who was a nurse practitioner, and she was so lovely. But she said, you know, just have a couple glasses of wine, and it’s going to be more comfortable. And I can see what she meant but I didn’t want to dull my senses all the time. And if you’re someone with high desire, I didn’t want to develop a substance use problem.
And then I went to my couples therapist that I found. And the suggestion was that kind of like work on the relationship. Improve it and sex can get better. That wasn’t the case, either. I mean, we our relationship was good enough. And the issue around sexuality was an issue around sexuality. So it wasn’t until I went to a sex therapist that I was able to see what was happening.
August (narration):
Dr. Moali said that working with this sex therapist completely changed her life. She helped her see the impact of the negative messaging she received as a child, and why her attempt to sort of run away from it all was working against her.
Dr. Moali:
And I thought I could just separate myself from them without processing them, without honoring them, without being curious about it. And it was a way of my body saying, No, we’re not, we’re not doing this. Like we have to resolve this issue.
So she helped me to see that. She helped me to understand more about my body and my arousal, and instead of getting frustrated with my body, which I see many women that are struggling with painful penetration struggle, is this kind of thinking of “your body is your enemy,” kind of seeing it as a friend that has a message for me. So I think that was also very powerful.
August:
Were you surprised by that being such a factor that it had so much to do with these messages?
Dr. Moali:
Absolutely. I thought, Okay…that was then, and this is now, and I’m not that person. But what’s interesting that some of these stories, ideas and beliefs are so deep rooted, and they’re with us unless we are exploring them. So I was very shocked and surprised.
I was surprised at how much our mind and body are connected. Things that we are thinking about are absolutely impacting our pleasure. It’s impacting our sexuality. So that was definitely a revelation.
August (narration):
Dr. Moali told me she went from starting to think that she was defective, that maybe she wasn’t meant to be sexual after all or that maybe sex isn’t really that important to being able to enjoy sex again and embrace adventurouness in the bedroom, thanks to the work she did in sex therapy.
Dr. Moali:
It wasn’t until I really lean into her approach to her messaging, started exploring that and being curious about my body, that I gradually saw some changes. And the more that I was seeing, of course, like this is impactful, I started doing more of the exercises. And that was also very powerful.
August (narration):
With the level of painful sex Dr. Moali was experiencing, she said an interdisciplinary approach was needed, which is often the case. Working with that sex therapist helped open her up to work with other helpful professionals, too.
Now, years and many helpful efforts later, Dr. Moali is in a much better place with her sexuality. And she helps others get to a similar place.
She said sexual pain related to damaging messages is unfortunately really common in her practice, which includes many Middle Eastern clients with conservative backgrounds.
Dr. Moali:
And it’s surprising to many women to learn that sex is not supposed to be painful, at all, unless you wanted it to be kind of a kind of some kind of inflicting pain. If it’s painful, then perhaps you need to make adjustments.
When I talk about this with my clients, they get shocked and surprised. So I would say like more than half of my practice are women that are working through this issue.
August (narration):
More than half, wow. And that matches up with various studies. One, cited by Harvard Public Health, showed that ¼ to ½ of postmenopausal people with a vulva experience unwanted pain during sex.
And negative messaging isn’t the only cause.
August:
I know there can be many contributing factors, the messaging has to be a huge one. What are some of the other factors that you see playing into sexual pain?
Dr. Moali:
One other factor is when there’s a history of trauma, not all the cases that people are struggling with painful sex. People have traumatic experiences, but I’ve certainly seen it with clients that they have unresolved trauma.
The other cases that I see, at times, are women that they had some kind of injury, like pelvic floor injury, and they sometimes they don’t put two and two together because we don’t think about it, the injury that impacts my sexual health.
August (narration):
Those clients, Dr. Moali refers to a pelvic floor specialist, sometimes to pair with therapy.
Dr. Moali:
The other type of clients that they are struggling with is that are women with low desire and their body is not ready for penetration yet.
August (narration):
One reason couples might go straight to penetration, she pointed out, is the way sex is typically portrayed in mainstream porn—which isn’t meant to be educational, but can seem that way when you don’t hear or see much else.
Dr. Moali:
We’re seeing maybe two to five minutes of some kind of foreplay, and people move quickly to penetration, and our bodies are not ready. For most women, it takes somewhere around 20 to 30 minutes to be really ready for penetration. So when our body is not ready, we might experience painful penetration.
August (narration):
Aging can also play a role in painful sex, especially around midlife or menopause, because of changes in the body and hormones.
Dr. Moali:
It doesn’t mean that sex needs to be painful or going to be painful, but it requires some adjustment at times.
August (narration):
Dr. Moali pointed out that medications, such as certain antidepressants and allergy medications, can also impact sexual function and lead to pain by fueling symptoms like low desire or vaginal dryness. If you have a penis, Peyronie’s disease, growths and erectile dysfunction can play a role.
If you’re experiencing sexual pain, regardless of the cause, Dr. Moali wants you to know, first and foremost, that you are not broken and there’s reason to hope.
Dr. Moali:
I want them to know that they’re not defective. It’s my experience that anyone who want to have satisfying sexual experiences, they will be able to have that. And people’s sexual health is important. So my invitation for people, if they are noticing pain, is going to think about is it sudden or it was present for a while. So that’s important. It’s important to talk to your partner about it.
I think one thing that was challenging for me that I wanted to hide it, and that kind of hiding it, it’s impacting the relationship. And also, it gets in the way of making adjustment. Sometimes it could be as easy as talking to our partner, adjusting the positions, because some positions are uncomfortable, and adding lubrication, like lubricant if your body is not ready.
Because sometimes what I see is people have couple of bad experiences, and they don’t talk about it with the partner. And it can turn to this negative feedback loop. So they, they kind of like they get scared, they kind of predict, they catastrophize that painful sex will happen. And that on its own impacting their experiences.
So definitely talk to your partner. Use lube. And if the issue continues to happen, go to your doctor or like perhaps your gynecologist. So if you’re seeing a therapist, talk to them about that and emphasize that my sexual health is important for me. This is painful. Can you help me? If not, can you refer me to someone?
August:
What would be your advice for someone who’s the partner of someone experiencing the pain?
Dr. Moali:
Well, I think it’s important to know that most of the time, it’s not about the relationship. Of course, relationship can play a role, but it’s not about you. Because what can impact the relationship, and kind of like this dynamic, is when the partner personalize that message that I’m doing something wrong, or I did something to my partner, and now she’s struggling. You can be their ally.
My invitation for people is to perhaps then take a pause from having intercourse. There’s so many exciting outercourse and other forms of sex that you can have that can be exciting and fulfilling. But if you’re forcing, like pressuring your partner, or kind of like thinking about that this is something that if you’re doing it, kind of continue doing it, it’s going to go away, that will just contribute to making the problem worse.
August (narration):
When one of these challenges crops up, something like painful penetration—really, most any sexual issues—it can feel less important than other aspects of your life, especially when you haven’t learned much about pleasure or sexuality. It’s never too late, though, to start shifting that perspective.
Dr. Moali:
Our sexual health is part of our overall health. So if you have a broken leg and you can fix that, you wouldn’t say, “You know, I’m just gonna go live my life with a broken leg and not fix it.”
I understand it can be, as you mentioned, confusing and frustrating, and at times expensive to tackle it. And it’s one of those issues that there are not necessarily one single answer. Like sometimes perhaps when there’s desire issues, people think if I take a pill, which is never that simple, but it’s going to go away.
With painful intercourse, it’s important to invest in your health, and absolutely it’s worth it. Because when we are sexually happier and more satisfied, we are more creative, we are more productive, and our relationships with self and others are more enriched and more powerful.
I don’t necessarily say that you need to have good penetrative sex to have good sexual experiences, but you need to be able to repair this relationship with your body so you will be able to show up for the experiences that you want to have in life.
August (narration):
Dr. Moali said it was completely transformative for her to really lean into her own sexual self and repair that relationship. She said it’s a common myth that only shallow people invest in their sexuality. On the contrary, it’s worth every effort. Because feeling more integrated in these ways can change nearly all aspects of your life.
Dr. Moali:
And when you’re sexually happier, you will be a better person, right? Like your experiences will be different, your relationship will be different. So if you’re trying to suppress that part of yourself, you’re pretty much suppressing a lot of parts. Our sexual self is not only about sex. It’s about pleasure. It’s about connecting with life.
Learn more from Dr. Nazanin Moali by listening to her weekly podcast, Sexology. She told me she started it because of the lack of evidence-based, scientific education around sex and sexuality. Learn more at sexologypodast.com.
One fun way to better embrace your sexual self is by bringing toys, lube or ideally both to the mix. There is still time to check out the Pride collection at The Pleasure Chest. To see a whole range of vibrant options for all genders, genitalia and relationship styles at thepleasurechest.com.
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Stream the full episode, which includes thoughts from Dr. Megan Fleming and me for a listener who’s curious about sex after her husband’s back surgery, up above or on your favorite podcast app!
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