Pain Isn’t the Price of Pleasure: Making Sense of Anal Discomfort
When a client says “I want anal sex, but it hurts every time”, I’m usually really investigating pain + desire + meaning, not just mechanics. Think biopsychosocial… with lube 😌
1. Normalize first (reduce shame + performance pressure)
Pain with anal sex is extremely common and not a personal failure or “doing it wrong.”
We might frame it as:
“A lot of people want anal sex but struggle with pain—there are many possible reasons, and most are fixable.”
“Wanting something and your body not cooperating doesn’t mean your body is broken.”
This keeps desire intact while making room for curiosity.
2. Clarify what kind of pain (this matters a lot)
We would gently assess:
When does the pain start? (initial penetration vs. during vs. after)
What does it feel like? (burning, sharp, tearing, pressure)
How long does it last?
Does pain happen with fingers/toys, or only with a penis?
Is pain expected/anticipated before anything starts?
This helps differentiate:
Muscle tension/guarding
Inadequate preparation
Medical issues
Trauma-related responses
3. Screen for medical contributors (without being alarmist)
I might encourage medical evaluation if any apply:
Pain is sharp, tearing, or persistent
Bleeding beyond minor irritation
History of fissures, hemorrhoids, IBS, Crohn’s, pelvic floor dysfunction
Pain occurs even with very slow, gentle insertion
A sex-positive PCP, GI specialist, or pelvic floor PT can be game-changing here.
(Yes, pelvic floor PT for men exists—and it’s wildly underutilized.)
4. Explore anxiety, control, and anticipation
Key therapeutic goldmine questions:
“What goes through your mind right before penetration?”
“How much control do you feel you have over pacing or stopping?”
“Do you feel pressure—internal or external—to make it work?”
“What would it mean if anal sex never became comfortable?”
Anticipatory anxiety → involuntary sphincter contraction → pain → reinforced fear loop.
Classic conditioning. Very unsexy, very human.
5. Assess trauma history without assuming it
Anal pain does not automatically mean trauma, but it’s worth gently checking:
Sexual boundary violations
Religious shame
Past painful sexual experiences
Power dynamics that make stopping feel hard
We might frame it as:
“Sometimes bodies remember things even when our minds feel neutral—does that resonate at all?”
6. Provide psychoeducation (aka the “your body is not a vending machine” talk)
Helpful points:
The anal sphincter does not respond to arousal the same way as a vagina
Relaxation is about time, safety, and control, not just desire
More lube than they think is necessary (and then more)
Slow progression over multiple sessions, not one goal-oriented attempt
If they’re trying to “push through” pain, that’s usually the biggest barrier.
7. Shift from performance → exploration
Invite reframes:
Anal play instead of anal sex
Remove penetration as the success metric
Focus on pleasure-adjacent sensations, not endurance
A body that feels respected is far more cooperative than one being negotiated with under duress.
8. When to refer out
I might recommend referral when:
Pain persists despite behavioral changes
Client feels stuck in fear–pain cycles
There’s relational pressure or consent ambiguity
Medical rule-outs haven’t happened
Collaborative care is hot. Lone-wolf therapy is overrated.
Bottom line
This isn’t about convincing the body to comply—it’s about helping the client listen to it, understand it, and decide what kind of sexual life actually feels good for them.
