Why Couples Have Sex Even When It’s Painful
by Dr. Denise Renye
Sex can be a source of pleasure, connection, and safety, yet for many people, it can also be uncomfortable, painful, or emotionally challenging. Despite this, couples often continue engaging in sexual activity. This topic came up in a recent case consultation, and I see it frequently in my practice, as many couples continue sexual activity despite discomfort or pain due to relational, emotional, and cultural pressures. Understanding why involves looking at biology, psychology, relationships, and the sociocultural messages that shape our ideas about intimacy and sexuality.
From a young age, we absorb messages about sex, gender, and relationships that shape how we approach our own sexuality. Societal expectations often influence sexual roles based on gender. Women or femme-presenting partners may learn that their pleasure is secondary or that pleasing a partner is a duty. Men or masculine-presenting partners may be culturally conditioned to prioritize their own pleasure while navigating pressure to perform or appear sexually confident. Nonbinary and trans people face additional layers of expectation, often navigating sexual scripts that were never designed with them in mind.
These messages do more than influence individual behavior. They shape the dynamics within relationships. Many people grow up with stories about love and sex that link sexual activity to closeness, loyalty, or proof of love. These scripts can make it difficult to say no, even when sex causes discomfort. Cultural messages frequently frame sexual activity as a necessary component of a healthy relationship, creating pressure to continue even when it is physically or emotionally painful.
Couples may continue sexual activity for a variety of reasons. For some, sex is deeply tied to emotional connection, and continuing despite discomfort can feel like a way to maintain intimacy. Others may fear that refusing sex will cause conflict, rejection, or disappointment. Some feel guilt or shame at the thought of denying a partner, while others hope the pain will resolve or that the sexual experience will improve over time.
Painful sex is not limited to any one gender or identity. People across the gender spectrum experience it, whether due to physical conditions such as endometriosis, vaginismus, or erectile differences, or emotional factors such as anxiety, trauma, or relational stress. Recognizing that everyone’s experiences are valid and that cultural pressures affect each person differently is essential for fostering understanding, compassion, and mutual care within a relationship.
Awareness and communication are essential tools. Partners benefit from openly sharing what feels uncomfortable or challenging, seeking guidance from sex therapists, medical providers, or somatic practitioners, and examining the cultural messages that shape their sexual experiences. Consent is ongoing, and sexual connection is healthiest when pleasure, safety, and mutual desire are present.
If you find yourself or your partner in a pattern of painful or uncomfortable sexual experiences, it may be time to explore these dynamics more deeply. Reflect on the messages you have internalized about duty, gender, and sexual roles. Consider what truly feels connecting and pleasurable for you and your partner. Seeking professional support can help identify both physical and emotional contributors to pain, and guide you toward a more satisfying, safe, and fulfilling sexual life. Sexual intimacy has the potential to nourish both body and relationship, but only when both partners feel seen, heard, and genuinely comfortable.