Replacing the P in Pain with Pleasure! - A Guide

vector illustration of a black person with blonde hair leaning back in their wheelchair while a white person with red hair is giving them oral.

Written by Dr. Sakshi Tickoo, Occupational Therapist, Personal Counselor

Illustration by Jessica Oddi


Sex and sexuality are expansive and dynamic, and undeniably pivotal to human expression, interaction, and intimacy. The way it shapes, defines, influences, and enables connections is not an unknown fact. However, even with time, one aspect of sexuality that has been most experienced and oddly normalised is pain.

It’s the year 2020 and we still find people settling for painful sexual encounters believing that it’s normal or inevitable. Pain is multi-faceted and can be especially challenging for many of us to navigate in the world of sexuality. Chronic, acute or situational - pain can be manifested in different forms for different reasons. It can be physiological, anatomical, trauma-induced, pathological, emotional, and the list goes on. Either way, it affects sexuality and intimacy for all, irrespective of the underlying cause, gender, age, sexual orientation, practices and expression. Pain is a far more common symptom/feature we see on a day-to-day basis, but the most overlooked one as well.

When I say it’s an overlooked feature, I do not mean to disregard pain. Instead, I want to highlight the fact that no matter how common symptoms of chronic or acute pain maybe, it’s unacceptable (and horrific) to propagate the idea that one ought to live with it and be uncomfortable, not experience pleasure, orgasms, and potential butterfly sensations in their bellies (or genitals) ever! As therapists, we may not be in the position to guarantee a pain-free life, but I can guarantee living a totally fulfilling and sexually satisfying, meaningful and pleasurable life.


Pain can often make your oh-so horny car feel a little rusted, not because of the symptoms, but because of the way these symptoms have left you feeling. We have been conditioned to feel a certain way only through relational experiences. While I agree relational experiences are necessary for a holistic life, it’s not the only way of living one. We often think of sex as something our bodies are doing, but it is our thoughts and feelings which play an equally vital role in making sense of our body, sensuality and sexuality. Right from paying attention to planning and executing your next move, our mind does a lot more than we credit it for. Deep emotions of guilt, anxiety, pressure, unworthiness, shame, and even fear is not uncommon when we cannot access pleasure, which can directly affect our desire, arousal, the reason to consent, or even our ability to authentically explore pleasure and intimacy with anyone.

Hence, one cannot simply separate mental health from sexual health or vice versa. These are mutually dependent characteristics that are essential in determining the overall health of an individual!

A way to move forward by acknowledging and embracing pain is by understanding and exploring sensuality. One can experience a holistic pleasurable experience by tapping into all aspects of individual senses to create a non-sexual pleasure that can be truly owned by you. Once we practice creating a routine of exploring and understanding our needs and wants as an individual and unapologetically submit to whatever our body needs, we create a conducive bond between our physical, mental and emotional minds. So, here’s an exercise I try often with my clients with or without guided imagery/meditation-

In this moment, what is that you can do to make yourself feel calmer and soothed in your skin?
You don’t need anything over the top! It can be as simple as cuddling on the bed with a blanket, watching a sunset, or just listening to some music. Anything that is accessible to you right now and will serve your need(s). Try submitting yourself to this moment and enjoy it to the fullest without thinking how lame, productive, meaningful or outcome oriented this exercise is going to be. It’s about placing yourself in a vulnerable situation to help you feel and tapping into your sensuality.

Often when we think and talk about navigating sexual and sensual lives with pain we immediately think of penetration, which absolutely isn’t the case. Penetration and orgasm put end goals to sexual encounters, and pleasure should have no end goals. It should be ongoing and served as and when required in whatever desired amounts (or more)! So, this little section is where I ask you to prioritise your pleasure as you have prioritised your pain. One way to customise your pleasure is by creating a Pleasure Toolkit personalised to your individual needs.

What’s a Pleasure Toolkit you ask?
Well, it’s your first aid kit to pleasure customised by you and for you towards your joy, even in uncertain and complicated times of pain. It’s a tool you create to come home to yourself. We house so much into our bodies and leaning in to pleasure thorough these ways could be a liberatory outlet to follow the lead to connection to your body. This kit is a constant resource to create/update for yourself.

What does it look like? Well, imagine an erotic menu with appetisers, entrée, dessert and all the order number of courses you would like to be served. It’s obviously no brainer that this will take time and practice to make a part of your routine. And it rightfully should! We spend so much time sulking and struggling with pain, sitting with ourselves to find pleasure via vulnerability is going to take time. Don’t rush it!

The easiest way to explore this is by creating a single running list- either on your phone or planner- of ways in which you can tap and regulate into each of your senses. Audio or visual erotica, guided meditation, burning an incense, feeling the touch of water against your skin, etc. Find whatever helps you to step out of your mind to these little (and often unnoticed) pleasures of life which enhance your sensuality and idea of being a sexual being.

Now, I know you must be thinking about sexual stuff again. But intimacy isn’t always sexual. We can manifest intimacy in several ways. And do you want to know the best part about it? No matter how you practice non-sexual intimacy, it stimulates your brain the same way as it would have with sexual intimacy. So, if you think penetration or genital stimulation are the epitome of deriving pleasure and orgasms, think again!!

Here are some Non-Sexual ideas for intimacy for you to (re)consider:

  • Do something you haven’t done in a while or wished you have catch up to
  • Move around and get active (a jog, walk, or stretch around the block)
  • Get a change in environment (even a spontaneous lunch works)
  • Talk about something you would like to try new with your partner
  • Make an investment (visit a sex toy shop and find something for yourself or explore together with your partner)
Physical Intimacy (Non-Genital):

    The following suggestions involve more bodily closeness and touching than the previous activities. Some of us may feel the need to have some extra support in their lives before they are ready to take some of this on, particularly if the pain has caused significant conflict and/or fear.

    Take a bath together or separately. Talk about your days, or talk about how it feels to have your back washed. Or don’t talk at all, but be there with and for each other.

    Attend to a body part that you haven’t paid attention to. Paint those toenails or flaunt those shoulders. Alternatively, you can do the same for your partner. Explore how they *really* love to being touched. Brush their hair, for example. Massage, shave or moisturise some part of them. If you don’t know what parts these are, it’s a good time to ask and start learning.

    Take a shower together. Find products and toys that help you touch and explore each other’s bodies—loofahs and differently textured washcloths, for example. Think about changing temperature of the water or pressure of the showerhead so you can manipulate the direction and pressure of the water. See if you can distinguish between sensation that feels good and sensation that feels sexual. During or after shower might also be a good time to explore your or your partner’s erogenous zones. You can use your knowledge of these personal erotic places to both enhance and replace genital sexual contact.

    Schedule or plan your next adventure, together! If you think it will take away the excitement and pleasure from your next encounter, trust me, it won’t! Anticipation is a powerful tool to build desire and arousal, plus it gives you and/or your partner dedicated time for each other, gives you space to schedule your medications (if any) beforehand or get some stretching done or any other routine that helps you calm your nerves and body. However, all of this does not have to be boring. Some ways to spice up your anticipation game could include:

    • flirting and/or sexting
    • creating a sex menu (a menu that talks about what you want to do with your partner(s) or what you would like to them more often and vice versa)
    • exchanging sexy pics (consensually)
    • using wearable pleasure products (especially ones that can be controlled by the partner remotely)
    • role-playing (choose from a broad range of identities or scenarios to increase the excitement)
    • watching porn that you like, either alone or together
    • buying a new toy, lube, or outfit!

    These are only some obvious suggestions and you are always free to create a wild, personalised resource for yourself. As long as it’s pleasurable to you and your partner and helps you build a connection, it counts.

    Sexual and Genital Intimacy:

    When I added the word genital, it’s to indicate that not everything that is sexual will be penetrative in nature. Masturbation is a splendid start for any sexual activity.

    Masturbation, solo or partnered, encourages you to explore your own feelings, reactions, and sensations to touching and being touched. Also, masturbation proves to be a great tool in relaxing and stretching your body before you engage in any high-energy, penetrative activities.

    Here are some things to consider when you masturbate or incorporate into your self-stimulatory play routine:

    • If you are trying this with your partner and feel low on energy, just submit yourself to pleasure while guiding your partner how you would like to be stimulated and how much.
    • Try doing this together or sequentially (mutual masturbation).
    • You can watch your partner (or vice-versa); they can tell you what they are doing and why it feels good to them and vice-versa.
    • Toys (vibrators, strap-ons, masturbation sleeves, clitoral suctions) and lubricants [preferably choose a water based one] can be excellent additions to your masturbation routine.

    The distinction between masturbation and genital massage is probably a fine one. Genital massage is a transition from self-pleasuring to including your partner in the experience. Each person can do genital massage (to the other) and can be a marvellous opportunity to experiment with lubricants and natural oils (olive, almond etc), remember these are edible options. Massaging is not only great for exploration and learning about your partners body but also an aid in increasing blood flow to the pelvis, improves muscular contraction and relaxation, and enhances the way you experience orgasms.

    If penetration is something that you particularly struggle with, here are some fairly common things I recommend to clients in my practice-

    Positioning aids- cushions, pillows and rolled towels are your best friends. Use them to support yourself. Maybe gymnastic positions can wait for a while unless you find a connection to work through pleasure with your partner.

    Consider lubricants with a change in pressure and depth of penetration. OhNut ring can be an excellent aid in controlling and managing the depth of penetration and can be used on both toys and penises. Alternatively, start using dilators (small to large), butt plugs or fingers first for vaginal and anal penetration to mobilise and lubricate the passages well before introducing dildos or penis.

    Switch it up! Try to switch between positions where either you can relax or alternate between relaxing and taking charge of the situation. This provides an equal chance to both you and your partner to express your sexual love for each other. This also applies for change in your environment- bedroom, sofa, chair, table, shower- find a location that suits you the best and consensually agreed upon.

    Take breaks as required and always keep a bottle of water next to you to stay hydrated and avoid muscle cramping if the activities go on longer than planned. You never know how water turns out to be an erotic aid!

    Lastly (and importantly), communicate! Communication is the best lubrication we already own and often fail to use in our relationships with self or others. There are certain things we should discuss with our potential partner(s) before getting down. In the actual world, it shouldn’t be acceptable to bypass these critical conversations. Get comfortable talking and knowing what pleasure means to your partner(s). This could include discussing boundaries and non-negotiables beforehand, talking about what you like and don’t like in bed, mentioning any physical limitations you might have, and more.

    Creating a Pleasure Toolkit and sex menu both create a safe(r) space for communication around disclosure and discovery with a potential partner(s). All of this information is truly the tip of an iceberg. Our sexual and sensual personalities are far more expansive than this. However, this was a way to start your own exploration, and to add to the list of suggestions with your own alternatives, both old and new. Don’t forget or underestimate your sexual fantasies. Listen to what your mind and heart say and your body will guide you on how to reach there.

    Happy Exploration!!



    My name is Dr. Sakshi Tickoo (she/her)- a cisgender, queer Occupational Therapist and Personal Counselor based in Mumbai, India. I’m the founder of Sex, Love, And OT, an inclusive space created for educating healthcare professionals and serving populations with Sexuality, Intimacy and Mental Health- Wellness and Rehabilitation based services across lifespan to have sex-positive, pleasure-focused, and meaningful sexsory experiences.

    In case you are looking for more resources, consultations or if you are just looking to find some support navigating your sexual self, reach me at or drop me an email at to see if we can be a good therapeutic fit for each other. You can also follow more of my work on the socials via Instagram- and Facebook- Sex Love And OT.

    Resources and Further Reading:

    1. Reasons you should be scheduling sex:
    2. Creating a Sex Menu:
    3. The Five Love Languages, Your Guide to Non-Sexual Intimacy:
    4. How to create Pleasure Toolkit, Bedside Podcast:
    5. Healing Painful Sex Holistically, Bedside Podcast:
    6. Literotica; for your dose of literature and erotica:
    7. Dipsea Audio Erotic Stories:
    8. Books on Sexuality for Further Reading:

    Jessica Oddi (@oddi.jessica) is a disabled graphic designer in Canada with versatility to spare. She is particularly interested in collaborations involving much needed representation, inclusivity and empowerment. 

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