Dear Dr. Kate, Any Treatments for Rough Sex Syndrome?

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in Boston and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

I’m a girl who likes it rough. Not a little bum-smack here, a little hair-pull there, but slap-me-across-the-face, black-bruises-for-two-weeks rough. The thing is, this predilection presents a rather annoying problem that I haven’t been able to find an answer for just yet. What do you do to relieve the pain caused by torn or scratched inner labia? I tried epsom salt baths, which work okay, but is there a product out there that I can rub on the affected area, like during the workday? So many things that you’d think might be appropriate are “for topical use only”, so other than Astroglide, I haven’t been able to find anything to soothe the affected area. Oh, and just in case you were wondering: yes, I use safewords with my partners – most of the time I’m really enjoying myself when the injury occurs; yes, I practice safe sex; and yes, I give myself a long resting period after stuff like this happens so that it can fully heal before I engage again.

— Hurts So Good

Dear HSG,

You’re right, there are very few products that are designed for internal use — the vulva and vaginal canal are very sensitive to chemicals, and most over the counter products haven’t been tested internally. You can ask your gyno for a prescription for topical estrogen cream, which not only may be soothing but will actually promote healing.

But I wonder if sex play that leads to actual injury is really healthy for you, physically or emotionally. All injuries that break the skin put you at increased risk of infection, even if you’re always using condoms. (And I’m not just talking about sexually transmitted infections [STDs], but infections of any laceration from your native bacteria — believe me, an abscess on your vulva is no fun to experience or have treated.) You say “most of the time” you’re really enjoying yourself…I think a realistic and healthy goal for the bedroom is to enjoy yourself 100% of the time, especially when you’re playing with fire like you are.

— Dr. Kate

dr_kate_100Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.


  1. The only drawback that I’ve seen to having Rough/extreme sex (assuming it’s consensual) is that if you leave your partner who enjoys said activities. It can be difficult to readjust to a more mild level, that most people enjoy.

    These have been my experiances, also if you and your partner are not already in a healthy relationship BEFORE you begins such practices it may invoke feelings of guilt or isolation when attempting to understand it.

    I myself enjoy rough sex tremondously, but it has led to complications in my Sex life now that I am seeing someone who isn’t so into that type of things.

  2. katherine, I am guessing you don’t participate in, nor really know *anything* about BD-M/s, D/S or other relationships which openly recognize the Power Dynamic which is present in ALL sexual relationships. CONSENSUAL Dom/Sub relationships do NOT end up with someone “in the trunk on the way to the landfill.” (Do we have an eye roll emoticon?) They are a way a lot of people enjoy each other, work out stress, find themselves, feed their needs and just have fun, their own way. You don’t have to participate, and you don’t have to like it. But, demonizing something you know nothing about simply shows immaturity and intolerance and even Prudery.

    Some people like it Rough. You may not. That’s fine. I am sure a few people in The Lifestyle may be playing out “past abuses” (and for some, it works better than “therapy”) but the misstatement that everyone involved in BDSM lifestyle or even the occasional Bondage and Domination Scene is somehow sick and doesn’t realize what they are doing and are “headed for the landfill” is ridiculous, unsophisticated and uneducated.

    Take a swing over to the Sex Toy Store mentioned on Em&Lo’s site (www.edenfantasys.com) and look at the Bondage toys, note the number of items on people’s Wish Lists, then go to the discussion forum and see the number of normal, happy well adjusted people who participate. You may actually learn something about a world you know NOTHING about.

    Good luck. I hope you actually can relate or tolerate instead of simply react after educating yourself on these issues.

  3. This is extremely interesting to me. I tend to think that if you are not basing your opinion on anything other than the stuff in head inserted there by inaccurate information that says that pleasure should hurt you, you may need to get some more information from a professional. I remember hearing quite a few newscasts where adults were apparently in mutually consenting activities such as this that gradually went too far or the perpetrator was grooming her for the eventual ride in the trunk and dump in a landfill. Making a mistake and oops does not cut it with me. How these activities or the potential for more serious injury or death could be appealing is beyond me. Also the doctor was ethically obligated to inject what she did even without the person asking.

    At least on some level she is beginning to understand that this activity is somewhat questionable. I am wondering if she hasn’t been a victim in the past somewhere in her life and sees this as pleasurable activity because she accepted it in the past and didn’t have a choice or her partner has convinced her because she doesn’t have the ability to set limits on these activities with her partner or to say no. I know a close friend that in the past had to work extremely hard in therapy to get out of this type of situation and it came to light that she was just replaying her abusive past.

  4. TB and Wendell have some good points.

    There is more than one kind of relationship. Mary, HSG isn’t “ruining it” for anyone. If her choice of sexual activity is consensual and enjoyable for both herself and her partner, it is not up to her to try to change either herself or her partner in case her partner assumes “all women” like it rough. My guess is, he already knows not all women do, and he and HSG CHOSE each other for this reason. People in the D/s, M/s and BD lifestyles not only choose each other, but don’t expect other people (Vanillas) to want the same thing their like minded partners do. (Real Life Dom(me)s don’t go around hurting people at random. Also, men involved in D/s relationships simply wouldn’t be interested in someone who wasn’t interested in their chosen activities.)

    I like the good doctor, but have found many physicians are often uninformed about sexual variations. It wasn’t that long ago that GLBT people were considered “mentally ill” by the medical profession, and I get the impression, as a nurse and as someone with sexual appetite that varies from “the norm” that people in The Lifestyle are treated as if their choices are always the result of some emotional illness or past filled with undealt with abuse. It simply isn’t true.

    TB made a very good point about comparing sporting injuries. NOBODY tells athletes to stop what they are doing, because they could get a life altering injury, an “infection” or even die, but I find the comparison very good. I also know of few people, either the Daring, the Kinky or the Vanilla, who enjoy themselves in the bedroom “100% of the time” as the doctor suggested she strive for. But, my guess is the Vanilla have a much lower percentage of 100% enjoyment than those with Variations.

    IMO, Doc should have suggested a treatment for the abrasions, perhaps a suggestion for better lubrication during the Scene, perhaps made sure the Safe Word was something HSG was comfortable using and left it at that.

  5. Mary –

    I’m very upset to hear you say you like it so soft. You’re ruining it for women like me who like it rougher, because a guy is going to be all soft with you and think that that’s what all women want. And that ruins sex for me when they’re so gentle with me.
    So please have rougher sex. Make sure to use a safeword so you can tell him if he’s gone too far, then let him whip you, and spank you and hold you down while he fucks you.


  6. Thank you, TB, for your perspective. It bothers me when people feel free to comment on someone’s sex life, especially when it is consensual and in this case uses safe words to check in with/maintain/withdraw consent.

    Anonymouse: if she consented to the “delicate bits” being part of her play, then where’s the issue? Her question is about finding something to help aid her body’s natural healing processes.

    I myself am pretty vanilla, but I think all us vanilla types (especially those who don’t know much about BDSM) should check this article out: http://clarissethorn.wordpress.com/2010/07/03/sex-communication-tactic-derived-from-sm-2-safewords-and-check-ins/ Safe words aren’t just for the rough/power-play folks any more!

  7. Because what if someone thought you wanted rough.And then while being rough.He may not mean to.And put his hands around your throat.And choke you to death.Or while holding you against something.Hurt something on your body that isn’t fixable!? just saying be more safe please.Because men are alot stronger then we are.And sometimes its hard to know their exact strength.So you have the rest of youe life to learn ways to do those things in bed your so crazy of.Because you never know what can happen, or hurt your insides!!!Something may not heal right one day.

  8. About the woman who likes things in the bedroom rough.Honey you are making it hard on yourself and other men.Its okay for a little rough place.But when you have to heal from it that has to hurt.and in your mind you must have thoughts that are painful also.I feel you are also making it harder for other females.When they get it rough.Then he may think every woman he has sex with. Is like that or wants it rough!And not the caes at all.As a matter of fact.Some woman would file charges or marks.However i understand you like what you like!!!But honey every female don’t like it rough.So you may wanna consider some softer sides to men. And then he may you..And insead of alot of bruises and marks.You could have a nice dinner under the moonlight or a nice buubble bath with candles.And then some spooning and making out. Without some much anger with it!!!

  9. TB- My point was not about comparing the health-factor of various activities (as I said, I was not comparing the healthiness of the two examples). All I was saying is that sometimes you want to ensure that you’re covering all sides of a question, including underlying issues. People who answer questions for a living are used to looking for issues that the LW might be avoiding/unaware of. It doesn’t hurt anyone, so there really isn’t any reason to object. She gave advice for the actual question as well. I say you’re being oversensitive.

  10. Alex,

    My labia are raw because I’m a long distance cyclist in training for a double century and I can’t go further than 100 miles without serious abrasions/swelling. Most of the time I really enjoy the long hard miles (but sometimes my friends and I will just support each other by going out for a ride even though we all have days when we’d rather sleep in – and save some energy for really rough sex). What can I do?

    PS – I know you’re a casual runner who can’t understand what I get out of cycling for 10 hours straight but please, spare me any judgmental suggestions about my having a screw loose in order to enjoy riding this far.

    Which analogy is more similar to the question posed by HSG?

    Sticking your fingers down your throat – not usually thought of as a behavior that one normally engages in (widely seen in some measure as healthy) but that at some point is judged excessive.

    Sex – Good luck trying to define normal. What about rough sex is inherently emotionally unhealthy?

    Some people like bell peppers and others like habaneros (and occasionally one might be hotter than you really wanted – quick, call a shrink). We might advise someone that too many habaneros might cause tissue damage but we’d never suggest that eating them was putting your emotional health at risk.

  11. TB-
    My knuckles are getting raw because they rub against my teeth when I repeatedly stuff my fingers down my throat to induce vomiting after meals. What kind of salve do you think would be best for treating my abrasions?

    I’m not trying to say that liking rough sex is as psychologically unhealthy as having an eating disorder, but if someone asks you a question and you feel that there may be a deeper issue to address, it’s understandable to offer advice for both issues.

  12. well yes, but how about also providing advice on how to get yourself treated roughly without causing so much damage to delicate bits? You can experience lots of rough treatment or pain by going for other areas with stronger skin yet plenty of nerve endings, without having to have your vagina injured.

  13. @TB, I think it would have been irresponsible not to mention the other potential risks of rough sex- both physical and emotional.

  14. Just to be clear, I don’t think that a comment about the risks associated with repeated soft tissue injury (scar tissue, necrosis, etc.) would not have been beyond the scope of HSG’s question.

  15. “But I wonder if sex play that leads to actual injury is really healthy for you, physically or emotionally.”

    I’m sorry but I must have missed the part where HSG was asking the OB/GYN to give an opinion on the her emotional health. The question was straight forward – is there something she can use to heal the abrasions? This seems a bit like going to a contractor and getting his unsolicited opinion on my being an omnivore (all at no extra charge – if you’d just stop eating meat you wouldn’t need the extra large freezer and you could save $5K on the new kitchen).

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