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Painful Sex: Where to Go for Help

Every month in Sex at Our Ageaward-winning senior sexpert Joan Price answers your questions about everything from loss of desire to solo sex and partner issues. Nothing is out of bounds! To send your questions directly to Joan, email sexpert@seniorplanet.org. 

Sex has been painful for me since a total hysterectomy 14 years ago, and it is at the point where it is seriously hurting my marriage.

For more than a year, I endured the pain until my husband discovered me crying, and I confessed how much it hurt. He was distraught, as was I. We stopped intercourse altogether and switched to non-penetrative sex from then on. 

I went to various doctors for help. The gynecologist who did the hysterectomy said to give it a little time because the yeast infections I was experiencing could be playing a role (the gyno retired before I could see him again). I told my GP that the hysterectomy worked well to eliminate the pain of endometriosis, but I had awful pain during sex. He said, “Well, ya can’t have everything!”

I was stunned, embarrassed, humiliated, embarrassed and wanted to crawl into a hole in the ground! I didn’t seek another answer for another two years.

Another gynecologist told me it was most likely dryness due to my age and said to use a vaginal cream; it didn’t help. Another doctor had me use a very small vibrator with a lubricant to slowly “exercise” the area. But instead of helping it got worse, to the point where neither I nor my husband could even insert a finger without extreme pain. 

We still have non-intercourse sex, but I don’t enjoy it. I know I have to do something to make a change, because if I don’t, I am going to lose my husband. And neither of us wants that to happen. —Hurting

You’re right that most doctors do not know much about how to diagnose and treat sexual pain. The big problem here is that all your doctors jumped straight to an easy and often dismissive treatment without diagnosing what was causing your pain! (If you could see me now, I’m furrowing my brow, gritting my teeth and pounding my fists, because I hear this problem so often, and it doesn’t have to be this way.)

Sexual pain is complicated; it can be caused by a number of medical issues, and each one is treated differently. Until you and your doctor understand why you’re having pain, you can’t treat it effectively.

Most doctors, even gynecologists, have not been trained to diagnose sexual pain. However, sexual pain specialists have been trained to do exactly this. It is absolutely essential that we learn to say to our doctors, “If you can’t help me, please refer me to a sexual pain specialist who can.” Ask for a specialist who knows how to assess what kind of pain you’re having and its cause, including an assessment that includes the pelvic floor muscles and nerves.

If your doctor can’t refer you to a specialist, find the nearest progressive, education-based sex shop. Yes, they sell vibrators – but the good ones also train their staff to answer questions about sex and refer people to the best specialists in the area. You can tell if a sexuality shop is education-based if it offers classes and the staff is knowledgeable and approachable.

Part of your appointment with a specialist will involve finding out exactly where the pain is through the Q-tip test: a process of gently touching different parts of the vulva and vaginal opening with a moistened cotton swab. This doesn’t sound pleasant, but the clinician will be slow and gentle, and it’s important for a good diagnosis.

Some of the many possible reasons for vulvar/vaginal pain
  • Vaginal atrophy. After menopause, the lining of the vagina gets thinner and lubrication diminishes due to lower estrogen levels. The vagina narrows, shortens and becomes less elastic. This results in dryness, irritation and vulnerability to vaginal infection (atrophic vaginitis), along with urinary tract infections.
  • High-tone pelvic-floor dysfunction. The pelvic-floor muscles that support the vagina, bladder and rectum become tense and cannot relax and stretch enough to allow penetration.
  • Vaginismus. Involuntary tightening of the outer third of the vagina when penetration is attempted, making intercourse difficult or impossible.
  • Vulvodynia: Burning, stinging, raw pain, which may be diffuse or localized to the vulva and vagina.
  • Provoked vestibulodynia (vulvar vestibulitis): A type of vulvodynia characterized by burning pain at the vaginal entrance with pressure, touching, penetrative sex or pressure, even from tight clothing.
Sexual Pain Resources

An extremely helpful book to help you and your doctor figure out the condition that is causing your pain is “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain, by Deborah Coady and Nancy Fish.

In addition, these websites are helpful:

I am incensed that one of your doctors was crass and demeaning by saying, “Well, ya can’t have everything!” Shame on him. Thank you for continuing to pursue a solution and for sharing this experience with us here. What you went through will help others. My best to you, and please let us know what happens when you try the options I’ve recommended.  — Joan

Would you like to see more questions and answers? See all of Joan’s advice in Sex At Our Age.

joan-price-150To send Joan your questions, email sexpert@seniorplanet.org. All information is confidential.


Joan Price is the author of the award-winning self-help book “Naked at Our Age: Talking Out Loud about Senior Sex” and of “Better Than I Ever Expected: Straight Talk about Sex After Sixty.” Visit Joan’s  blog, “Naked at Our Age.”

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6 comments
  • Saniya Khan
    REPLY

    Hello and greetings!

    It was nice to learn the experience by Mrs. Hurting. And definitely it was wrong for doctor to advice that without examination. For every pain there is a solution. I am 35 and was a learning for me, something for me to think and keep me in mind. I would really like to thank Mrs. Hurting for sharing this (Her) article and trauma. And I hope she has found a solution by now.

    Do not worry girl, your hubby will not leave you. No matter what. Take care and things will fall in its place.

  • Sport
    REPLY

    15 years after a TOTAL hysterectomy and HRT ending several years ago (I’m 48), intercourse is excruciating. I was also sexually assaulted by someone I trusted a few years ago. My husband is very patient (it’s been 2 years since penetration happened) and I want this to work.
    My problem sounds like vaginismus as my entire body tightens up and goes rigid. I, too, am afraid of the pain that I know is coming.
    I’m out of the US for another 6 months or so and really want to get treatment there if I can. I purchased various size ‘inserters’ to try. It might be helping, but that because I’m in control – I think. Any suggestions?

  • Adriana Kraft
    REPLY

    Excellent article, and such a common problem. One more potential cause is vaginal lichen sclerosus, a skin disorder characterized by white patches of thinning skin in the vulva that are painful to the touch. Easily treated once diagnosed, I’m here to say.

  • Sue
    REPLY

    Joan: “Hurting” might really be helped by the hormone implants I told you about. A small pellet containing testosterone, estrogen and then a daily progesterone capsule injected under the skin on the hip was immensely helpful to me.The cost where I live is $280 about every 4 months. I totally get wet after some foreplay time. I am 58 and 8 years post menopause. I go to a nurse practitioner and perhaps she should make that switch. Doctors, male and female, don’t have the time for conversations with their patients about their lives, sexual or otherwise, my NP makes the time, and for me that has made an amazing difference. AMAZING! My husband and I now have intercourse without lube……..The painful sex was ongoing for about 6 years. Every time I would go in for my annual, Marsha, my NP would ask me how things were going, and I would tell her. SHE was the one who went to a workshop, she paid for, to learn how to do this hormone implant. It is now one of the most asked for procedures and all the women who have had it done are very happy. the hospital can not advertise it because it is a Catholic hospital, but she can tell patients about it. I really hope this helps. Wish I could talk to “Hurting” but hopefully you will pass along this info. Thanks much.

    • Ra
      REPLY

      People who are high-strung, who are more or less allergic or who are deficient in calcium and other constituents that help to keep the skin healthy and relaxed are liable to such pains. Why? Because their defence and reactive stimuli are too critical and liable to violent reactions for trifle forceful penetrations which they take as their enemies likely to inflict sharp pains. Their minds are moulded in such reactive stimuli. To go over such a phenomenon, they will have to be more composed and less strung. Perhaps, a good dose of meditation daily could help them a lot.

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