Every month in Sex at Our Age, award-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:

• National Vulvodynia Association patient education page, “Everything You Need to Know About Vulvodynia.”
• International Pelvic Pain Society. Find a local provider here.
• International Society for the Study of Vulvar Disease, patient education page.
• Vaginal Renewal program, downloadable PDF from A Woman’s Touch Sexuality Resources.

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.

To 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.”