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! If you’re over 60, submit your questions to this column by emailing Joan directly at sexpert@seniorplanet.org. There are more details on how Joan selects questions at the end of this article.

• “My vaginal opening feels very tight and when I insert a finger it is uncomfortable to the point of being painful. Is this lack of use or just vaginal dryness? For some reason, I am suddenly always horny and would like to be active with my husband.”

• “I have severe vaginal atrophy and dryness. I use Replens and a topical lubricant, but they barely help. Because of multiple family members with breast cancer, two gynecologists said, “Absolutely not!” to hormone replacement. Even if I touch myself indirectly, it hurts incredibly. It’s like my vagina is raw.”

• “I am unable to have sex with my husband due to my pain. When he tries, it feels like I’m tightening the muscles without realizing it or meaning to I’m suffering and so is my husband because we can’t have sex anymore.”

• “I can get aroused and I want to be sexually satisfied—I’m itching, squirming and don’t get a second’s sleep all night long. Sometimes I try to please myself gently, but touching is too painful, and I can’t reach orgasm. If I keep trying, I’m in pain for three or four days.”

I keep getting questions such as these about vaginal and vulvar pain. It’s a big problem. Rather, it’s many big problems, because genital pain can be caused by a variety of medical conditions. You can tell that the examples above all have pain in common, but the type of pain, location, and what provokes it varies.

Make an action plan 

It’s essential to determine what condition is causing your pain, because each condition requires its own treatment. If you only know that it hurts, but you don’t know what is causing your pain, you can’t know how to treat it. That’s why your course of action should include these:

• Pin down your symptoms exactly, and learn as much as you can about what might be causing your pain. An excellent new book to help you do this is “The Vagina Bible: The Vulva and the Vagina—separating the Myth from the Medicine” by gynecologist Jennifer Gunter. The second half of this book is a comprehensive resource about infections, conditions, symptoms, and treatments for sexual pain.
• Find the right medical professional to help you. If your gynecologist doesn’t take the time or have the skills to figure out why you’re in pain, ask for a referral. Don’t let your doctor dismiss you with “Why do you care about sex at your age?” or a similar attitude. If you hear that, divorce your doctor and find a new one who is sex-positive and age-positive.
• A pelvic floor therapist is trained to diagnose and treat sexual pain and might be the best professional for you. Find a provider here.

If you’re partnered

What can you do about sex meanwhile? If you’re partnered, be honest with your mate about what you’re feeling. Expand your sexual expression to include activities that arouse you and your partner without hurting you. If vaginal penetration hurts, but the vulva welcomes touch, explore ways to arouse yourself that bring you pleasure without pain. If all genital touching is painful, are there other erogenous zones on your body that invite erotic caressing? Are there ways you can pleasure your partner that you’re happy to do?

Try this reference guide

More about “The Vagina Bible,” which I recommend wholeheartedly: Dr. Gunter offers individual chapters on five sexually transmitted infections, seven vaginal/vulvar conditions, and six sets of symptoms. She explains clearly what each condition is, how it is diagnosed, and treatment options.

For example, tightness of the vaginal opening might be pelvic floor muscle spasm (PFMS), where the muscles that wrap around the vagina spasm and cannot relax, making penetration excruciating or impossible. This may feel like the vagina has shrunk and is too narrow, or it may feel like a roadblock is preventing penetration. Vaginismus is a type of PFMS where the muscles spasm only before sexual penetration, not all the time.

Most women have never heard of PFMS and most of the other conditions that can cause vaginal or vulvar pain, which is a statement about our society’s hush-hush attitude toward women’s sexual symptoms. We all know about erectile dysfunction, right? But how many vaginal conditions can you name? In Dr. Gunter’s words:

Pain with vaginal intercourse affects up to 30 percent of women. While for many women this is temporary, it can be very distressing. What is also upsetting is many women do not get a diagnosis, never mind therapy. Some women are led to believe that pain with sex is normal or that it is somehow their fault. Pain with sex is a medical condition.

Bottom line: If you have pain, read the relevant chapters of “The Vagina Bible,” then, armed with this information, consult your doctor.

Some additional resources:

• Painful Sex: Where to Go for Help. More resources and an overview of some reasons for vulvar/vaginal pain.

• Vaginal Renewal™ program from A Woman’s Touch Sexuality Resource Center: Self-help program for maintaining a healthy vulva and vagina after menopause.

• A Senior’s Guide to Lubrication: A good lubricant is essential for comfort, whether you experience pain or just the normal dryness of aging.

A Message from Joan:

I receive many more questions than I can answer. To help yours get chosen, know this:

• I select questions solely from readers age 60+.
• If I already answered a similar question, yours is less likely to be chosen, so do a search for your topic first.
• When you submit a question, describe your problem, how it affects you, what you’d like to know. Your story will be edited.
• For medical advice, consult your doctor. Change doctors if you’re not satisfied or if you’re treated dismissively.
• I select questions for publication only. For a private answer, request a consultation. Most questions about sex and aging are answered in my books and webinars.

Send Joan your questions by emailing sexpert@seniorplanet.org. All information is confidential. Joan can only answer questions that are chosen for publication from readers age 60+

Joan Price is the author of several self-help books about senior sex including her newest, “Sex after Grief: Navigating Your Sexuality after Losing Your Beloved,” and the award-winning “Naked at Our Age: Talking Out Loud about Senior Sex.” Visit Joan’s website and blog and her Facebook page. For senior sex news and tips, subscribe to Joan’s free newsletter.

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