When Penetration Hurts: Vulvar and Vaginal Pain

One of the most helpful chapters in Naked at Our Age (coming June 2011) addresses vulvar/vaginal pain, a complex issue. You'll read real-people stories from women whose vaginal or vulvar pain prevented them from enjoying penetration, or who learned how to renew their vaginal health, plus information and direction for getting your own pain diagnosed and treated. Although you'll have to wait for the book, until then, these posts about vaginal/vulvar pain will be helpful, and here is a list of websites that offer more information and/or referrals to knowledgeable professionals:

• American Association of Sexuality Educators, Counselors, and Therapists: http://www.aasect.org/.

• American Physical Therapist Association, Section on Women’s Health: http://www.womenshealthapta.org/.

• American Urogynecologic Society: http://www.augs.org/.

• International Society for the Study of Vulvar Disease: http://www.issvd.org/.

• Mypelvichealth.org: http://www.mypelvichealth.org/

• National Vulvodynia Association: http://www.nva.org/

• OObgyn.net: http://www.obgyn.net/

• Pelvic and Sexual Health Institute: http://www.pelvicandsexualhealthinstitute.org/

• Secret Suffering: Helping Women Cope with Sexual and Pelvic Pain (patient site): http://www.secretsuffering.com/.

• Vulval Pain Society: http://www.vulvalpainsociety.org/.

• Vulvar Pain Foundation: http://www.vulvarpainfoundation.org/

• Vulvodynia.com: http://www.vulvodynia.com/

No sex, and we can't talk about it

“My wife and I are in our fifties and rarely have sex, about once or twice a year,” John wrote to me. “I cannot talk to my wife about it at all, as I suspect she is not interested.” Here is his story:

Because she never initiates anything I am assuming that she can live without sex. We once went five years of abstinence. This is really a problem for me as I need sex much more frequently. When sex occurs it is not great anyway, following the same pattern each time.

Since menopause my wife finds intercourse painful. Is this just because it’s been a long time since we had sex and the menopause has really kicked in? She never used to find it painful, but I noticed that she does not seem to become aroused much and vaginal fluid has become a thing of the past. Gel did not work either.

John went on to explain that he masturbates a couple of times a week to “fend off the urges that could lead to infidelity,” but he worries that this is harmful and he’s trying to stop. He admits that their sex life in earlier times wasn’t terrific, either -- lights off, no variety -- but they lived with it for the thirty years of their marriage. He continued:

I have racked my brain for a plan of action. I know the hard part is putting it across to my wife in a way which is pleasant and attractive. So my first move is to stop masturbating to stop the urge. I think that if I leave things until I get really desperate, I will have to communicate with her as the only option.

John’s story tugs at so many important concerns: lack of communication and his wife’s vaginal pain, lack of lubrication, and diminished desire. In my new book, Naked at Our Age: Talking Out Loud about Senior Sex, I devote an entire chapter to each of these four problems. I wish I could send him the book now, but it won’t be out until June. Of course I’m not going to make him wait until June to get some direction.


First of all, John, your wife needs to get a medical evaluation for her vaginal pain. There can be several causes (which I go into in Naked at Our Age), and yes, there are solutions! A common cause is the tightening of the vaginal floor muscles after menopause when they don’t get regular practice relaxing through sexual arousal and orgasm. An excellent resource for making vaginal intercourse more comfortable is the Vaginal Renewal Program from A Woman’s Touch.

Please also try different lubricants. I don't know which "gel" you used, but lubricants are very important at our age when our own lubrication decreases. These posts about lubrication will give you more information.

However, you’ve got to be able to talk about this problem in order to fix it! A sex therapist would be a great help here, especially since this isn’t a new problem. Sex therapists are trained to understand what’s preventing you from having a good sex life and offer strategies for improving communication as well as sex itself. This has gone on so long that although I could offer some communication tips, I think you do need a third person listening. If she wouldn’t be willing to go to a sex therapist, a couples therapist would be a good start.

For now, can you say something like this to your wife?

“Our marriage means the world to me, and I would feel happier if we could work on the problems that are interfering with our sexual intimacy. I think we need some help and guidance, because we’re staying stuck on our own. Could we see a doctor about your vaginal pain and talk to a counselor about how to bring intimacy back into our marriage?”

Please see also Yvonne Fulbright’s comments on communicating about sex.


Please realize, John, that there's nothing wrong with masturbation at our age or any age. Our sexual urges tell us that we're fully alive -- they're not our enemy.

I know this is a small answer to a big problem, John, but I hope it will encourage you to take the first steps at talking with your wife openly and lovingly and seeking professional guidance. Would you please let me know what you do and what happens?

Too tight? Vaginal dilators can help.

Women write to me that after a long period of celibacy, they find someone they want to have sex with again. Often they didn't think they would discover love/lust again after so many years. Their elation dims when they discover that they've become too tight for intercourse, or it's too painful.

There are several reasons that vaginal pain can happen (which I discuss in my new book, Naked at Our Age, coming in June 2011). With age, especially if you're sexually inactive, the vaginal tissues thin and there's less blood flow to the genitals. Without vaginal penetration and/or regular orgasms and internal stimulation, the pelvic floor can lose its ability to relax, and in its contracted state, the vaginal opening feels too tight to admit a penis or a larger-than-slim sex toy. If this is your situation, please download this Vaginal Renewal program from the wonderful folks at A Woman's Touch sexuality resource center, and put it into action for the sake of your sexual health and future joy.

Part of this program is at least one orgasm a week (you don't need a partner for that!) and internal massage using vibration. Yes, really. Internal massage with vibration brings blood flow to the vagina and helps strengthen the tissues. If you're so tight that insertion hurts, vaginal dilators will help. These are more wands than dildos, starting very slim and progressing in graduated sizes as your body adapts and is able to accept more.

It used to be a hassle to even find vaginal dilators, but now there are two different styles that are easily obtainable and will fill your needs:

The Oasis Dilator Set is made of smooth, durable, ABS plastic and comes in three graduated widths: Slim (1/2"), Midi (1"), and Maxi (1.25"). Order the size or sizes you need for $25 each. If you've been finding insertion painful, the 1/2" size is a good place to start, then you can order larger as you're ready. Each has a dial to control vibration intensity, from very mild to moderately intense. Thank you, Babeland, for sending me this set for review.

The Berman Vibrating Dilator Set is a set of four graduated dilators that fit like nesting dolls over a base with a dial to control vibration, from very mild to moderately intense. You can start with the slimmest, which tapers from 12/16" to 14/16", and build up over time to 1-1/8", 1.25", and 1.5". You get all four sizes in one package for $46. It also comes with a stretchy, nubby sleeve that is supposed to increase sensation. (The sleeve didn't do anythng for me, but you might like it.) Thank you, Good Vibrations, for sending me this set for review.

Both brands do the job very well. If you need super slim, the Oasis has the thinnest. If you don't have a problem with tightness and you like a fuller feeling, the Berman set has the thickest.

Using dilators is a process for your own sexual health and the health of a relationship you might have now or in the future--and it can be extrememly pleasurable, besides! For optimal pleasure, pair your dilator with a clitoral massager (see an array of reviews in my other sex toy posts here).

No Sex for 12 Years, Now Vagina Too Tight for Penetration

Frustrated in Florida, age 61, had not had sex for nearly 12 years, until recently. She wrote in an email to me:

Apparently one's vagina does change after not using it for a long period of time. I always thought sex was like riding a bicycle, but it is not. One can't just get back on and ride! I experienced such pain during the attempted penetration that we had to stop. What a disappointing and embarrassing moment. My partner was very understanding, however I was just frustrated and disappointed.

I went to my GYN for an examination soon after and explained my circumstances. She gave me a thorough exam and said although I had many tiny lacerations and redness, my vagina seemed normal. She explained how one's vaginal lining becomes thin after menopause and her advise was to abstain from sex for two weeks, using lubrication to aid in healing.

When we engaged in sex again, very gently, I was once again disappointed with the level of pain even though using lots of lubrication. We once again had to stop.

So now I am wondering if there is some way I can stretch my vagina for it seems like it has shrunk. (Perhaps it is just my imagination running wild!)

Have you had anyone else write you with a similar problem and if so is there a solution? For your information I have never been on hormones and my partners
penis is of normal size.

No, it's not your imagination, and yes, it's true that the vagina will seem to shrink after a long period of abstinence, especially after menopause, and penetration will be painful or sometimes impossible. I did, in fact, deal briefly with this in my book, Better Than I Ever Expected: Straight Talk about Sex After Sixty. I had interviewed a 75-year-old woman who had been celibate for 38 years and was in a new relationship. She was unable to have intercourse because her vagina had dried and narrowed to the point that penetration was impossible. She sought help from her gynecologist (a wonderful woman who has bought dozens of copies of Better Than I Ever Expected to give to her patients!), who helped her with stretching exercises.

I'm disappointed that your gynecologist is not this helpful. Telling you you're "normal" while you have lacerations and pain is not helpful, is it?

Please read Step-by-step program for Vaginal Renewal by Myrtle Wilhite, M.D., at A Woman's Touch, a wonderful sexuality resource center in Madison, WI. It tells you step by step how to massage and stretch your vagina. Dr. Wilhite permitted me to quote an abridged version of these steps in Better Than I Ever Expected, and I'm repeating them here for you:

* External Moisturizing and Massage: Increase the suppleness and blood circulation of the skin of your vulva and vagina with a five- to ten-minute massage with a moisturizing sexual lubricant like Liquid Silk®, a water-based lotion that will soak in and moisturize your skin, won't get sticky, and will help you massage with very little friction.

Push in to the skin with circular strokes, and massage what's underneath the skin, rather than brushing across the skin. Include the inner lips, the hood of the clitoris, the head of the clitoris and the perineum.

To complete your external massage, massage into the opening of the vaginal canal, using the same circular strokes. The massage itself does not need to be self-sexual in any way, but if that is comfortable for you, by all means explore these sensations.

* Internal Vaginal Massage: To massage inside your vaginal canal, we suggest using a lucite dildo which is very smooth and will not cause friction or tearing. Choose your size based upon how many fingers you can comfortably insert into the opening of your vagina.

After a session of external vulva massage, apply the same massage to the inner surfaces of your vagina with your dildo with lubricant applied on both skin and dildo. Rather than pushing the dildo in and out, use a circular massage movement. You are increasing skin flexibility so that your body can adjust to comfortable sexual penetration if you choose it.

You might also choose to use a slim vibrator for massaging the vaginal walls. Coat it in Liquid Silk and then insert it gently. Turn it on and let it run for about five minutes. You don't need to move it around, just lie there and let it do its work.

* Orgasm: For women who stop having orgasms, the blood vessels literally can get out of shape, preventing future orgasms. If you are able to bring yourself to orgasm, do so at least once a week (for the rest of your life). (Seriously.) This is preventive maintenance of your body.

* Kegel Relaxation: Kegels increase both the strength and flexibility of your pelvic floor muscles. Pay attention to the relaxation and deep breath part of the exercise. Learning to relax your pelvic floor will help you to avoid tensing up before penetration. (In Better Than I Ever Expected: Straight Talk about Sex After Sixty I also give Dr. Wilhite's tips for perfect Kegels.)

I plan to go into more detail in the new book I'm writing, which goes more deeply into the challenges of staying sexually vibrant in an aging body, and how to cope with these challenges.

Best wishes for a joyful resolution to this problem -- please keep me posted.

--Joan