Vaginal and Vulvar Pain

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  • 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 vary.

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:

  1. Pin down your symptoms exactly, and learn as much as you can about what might be causing your pain. AnVagina Bible front cover 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.
  1. 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.
  1. pelvic floor therapist is trained to diagnose and treat sexual pain and might be the best professional for you. Find a provider here.

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? Please view my “Great Sex Without Penetration” webinar: 90 minutes filled with helpful information and suggestions.

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:

 

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This article was originally published  in a slightly different form in October 2019 as “Ask Joan: Intimate Pain” on Senior Planet, where Joan Price answers questions in her monthly column.

The Vagina Bible by Jen Gunter: book review

Vagina Bible front cover

The Vagina Bible: The Vulva and the Vagina—separating the Myth from the Medicine by gynecologist Jennifer Gunter is a lively, educational guide separating information from misinformation, presented in a clear, smart, sassy style.

“There’s a lot of money in vaginal shame,” writes Jen Gunter. She is known as the clever and outspoken OB/GYN on Twitter (@DrJenGunter—follow her!) who challenges celebrities and companies trying to sell us unneeded (and sometimes harmful) solutions for invented problems. She rips their claims and substitutes solid facts. All of this book is educational, revealing, and empowering. Examples:

  •  “[T]he other problem with doctors not asking about sex is women who have medical conditions that interfere with their sex life, typically conditions that cause pain with sex, end up minimized. Many women suffer for years not realizing they have a medical problem that has a diagnosis and treatment.”
  •  “It is hard to overestimate the damage done by Sigmund Freud in popularizing the myth of the vaginal orgasm. Only one third of women are capable of achieving orgasm with penile penetration alone…so the idea that everyone should be having orgasms this way results in two thirds of women believing there is something wrong with their sexual wiring when really they are perfect. Not orgasming with unassisted penile penetration is not a flaw, it’s a feature.”
  •  “MRI studies looking at anatomy during heterosexual sex reveal that the clitoris can be compressed by the penis, which is why some women can orgasm with penile penetration.”
  • “Vulvar cleansing has never been studied. That is interesting, considering the array of products that claim to be gynecologist tested or approved…Some of these washes make claims they can reduce bacterial vaginosis (BV). They can’t. An external wash cannot possibly impact the inside of the vagina, and washing internally with one of these products (some women do that—please don’t) could definitely increase your risk of BV by killing good bacteria or irritating the vaginal mucosa.”

Parts of The Vagina Bible are so hilarious that you’ll want—as I did—to read them aloud to a companion:

  •  “Almost every woman has been told at least once…to wear white cotton underwear as a medical recommendation to prevent yeast infections and other vaginal mayhem. This makes it sound as if vaginas and vulvas are accidents waiting to happen. The vulva can handle urine, feces, and blood, and vaginas can handle blood, ejaculate, and a baby, so this idea that a black lace thong is the harbinger to a vaginal or vulvar apocalypse is absurd.”
  • “I have read about plastic surgeons who do labiaplasty [surgical reduction of the labia minora] so women can look ‘sleeker in so-called athleisure wear.’ I know some people call this look ‘camel toe,’ but I prefer ‘labial cleavage,’ and the answer is not surgery—it is better-fitting athletic wear.”
  •  “I’ve stared at more male butt cracks (gluteal clefts) than I care to remember…What I never hear is that men should seek out plastic surgeons to get their gluteal clefts sewn shut. I also can’t imagine a similar industry for men that profits from surgically trimming penises so they look better in tight jeans.”

Table of contents, second half of Vagina BibleThe second half of this book is a serious, comprehensive, scientific resource about infections, conditions, symptoms, and treatments. Dr. Gunter has been treating vulvar and vaginal diseases for nearly 30 years. If you have discomfort, pain, or other symptoms that might be a medical issue, read the relevant chapters of this book, then, armed with this information, take it to your doctor.

This guidebook to the care and functioning of the vulva and vagina by cheeky gynecologist Jen Gunter should be on your bookshelf. Thank you, Dr. Gunter, for this much-needed resource: The Vagina Bible.

Vaginal atrophy? Tight pelvic floor muscles? FeMani®Vibrating Massage Wand can help.

5/15/2016: I have updated a previous 2010 review of vaginal dilators, now that the FeMani®Vibrating Massage Wand is available. I’ve also added some wonderful wisdom from Ellen Barnard.   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 attempt penetration and discover that their vaginas feel too dry and fragile for comfort if they try to accept a penis (or sometimes even fingers).

There are several reasons that vaginal fragility, tightness, discomfort, or pain can happen (which I discuss in my books, Naked at Our Age and The Ultimate Guide to Sex after 50). With age, especially if you’re sexually inactive, the vaginal tissues thin and there’s less blood flow to the genitals, causing dryness and fragility, known as vaginal atrophy. A separate but related problem is that 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.

Here’s how Ellen Barnard, co-owner of A Woman’s Touch sexuality resource center, helps women distinguish between menopause-related vaginal dryness and atrophy and “high tone pelvic floor dysfunction” that can be caused by the lack of blood flow to the genitals after menopause:

If you feel like your skin is very dry, fragile and tears easily then you have vaginal dryness and atrophy. You may experience tearing during penetrative sex and find a little bit of pink discharge after sex. If you feel like the skin is stretching or tearing at the opening of the vagina that is another sign of vaginal atrophy. A good quality, long lasting lubricant relieves your symptoms, and the Vaginal Renewal program will provide further relief and comfort both during daily activities and during sex.

 

If you engage in penetrative sex and your partner feels like they “hit a wall” either at the opening of the vagina or about 1-1/2 inches inside, or you feel pain deep inside the vagina with deeper penetration you may have an over-tight pelvic floor. The pelvic floor is made up of 3 layers of muscles. After menopause, those muscles can tighten up and not relax because there is not enough blood going to them once estrogen is no longer present.

 

If this happens to you then your first step is to see a pelvic floor therapist and get an evaluation of your pelvic floor muscles. If you have over-tight muscles the therapist can work with you to get them relaxed and learn appropriate exercises so you can consciously relax them once the therapy is over.

The Vaginal Renewal program may or may not help your pelvic floor muscles, so it is important to get additional help if the description above sounds like what happens to you.

Please download the 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, slim wands (a.k.a. dilators) will help. These start very slim and progress in graduated sizes as your body adapts and is able to accept more. Barnard adds,

A set of dilators may be used to treat the involuntary tightening of the outermost layer of the pelvic floor that happens with a condition called vaginismus, or when you have high tone pelvic floor dysfunction (over tightening of the pelvic floor muscles that surround the vagina) in the outermost, middle and/or deep layers of the pelvic floor. You would work with a pelvic floor therapist to use the dilators to help you learn how to relax with progressively larger dilators inside the vagina. This work may be accompanied by other work such as psychotherapy when the tightening is caused by pain or trauma; meditation; and relaxation breathing in the case of high tone pelvic floor dysfunction.

It used to be a hassle to even find vaginal dilators, but A Woman’s Touch has done the research and development and created FDA-registered, therapeutic vibrating wands that are ideal for the Vaginal Renewal program:

 

Sizes 2 and 1

The FeMani Vibrating Massage Wand is made of smooth, durable, medical-grade ABS plastic and comes in three graduated widths: Size 1 (3/4″ diameter), Size 2 (1″ diameter), and Size 3 (1-3/8″ diameter).

Order two sizes in a kit with one silicone controller (detachable handle that controls the vibrations). These vibrating wands use AAA or AA batteries (included), depending on the size.

To figure out the size that’s right for you, A Woman’s Touch recommends this:

 

Determine how many lubricated fingers you can insert into your vagina when you are not aroused. For one finger, choose the 1 & 2 set, for two fingers choose the 2 & 3 set. If you are unsure or between sizes, we recommend choosing the smaller choice, which will still provide the beneficial massage without the potential strain or discomfort of being too big.

Using vibrating wands 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 extremely pleasurable, besides!

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FeMani Wellness Sexual Health Massage Wand

If you’ve read my book, Naked at Our Age, or the advice given on this blog, I hope you’ve noticed the valuable information contributed by Ellen Barnard and Myrtle Wilhite, MD, co-owners of A Woman’s Touch. They are brilliant sex educators and compassionate human beings who devote themselves to women’s sexual health and pleasure, with a special emphasis on helping women with sexual pain and limitations.

I’ve recommended A Woman’s Touch’s Vaginal Renewal Program often, and many of you told me how helpful it has been for you. An attendee at one of my workshops recently emailed me:

I wanted to let you know how much I benefited from your workshop. Using some things that were discussed, the Vaginal Renewal Program you recommended, your books that I purchased (I went straight to chapter 11 — “When Sex Hurts” —  in Naked at our Age), and some steamy stories from Ageless Erotica, I was able to have penetrative intercourse for the first time in 4-1/2 months. It can only get better from here and hubs is very happy.

Ellen Barnard

I’m including this testimonial here not only because she specifically mentioned AWT’s Vaginal Renewal Program, but also because  much of what I know about vaginal pain and self-help solutions I learned from Ellen and Myrtle. I consult and quote them often, and you’ve benefited from their expertise several times on this blog as well as throughout the pages of Naked at Our Age.

Myrtle Wilhite

Ellen and Myrtle have been working for years on developing the best sexual health internal massage wand for women who have pain and/or limitations with penetration and with medical internal exams due to aging, cancer, or other issues. They (and we) were dissatisfied by the wands — aka vaginal dilators — that were available to women with sexual pain, either from doctors or online.

After years of research, they’ve designed and tested the FeMani Wellness Sexual Health Massage Wand, which has been perfected to their high standards. FeMani Wellness Sexual Health Massage Wand is ready for manufacturing — but their funds have run out.

That’s why I’m appealing to you. These amazing educators have been (and continue to be) generous with their expertise, helping anyone who needs them. Can you be generous to them now? You’ll be helping yourself and many other women who will be able to have comfortable, pleasurable sex because of these tools.

If you’ve been helped by the expertise of Ellen and Myrtle, either through my books or elsewhere, or you just want to help other women, can you assist with a donation of any size?*  Go here to learn more.

 

* You know I don’t use this blog for fund-raising appeals. You may not know that I turn down about one worthy project a week, because I know you come here for senior sex news and views, not to be asked for money. But this project and these people are so special in our world that I had to make an exception.