Dear Dr. Roach: I am a 71-year-old woman in good health, but sex for me is extremely painful. Not only the start and insertion, but also once inside. I’ve seen ads for laser treatment; however, this is $2,000. What do you suggest? — Anon.
Answer: Painful sex is a very common problem in women and, unfortunately, one that some women aren’t comfortable bringing up to their doctor.
There are many, many different causes, and most of them are treatable. They can be physiological (low estrogen levels, which are nearly universal in women after undergoing menopause, can often lead to painful sex); anatomical (including endometriosis and benign tumors); neurological (such as pudendal neuralgia); and psychological (such as a history of intimate partner violence). There are many others, and I couldn’t do justice to them all in 10 columns. A comprehensive evaluation is essential by an expert, such as a gynecologist who subspecializes in pelvic pain.