Obstructions abound

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Dear Andrea:

My wife and I are both about 41 and have been married 10 years. Our marriage has been satisfying except in one big area: intercourse has become impossible, owing (I suspect)to my wife's multiple abdominal surgeries. The problem is that initially I can achieve nearly full penetration, but as the action continues, a strange foreshortening seems to occur in her vaginal canal so that eventually I am only able to get in about half as far as when we started, and it is somewhat painful, as if there is something actually obstructing me. Do you have any idea what might be the problem, and could you suggest anything that may help? We are both quite depressed about this.

Love,

 Kicked Out


Dear Out:

I don' know what procedures your wife has undergone, or what conditions caused her to undergo them, but any abdominal procedure, most certainly including hysterectomy and childbirth vaginal or caesarian, not to mention pregnancy itself, can cause nerve or muscle damage, scar tissue, and unhelpful structural changes. Something, a muscle or suspensory ligament, has been weakened. Something is pushing on something or falling into something — I'd assume uterine prolapse (although I'm not a doctor) and needs to be coaxed back into place. No matter which structure has wandered off where (uterine prolapse does make me think a bit of "hysteria," the "wandering womb" of yore), something, needs to be done, whether more surgery (one hopes not), physical therapy (exercises or dilators), or the acquisition of an odd little item called a "pessary," which is worn in the vagina.

These problems can be tricky and even intractable, so I don't want to promise you that it can be all fixed up in a jiffy, but any progress would be better than where you are now. And I hope you two have good insurance, the kind that allows you to see a specialist when you think you need one, not just when your PCP thinks so, because this is going to require one. Assessments like "Nope, looks normal," aren't a diagnosis — they are a dismissal.

This is all putting me much in mind of vulvodynia and vestibulitis, the long-dismissed "all in your head" pelvic pain conditions that, due to the efforts of the National Vulvodynia Association and some recent breakthroughs in diagnosis and treatment, have received quite a lot of press lately. I'd never given persistent pelvic pain enough thought myself until I started teaching classes in keeping your relationship and sex life going after you have kids. After the third class in which one woman raised a hand at the end and asked, reasonably, "But what if it still hurts?" I realized we are dealing with something of a silent epidemic here, the "silent" element of which can still induce feminist rages in "mostly too lazy/busy for feminist rages these day" me.

We must be honest — if men's balls fell out on a regular basis, or if becoming a father often caused lifelong painful intercourse, you'd better believe we would hear quite a lot about it.

Love,

 Andrea