I have pain with intercourse and I'm not sure what is causing the problem. (photo)

I can only have intercourse for about five minutes before I am in pain. It is at the entrance of my vagina and I have had a procedure to remove the old skin in the area that hurts and resewn to hopefully improve the pain but it did not. I have also had Mona Lisa laser treatments in area and that did not help. I am not sure if I have a partial Hymen or if it is my chronic Lyme Disease causing a skin problem.

Doctor Answers 7

A vaginal laser treatment will not help you.

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A conservative approach for the band of skin at the vaginal/perineal opening  which is causing your pain is local estrogen cream and vaginal dilators. If this option fails over 6-12 weeks a incision of the skin and suturing with fine absorbable suture will widen the opening. You will need to avoid intercourse for 1 month. Hopefully this helps.

Painful intercourse

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You appear to have a band of tissue that is being trapped with penile penetration and being irritated.   A procedure to "relax" the vaginal introitus by enlarging the opening should resolve the problem. The surgeon should make a mildine incision across the band from 12-6 oclock and the close the incision from 9-3 oclock.   I would recommend that a monofilament suture be used to close the incision (4-0 Monocryl) to minimize inflammation during the healing process and minimize scar tissue formation.
Best wishes!

You have a perineal web causing pain with sex. It needs to be resected.

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Webbing of the perineal skin can happen naturally or as the result of surgery. It won't go away. It won't get better on it's own. It won't improve with lasers. It needs to be removed. This is a type of procedure I refer to as reverse perineoplasty and based on your photo it could probably be treated in a few minutes under local anesthesia.

Appears to be a band of scar tissue

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It appears that your pain may be due to a band of scar tissue at the opening of the vagina. Scar tissue often does not have the normal elasticity, and can cause painful intercourse. I think it is possible that this could be improved with a revision surgery to may the opening of the vagina just a bit larger, and hopefully the tissue would heal in a more healthy fashion. Some vaginal estrogen during the healing process may help. If you really want to avoid another surgery it is possible a series of vaginal dilators may help, but it will take a lot of time and commitment.  Find an experienced gynecologist or urogynecologist to do a good exam and give you some options.

Opening pain

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this is a difficult problem, and not necessarily helped by fractional laser (MonaLisaTouch). It is a more serious problem that could remain indefinitely. However, that band of skin across the opening has sensation, and is probably scarred down from revision. Your OBGYN should be able to enlarge the skin circle (cut one direction/sew 90 degrees opposite) probably in office with local anesthesia.  How could you be worse? This is probably what he/she will recommend--do not give up.  I think MLT is expensive for no proven benefit. Good luck.

Pain with intercourse at the entrance of the vagina

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Hello Cape Cod,

Thank you for your post and photo. Not having all of your information and not being able to examine you limits my response. I don't know your Ob/gyn history, sexual history, age, etc.

I can tell you though, that the source of your pain is the perineal or vulvar stricture that your arrow is pointing to. I assume this is where old skin was removed and you are now left with scarring and a stricture at the perineum. It acts very much like a purse-string at the entrance. You will need to have this area revised if there is no improvement following 6 weeks of aggressive perineal stretching and estrogen cream application. IT will only get worse as you have less and less sex and with aging.

Stop the Mona Lisa treatments!

Nothing to do with a partial hymen.

Unrelated to chronic Lyme Disease.

I recommend you see an experienced vaginal surgeon familiar with performing perineoplasty procedures.

Best of luck,

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 38 reviews

Sex hurts

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Hi and thanks for your question. Your concern will go beyond the scope of a cosmetic correction which is what most of the doctors on here will be trying to answer.
You should seek out a specialist in your area that deals with vulvar vaginal disorders. There may be folks in Boston that do this or at Brown. 

Hope this helps.

Kurian Thott, MD
Fredericksburg OB/GYN

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