Q: Sex is painful, but it’s not dryness. Help?

To know the ultimate solution for treatment of painful intercourse, it’s important to know the exact cause of the pain. If it is vulvovaginal atrophy, then a vaginal estrogen, like Estrace vaginal cream (which you say you’re using), or Osphena, a non-hormonal oral medication, should be helpful. But not every option works for 100 percent of women, so if this is the diagnosis and you are not responding, another product should be considered.

There may also be another diagnosis apparent after a thorough exam. The condition you describe may be vulvodynia, which is referred to by a variety of names including provoked vulvodynia, localized vulvodynia, or vestibulodynia. I normally hear a description of burning, tearing, sandpaper-like, usually near the opening of the vagina.

Another cause of pain can be vaginismus, which results from too much tone of the pelvic floor muscles and results in painful intercourse. It’s the involuntary spasm of the muscles, which prevents or limits penetration.

Please persevere to get both a diagnosis you trust and a treatment that’s effective for you!