Q: Why am I too tight for sex?

What you describe could well be vaginismus, which is the involuntary spasm of pelvic floor muscles of the outer (lower) third of the vagina. The resulting interference with intercourse is experienced as "too tight," "he can’t get in," or "it’s like he's hitting a wall."

Because the spasm is involuntary, the cause is sometimes difficult to understand. Pain in the area of the pelvis can be a contributing factor, so the hip pain you describe is likely involved. Beyond interfering with intercourse, vaginismus--those pelvic floor muscles in spasm--can also be experienced as pain in the pelvis, low back, low abdomen, and upper thighs.

It's important to have an exam to better understand what's happening for you, and I'd advise that you have the exam sooner than later. If you have surgery in your future, physical therapy that starts before-hand (and continues after) could help in your recovery, too. Vaginal dilators are often a part of therapy for vaginismus, and that, too, can start now and deliver benefits for your recovery.

Good luck in working through this! With patience and good information, you can do it.

Q: Are treatments for cysts different after menopause?

Both before and after menopause, the indication for treating an ovarian mass is based on its symptoms: Is it causing pain with daily life? Is it causing pain with intercourse? How big is it?

Cysts, which are fluid-filled, are not usually worrisome, and usually resolve themselves without intervention—either before or after menopause. We are concerned if they continue to grow (anything less than 5 cm in size is not a worry).

Any solid mass requires investigation, because it is more likely to be a tumor or cancer. Again, the size and growth rate help us to determine a treatment route.