My wife and I have been married for six weeks, and we have not been able to have sex yet. My wife has a very small and tight opening. Before we were married, her doctor gave her some plastic tubes to stretch it out. She tried them once or twice, but it hurt her too much so she stopped. Since we have been married, we have attempted to have sex several times, but my penis is too large for her, and it hurts her to the point that we have to stop. Also, because she is so small, we have to put my penis in slowly without any movement. During this process it goes limp. How can my wife stretch herself without too much pain, and how may we have sex without so much discomfort to her? Our marriage is suffering.

-- Nate

The opening to the vagina is covered by a thin membrane called the hymen. This usually tears easily with the initiation of sexual activity. Sometimes, however, the hymen is thickened and blocked, causing pain during sex. If this is the case, then a simple outpatient surgical procedure is the best approach.

The tightening may also be due to constriction of the pelvic muscles that encircle the vagina -- that is, the muscles around the vagina are too tight. Or it may reflect incomplete development of the vagina, in which the vagina is simply too short or narrow. In either of these situations, dilation is the best approach. This involves inserting lucite dilators of gradually increasing diameter into the vaginal opening on a daily basis.

A skilled reproductive endocrinologist should be able to determine what is causing your problem and advise you about the easiest solution.