"My wife and I are very happy in and out of bed, but I notice that when we get started, she always winces like she's in pain. I ask her about it and she says it's nothing. I really hope that it's nothing, but it's clearly not because it actually does lead to a struggle to get started. Aside from a gallon of lube, what can I do to make it easier for her?"

People regularly ask me questions or come see me in my office, as a way to get around talking to their partners. Unfortunately, there's simply no substitute for direct and honest communication. It sounds like the first thing that needs to happen here is another conversation with your wife. She's the expert at what's going on with her body and neither you or I will be able to figure it out by guessing.

If she's saying that it's nothing it could be that she feels embarrassed to talk about it, so it's important to be sensitive to that. The next time it comes up, try to approach it in a way that's very gentle, and avoids all blame or accusation. Saying something like, "It seems like when we have sex it's uncomfortable for you at first and I really don't want to hurt you. I'd love to talk more about how we can make sure this is fun and pleasurable for both of us."

Sometimes the best way to have a conversation about a touchy subject is to set aside a specific time to have the talk, rather than spring it on someone in the moment. Telling someone you want to talk, and setting a time to do it when you're both emotionally ready, can be a good way to set yourself up for a productive discussion.

One question to ask is whether she has always experienced this pain during penetration or if it's something that started more recently. While there's a great deal of misunderstanding and misinformation about hymens, some people have a hymen that is far more substantial and inflexible, that doesn't stretch out of the way naturally, and a medical intervention can be necessary in these cases.

If it is a recent development, the pain could be caused by any number of infections. Anything from a yeast infection to bacterial vaginosis can cause discomfort. Although most people with vaginas will be used to the symptoms of these infections, that's not a sure thing. Sometimes they can sneak up on you.

There are also irritations that can develop over time, such as a sensitivity to latex or to common spermicides such as Nonoxynol-9 that are often used on condoms. Besides barriers, anything that comes in contact with the vulva or vagina might be an irritant, such as a new laundry detergent or any kind of body wash, especially if it has fragrance added.

Another possibility with painful sex is that it could be caused by a disorder commonly known as vaginismus. According to vaginismus.com, two in 1,000 women experience this condition.

"Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse," the site says. "The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. The woman does not directly control or will the tightness to occur; it is an involuntary pelvic response. She may not even have any awareness that the muscle response is causing the tightness or penetration problem."

A diagnosis of vaginismus is relatively rare, but it's worth a visit to a gynecologist familiar with the condition to rule it out. While there, other physical conditions could be investigated as well. If you don't have a doctor you already feel comfortable with check out Catherine Leclair at OHSU, she specializes in vulvar pain.

For many people, readiness for penetration simply takes a while. It can take 40 minutes or more for the tissues in the vaginal wall, and the clitoral complex, to fully engorge. And for some people penetration isn't pleasurable until this occurs.

This is a great reason to slow down and focus on a wide range of pleasurable activities, and ways to build intimacy. Making out, exchanging massage, watching porn, reading erotica—all of these activities can take place long before there's an attempt at penetration. Also, penetration doesn't need to be part of all (or any) sexual encounters! Try exploring how much pleasure you can find with other forms of giving and receiving touch, including manual (hand) sex and oral sex.

Feel free to think outside the box, too. Adding some kink to the mix can be a great way to find new forms of connection and intimacy that don't involve any genital touch. From bondage to spanking to sensation play (wax, feathers, ice cubes,) there are dozens of ways to interact that you may never have tried before.

With all these options to try, it's important to not lose sight of the basics, and how important simple communication is. We get very wrapped up in ego, and expectation, and people-pleasing when it comes to sex. All of us want to please our partners or have particular ideas of what we think is "normal" or what we're supposed to do. Sometimes we need to derail those patterns in order to have an open conversation, and that can be easier said than done. So make sure you're finding ways to make time and space for the vulnerable conversations, and try making yourself vulnerable first, by sharing something scary or sensitive, to make it safer for her to do so as well.

Have you got a burning question of your own? We're listening! Email askhumptown@wweek.com and keep your eye out for an answer in an upcoming column!