This topic is about a woman who has been experiencing painful intercourse after undergoing an abdominoperineal resection, which involves the removal of the rectum and anus, along with pelvic radiation. She now has a permanent colostomy and is seeking advice from others who might have faced similar challenges. Here are some insights and suggestions that might help:

1. Radiation-induced vaginal narrowing might be the cause. She plans to discuss the use of estrogen cream with her gynecologist.

2. Her husband is supportive but worried about causing her pain during intercourse.

3. Radiation has also affected her ability to urinate easily, but squatting over the toilet seems to help.

Advice and insights from others include:

- Possible anatomical causes:
- Adhesions or scar tissue might be causing tightening. It's a good idea to consult a specialist in colorectal or gynecologic issues.
- The uterus might tilt backward after surgery, causing deep pain. Imaging and a pelvic exam can help confirm this.

- Estrogen therapy:
- Vaginal estrogen cream can help thicken and moisten tissues, reducing dryness and pain. Many women have found relief with this treatment, so it's worth discussing with a gynecologist.

- Dilators and gradual stretching:
- Radiation can cause the vagina to shrink or scar. Doctors can provide dilators to help gently stretch the area. Gentle, frequent intercourse might also help, but only if it's not too uncomfortable.

- Pelvic-floor physical therapy:
- This therapy can help release tight muscles and stretch scarred areas, which some prefer over using creams.

- Lubrication and dryness:
- Many experience reduced natural lubrication after surgery and radiation. Combining water-based lubricants with estrogen cream or using silicone lubricants might help.

- Alternative sexual practices:
- Some have found comfort in exploring other forms of intimacy, such as oral sex, manual stimulation, or using erotic lingerie. It's important to focus on what feels good and avoid anything that might cause tearing.

- Emotional and relationship notes:
- It's common to feel a loss of self-image and confidence after surgery. Remember that your worth is not defined by intercourse alone. Open communication with your partner can help maintain intimacy and reduce anxiety.

- Bladder issues related to radiation:
- Weak urine stream or incomplete emptying is common. Using abdominal muscles, coughing, or squatting can assist. If these issues persist, consulting a urologist might be beneficial.