OPEN, I wish you provided us with more insight about your conversations about opening your relationship. It sounds like an open relationship is something he broached, which suggests that you need to raise two issues with him. First, you are uncomfortable about an open relationship, and that may not change. Two, how will his feelings about marriage to you change if your medical condition leaves you permanently unable to have pain free PIV sex. You haven't provided any detail about your condition, so I don't know whether this is likely temporary or whether this could be a chronic condition, lasting a lifetime.

Whatever decision you make about opening up your relationship, I would suggest pushing off a date for the wedding until you have greater clarity about your medical condition and about whether a marriage without PIV sex (but with the sex you can have*) is something that your fiance will agree to if it turns out that your medical condition cannot be resolved. I think you're likelier to have a more successful sexual connection and marriage if you've spent the time developing a mutually agreeable set sexually activities and both have a good sense of how your medical condition will progress before getting married.

*Last week, some female commentors indicated that for various reasons they prefer anal sex to vaginal intercourse. Perhaps you may find that works well for you and for finance too.

It's a tough one LW. If, as SA@1 has suggested, it was your beau who brought up this plan, then it is something he is keen for. Dan likes to throw out that PiV sex ain't the be all and end all,and for him, it isn't. For others, it is an important part of their sexual expression.
Don't open the relationship at this time, it would be too risky emotionally. You guy maybe could visit a sex worker, every couple of weeks or so, how would that feel for you.

@2. Lava. Your second and third sentences aren't incompatible!

OPEN's fiance is at fault here, I think. He hasn't in a spirit of genuine inquiry said anything like, 'would you really be OK with my having penetrative sex with somebody else?'. It should be clear to him she isn't OK with this. If she can explore other forms of sex--all those that Dan indicated, and maybe most crucially taking it up the ass--then I think there would be more power to her negotiating elbow in telling him 'don't have sex with someone else'. Even supposing this isn't something she had considered or bargained on before, she would still be within her rights to place a veto on opening the relationship while they work out what they can and can't do while she has this medical condition.

We don't know the nature of LW's medical issue, but if she has something like, say, a fistula, "taking it up the ass" is no more feasible than PIV.

All the best to you, OPEN, regarding your medical issue, but I don't think I'd even consider marriage until I'd resolved the PIV mystery and was once again whole and healthy.

Go and see a Certified Sexological Bodyworker. They can help you to find new areas and practices of pleasure for yourself and your partner. They may also be able to approach/recover whatever is currently keeping you from enjoying your vagina.

To give a more explicit answer to her very practical question first ("Are there things we can try in the bedroom to simulate P&V to help tide him over?") Yes. Variations of the toys and frottage that Dan mentioned: (1) grasp a fleshlight between her thighs and let him go at it, (2) lots of lube in the same area and he can simulate penetration between her pressed-together legs - in either case, they can gaze into each other eyes, he can look at and play with her tits, etc. Similar to PIV but without the P in the V.

I'm not hearing in the letter that they've tried anything besides PIV. Oral, anal, hand jobs? If he insists he needs PIV from someone else without exploring more options with her, he's not ready to get married - has he seized on it as an excuse to fool around? And that she hasn't gotten more creative "so he can find relief", suggests maybe she's not that keen on any kind of sex (at least with him) and but for her feelings of inadequacy, a future of no PIV and not much sex in general with him might be fine with her. Because she never says sex is something she wants.

If two adults can't/won't apply some creative problem solving to improve the situation and give one or both of them pleasure, that really doesn't bode well for a marriage in which challenges with no fun outcome (finance issues, home repairs, ill health, dirty diapers) arise all the time.

Blowjobs. C'mon now.

she never said if this is a new thing or a long-time condition, or if he signed up before or after it started.

@3, Harriet, trouble here is, as SA @1 pointed out, we have no idea what this condition is, how long it's been going on and for how much longer.
If it's only been a few weeks, than yeah, husband to be isn't showing much backbone or as David @7 said, not showing very resilient marriage material, if he's into outside vaginas already. Otoh, if it's a long time situation and may continue to be, a different response might be needed.

@4 & 10. Originalcinner, you're right if the problem is something like an anal fistula. My read of the letter was that the problem was something like vaginismus i.e. a physically manifesting condition that could be understood--no doubt unsympathetically--to have a psychological trigger. If she had something clearly temporary, about which no fault could be assigned to her psyche, my sense is that she would just have said; and that this issue of opening the relationship up would not have exploded to such a degree during her engagement.

Just in the spirit of not being embarrassed about my sexual argot, I'm going to change 'taking it up the ass' to 'enjoying a sloppy mouthful'. There's another point to doing this, in that OPEN might not be feeling sexy right now. She might be feeling like a sexual failure. A sexual reject. There's no reason to feel this. She shouldn't internalize it; her boyfriend shouldn't impose it on her. She can't have one kind of sex for a time. She should be making eyes at him alluringly and purring, 'well, maybe I can make it up to you some other way'.

HaHa, Harriet. True. Seduction is a very under appreciated sequence of behaviours.
Yes. it would be making the LW feel unsexy, and if he's in for the long haul, staying put while the LW goes thru the Dr/ therapist route, proves it.
She's got to meet him half way. Slip on some sexy lingerie, place some candles around the bourdoir, put on her mask and take out the small crop and give him a very satisfying blow job.

What Dan said. There have always been things other women can give your husband that you can't. And getting PIV sex isn't going to make your husband "suddenly realise" he's not getting PIV sex with you; he already knows that, and misses it, hence his request to go find it with other women.

Those people who don't think it's occurred to a straight couple that there are things besides PIV that they could do, I say, come on. The overwhelming majority of straight people also have oral sex, a very high number have anal sex, and very very few lack the internet. It's just that for most, PIV is the main dish, with oral/anal/toys typically serving as either appetisers or occasional alternatives for variety. If I had to accept no PIV ever with a partner who had a P, I'd be disappointed.

I agree with the commenters who noted that a medical problem preventing PIV is likely to also make PIA too painful, and Harriet makes a good point that OPEN may be feeling like a sexual failure, which is not conducive to being keen to give head. (Particularly if, ahem, he's not reciprocating. A tongue on the clit is not painful.) I hope OPEN's doctors can find a solution pronto, and in the meantime, a DADT arrangement may work for them.

DADT could be more problematic than going to see a sex worker, Fan. As pointed out by Harriet, the LW is not keen to go this way, and wouldn't it just give her more stress, him off forming relationships.
Why can't she give head, it doesn't sound like she's in pain outside her vagina. Her mouth probably works fine.

It seems unlikely, to the point that we can dismiss the possibility, that anyone writing to Dan Savage hasn't ever thought of the various obvious alternatives. (I did have a brief flash fantasy of her response "What's a 'blow job'?" but I have an odd sense of humor.) And as has also been pointed out, she probably wouldn't need to write if the medical issue weren't looking like it could be long-term. But she does seem OK, in theory, with opening up the relationship if the motive were just an honest mutual effort to get some variety, so they've given that some thought, I think.

All in all, then, she doesn't sound naive or sex-disinterested, so I have to think this is just really fucking with her head, to feel like "she's incapable of doing it right." And yeah, the letter does not make it sound like he's much help there.

Which makes me wonder, just thinking out loud really ... who's actually writing this letter? Her, or him?

(The answer, btw, to "What's a 'blow job'?"
"$50, same as downtown.")

Lava @14: Wow. This poor woman, she is suffering from a medical condition so severe she can't enjoy penetrative sex, and now you expect her to placate her fiancé by giving, presumably, unreciprocated blowjobs to keep him from wandering. What a 1950s attitude. She may prefer to suffer in silence, and what she doesn't know (about who else may be servicing him, and whether or not he's paying her out of their presumed wedding fund or not) won't hurt her. At the very least, it won't hurt her jaw.

(I agree, they should do as Dan advises and continue to engage in mutually enjoyable, non-PIV sexy times. That is not the same as her being his unpaid sex worker.)

In addition to wishing OPEN had given us more clues as to the nature of the medical trouble, I really wish OPEN had told us what sexual activities she loves. If the pain and medical issues weren't there, or before the pain and medical issues were there, what did she enjoy and fantasize about? So far the letter is all about what she does to satisfy him. The only thing he does to satisfy her is not have PIV sex with her. If this is the dynamic over the long term, opening the marriage isn't going to help.

Although I want to agree with people that a regular reader of Dan's would be very aware of all the alternatives to PIV, like David @7 I am concerned that she doesn't mention all the other fun things they're doing. Maybe the letter was heavily edited, but I would expect at least something like "We're still enjoying some oral and mutual masturbation, but he/I/whatever really miss..." I don't think it's impossible that despite reading Dan, they're in that category of straight couples for whom PIV is the whole point and all other activities are merely preludes to it, and therefore when it's off the table, they think there's no reason to even start. If this is the case, Dan's advice is perfect. Shake out of that mental space and realize lots of people--for instance, every gay and lesbian couple everywhere--enjoy fulfilling sex lives without PIV.

Bi @17: I don't see how a suggestion that they incorporate blowjobs is at all out of line--nor does it feel like channeling the 1950s to me. We don't know that that would feel like "placating" to her, but even if it did, so what? We do things to help out our partners. But then I'm always in the camp that maintenance sex is a reasonable part of a relationship, and not everyone has to be 100% into it every time. Not that it isn't best if everyone's up for it! But that's not always realistic over a LTR.

It's also possible that PIV isn't really that important to her, and that although she wants to be able have it, it's more stress to be worried about fixing her condition than it would be to just let it go.
Stress can exacerbate medical situations, and it sounds like she's feeling a lot of pressure about this. If that's the case, maybe opening the marriage really would help. If they have a strong connection otherwise, and can work with each other to deal with her fears about what might happen, maybe it would be a relief to her. Take that pressure off. That might even help her, later, with her own condition.

Also, slomo @16: alol!

Ciods @19: Welcome back!
I wasn't reading Lava's advice as "incorporate blowjobs." See my post @13: I'm assuming that blowjobs, or at least cock sucking (the kind that doesn't necessarily require persisting until he ejaculates), are probably part of their sex life already. If she hasn't been giving him at least occasional blowjobs-to-completion, I'm guessing that's because she doesn't enjoy them, or finds them painful. And where in Lava's suggestion was him reciprocating?

A suggestion for an occasional BJ is no problem. But if the issue is she has to find some way to fulfil his sexual needs to the point where he won't want other women, we're not talking "occasional," are we? We're talking about putting the job in blowjob. Hell, I like giving head, and I wouldn't want to be expected to do it several times a week, particularly with no one looking out for my wants and needs. In that bleak scenario, I'd certainly prefer to outsource until my sex life could once again be enjoyable for me too. OPEN's preference may of course vary.

I agree, there doesn't seem to be anything in the letter about what OPEN herself wants sexually. Perhaps she's too worried about whatever this underlying health condition is to be thinking about it.

OPEN cannot have PIV sex now, and that is understandably an issue in their sexual relationship. If this is a treatable and temporary condition, then it seem clear that this couple needs to focus on her treatment and recovery, while enjoying whatever sexual connection they can at this time.* If OPEN's fiance is unwilling to do so, then OPEN needs to terminate this relationship, because that behavior would be a significant red flag.

However, if the resolution of OPEN's condition is uncertain, and PIV may be intermittent or impossible from this point forward, then they need a frank discussion about what that means long-term. But before having that conversation, OPEN needs to understand her diagnosis, her prognosis, and treatment options before they start that conversation, because there will be too many "what ifs" to reach any meaningful and informed resolution.

Should OPEN learn that this a chronic condition, and PIV sex may not be possible regularly from this point forward, then there are three possibilities: (i) OPEN's fiance will need to accept that he will not have PIV sex regularly, (ii) they open the relationship, or (iii) they part ways before getting married.

*I'm going to take it as a given that they know about oral sex, mutual masturbation, anal play, sex toys, etc., and that these things are being engaged in mutually for both partner's pleasure. If OPEN and/or her fiance aren't interested or knowledgeable in these sexual activities they have bigger issues than whether to open their relationship. Realistically, I do think there needs to be some amount of frequency in their sexual activity, in whatever form it takes. If they are not having PIV sex and they are not otherwise engaging sexually regularly, I'm going to guess the relationship will not last very long.

Sublime @21 wins the thread.

I found DAVIDinKENAI @ 7 to be very helpful, as quite a few others.
Everyone's a winner.

You're right Fan, I didn't mention LW receiving sexual pleasure because she doesn't present herself as wanting any. Her panic is over her fiancé going elsewhere. The lack of details re her condition makes it difficult to know how long this situation has been going on etc. Is she so worried about her illness that she doesn't have much desire? We don't know. You might prefer to outsource, she is not happy to do that. Is he a cad? Has she got psychological barriers to her own pleasure? By her writing in, the situation has hit a crisis point.

Dan and others can say over and over that mutual oral and toys and play can satisfy, and obviously, as ciods pointed out, gay and lesbians enjoy full sex lives without PiV.
For those who do want PiV as part of their sex, it's crazy to tell them that no, you've got it wrong. Because they will still seek out that pleasure, because well, for that pleasure. And the guy in this letter wants it. I doubt the LW brought up the open conversation.
These two need to talk, with each other, with therapists. Get a bit real here, before the LW gets her heart broken when her fiancé falls in love with someone else.

@25, cont. " .. that mutual oral, *anal, toys and play.. " Apologises. I don't do anal, so it skipped my mind.