I would start by getting rid of the Mirena and getting a non hormonal IUD. The only reasons to have a have a hormonal IUD seem to be to make the manufacturer more money and to make your period shorter. Is a shorter period and other side effects worth trading your sex drive for?
Talk to you mid wife about this. You may need to see a GYN - a good one, not just a random one. You may have scar tissue that is causing some trouble. Episiotomies are rarely done anymore as it has been conclusively found that they heal less readily and with more scaring than a tear. There is no reason to tear if you do your perineum massage during pregnancy. However, that won't help now. You may need surgery to reduce scar tissue.
Anticipation of pain is surely not helping either. Can you orgasm with masturbation? Perhaps a lot more play before hand? Or finding ways to pleasure each other without as much intercourse?




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