Over the last several weeks I (Stephanie) have been busy trying to catch up at work, getting to my commitments on-time, and generally just trying to keep my head above water among all of life’s responsibilities. What typically is a low to no pain sexual experience for me one night turned out to be excruciating pain instead. I alerted my husband and we enjoyed other forms of intimacy (I never go through with painful sex, it only serves to heighten the fear of it next time). When we discussed it later I expressed my frustration: “I don’t know why it’s hurting, it doesn’t make any sense”. I set out my towel and pillows to use my dilators so I could get a sense for where the pain was and why. The smallest dilator was difficult for me, which is usually never the case. As I worked through the process it began to hit me. Of course it made sense!
In my constant rush I’d neglected to practice my massage techniques on my stomach and inner thighs for days. After my dilator use (I could only successfully use the smallest size without resistance) I immediately grabbed the lotion and sure enough, very tight, tense, and painful sections in both areas. I had multiple trigger points to release. As I practiced my relaxation breathing while holding pressure on the trigger points I realized I’d been holding my stomach tense and had slipped back into “chest breathing”. I also noticed areas of tension in my hips. So after my massage techniques I got my tennis ball and found these points of tension and pain in my hips. I then stretched my hip musculature and did hip strengthening exercises. I was reminded of the couple times over the week I had worked out. Maybe I had overdone it a bit, after all my inner thighs are touching so I could be getting fat. And in my morning and evening rush I’d forgotten my probiotics and hadn’t been very mindful during the day of drinking enough water. The recollection came to me that my stools had been hard to pass lately.
I scolded myself that night for putting my pain on the back burner. If I had been mindful to check in mentally with my stomach, hips, legs and pelvic floor I would have caught the fact that they were holding tension. If I had sat down for a few minutes to participate in guided mediation it would have prompted me to notice these areas of tension I was holding in my body. If I would have taken my work out slower, not been so concerned with my body image, and more diligently drank water and remembered my probiotics I could have avoided this current predicament. Grateful for the reminders, I forgave myself and went to bed.
The next morning I woke up with the image of the volume dial in my head. Over several weeks all of the combined factors added up and my pain volume dial got turned way up! Stress: notch up. Chest breathing: notch up. Muscle tension: notch up. Hard and big stool: notch up. Lack of water: notch up. And then I went into sex expecting a pain-free experience. With a new-found commitment I pledged to take the daily steps to turn that volume dial back down. Keeping this promise to myself might mean I don’t get as much done in a day. It might mean that I’m not as skinny as I’d like to be. It might mean asking for help more than I’m usually willing to admit I need so I have more space and time for healing and mindfulness. But I’ll do it. Whatever it takes. Because sexual pain is not acceptable. It’s not good for me. And It’s not good for my relationship with my husband. And those are the things that truly matter to me. *
Caution Ladies: This is what my journey looks like right now. And we hope that it connects the dots for you on how inter-related factors can add on top of each other, causing the pain volume dial to get turned up. Not everyone, including me, can always take the time and effort to perfectly keep the pain volume dial turned down. Children, work, demanding partners all come into play. We encourage you to not let feelings of guilt creep in if you can’t keep up. Guilt and its side effects are counter productive in managing your pain. Give yourself lots of grace in this area and just do what you can, when you can.
Great article in the Toronto Star. This is one of the best we've seen in the public media, telling the story of a woman with vulvodynia. We hope it inspires more public media awareness regarding this and other related chronic pelvic, sexual and genital pain conditions.
Toronto Star Article
Q: I now have “pain down there” for no apparent reason. The first time I had sex it was slightly painful but the pain faded away and felt good. On a few other occasions following that time, the same thing would occur: a little bit of pain but then fading away. But lately if we switch positions or he falls out he cannot insert again. If he does it’s excruciating pain for me. He can’t put it in again, it feels “too tight”. I experience burning pain during sex and afterwards it hurts to urinate (only right after we have sex though). I’d go to a doctor but I have no insurance so I’m unable to afford it. What’s going on?
A: First of all, let us assure you that you are not alone in experiencing these symptoms. There are countless individuals going through very similar situations right now, many of whom also are not getting helpful answers from the medical community. We often see "UTIs" and "yeast infections" overly diagnosed in cases like yours. Of course you need to rule these out. But this can easily be done by going to a nurse practitioner at a Planned Parenthood clinic (fees are usually reasonable even without insurance). If the tests are negative or the treatments don’t help you, don’t continue to accept antibiotics or creams that aren’t proving to be affective in treating your pain. Please also consider:
1. Be sure to always use a good vaginal lubricant, such as Astroglide Gel (not the liquid), another product actually named "Slippery Stuff" which you can find on-line, or even simple coconut oil. These products are generally tolerated by most women even if they have minor inflammation at the vaginal opening (Vestibule). Make sure to put these lubricants on yourself and your partner to eliminate any friction which can help to minimize the pain
2. You could also be experiencing muscular restriction at the vaginal opening (Pelvic Floor Dysfunction - a clenching response to increased sensitivity to touch or friction at the Vestibule). With initial penetration - these muscles (pubovaginalis) are stretched, which may be creating your initial burning pain which then subsides as sex continues. Any time re-entry needs to happen (switching positions or him falling out), your brain perceives this as a "dangerous" situation and your pubovaginalis "clenches" to protect the area of pain. There are certainly exercises that can be done to help to 1) stretch the vaginal opening and 2) retrain the brain that your vaginal opening is not a "danger zone" so that the red flags gradually fade and your gripping reflex is no longer present allowing your partner to enter with low to no pain.
3. Since you say you have "excruciating pain" with penetration, the simple suggestions above may not be helpful enough. If you have already tried these simpler solutions and they are not helpful and you continue with pain, you may have the early signs of vulvar vestibulitis as well as interstitial cystitis / painful bladder syndrome (IC) contributing to penetration pain. Early signs of both of these conditions are quite common in young women. (Usually deeper penetration pain is associated with IC as the tip of the penis "hits" the irritated bladder. Initial penetration pain can be associated with vulvar vestibulitis as the sensitive tissue of the irritated vestibule are stretched) Consider drinking more water and de-acidifying the body by lowering acids in the diet to lower the inflammation that can occur in the bladder, urethra and vestibule. To download our Vaginal Health Guide click here.
4. Our DVD Healing the Pain 'Down There’ can help educate you on why this all might be happening and will give you strategies to help make it better yourself and also to help find professionals who may know more about these issues.
Interstitial Cystitis: Also known as Painful Bladder Syndrome or IC. It is a very common disorder of the bladder, it is estimated that about one out of every six reproductive aged women have some degree of IC. This condition is caused by a loss of the “protective lining” of the inside of the bladder, allowing for an inflammatory reaction of the bladder wall. Since urine is ordinarily very acidic and with the protective lining already diminished, the acidic nature of the urine also causes an inflammatory response which in turn triggers off symptoms of urinary frequency, urgency, and pain, pressure or discomfort anywhere in the pelvic region.
Unfortunately, many pelvic practitioners do not mention or think about this disorder when diagnosing pelvic, sexual, or genital discomfort. However, cumulative research has shown that persistent pain in the pelvic region is triggered by the bladder and/or bowl function at least 80% of the time and by gynecological disorders alone only 20% of the time.
If you are being diagnosed with frequent urinary tract infections or "UTIs", always ask your practitioner for a urine culture before taking any antibiotics. Instant "dip sticks" of your urine can look the same with IC as in a UTI.
For more information we recommend:
Interstitial Cystitis Association
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.