Easing Vaginal Penetration PaiN
After our vaginal entrance pain vocab post last week, we got a good question about sexual abuse and pelvic, genital, and sexual pain. We'd like to address that in this blog post, as well as strategies for easing pain at the vaginal opening.
Q: Can sexual abuse make nerves in the vaginal opening more sensitive? If so, how do you ease the pain?
A: Sexual, physical, and emotional abuses remain so prevalent in our society and are a tremendous burden. Like anxiety, depression, stress, genetic and hormonal influences, injuries, accidental traumas, pelvic surgeries, falls and straddle injuries, abuse is a predisposing factor for female pelvic and sexual pain. This means that all of these factors can make an individual woman more inclined to these conditions. Pain that results from sexual and/or physical abuse can absolutely contribute to an over sensitization of the pain receptors at the vaginal opening (the vestibule). The experience of this “bad” pain is "remembered" by the nerves. Our nervous system stores these bad memories chemically and awakens them when it is feeling threatened and trying to protect itself (when you’re attempting pleasurable, consented sexual intercourse for example).
So sexual abuse is one of many possible traumas that can be precursors of pain and sensitivity of the vaginal opening. Vestibular pain (vestibulodynia) is by far the most common reason for entrance pain and sensitivity in the vaginal opening in reproductive aged women. It is a common subset of a condition known as Vulvodynia (pain in the vulvar or genital region of women). It is estimated that about up to 15 million women suffer from vulvodynia in the United States alone. All too commonly, even when young women are barely able to be touched by the use of tampons, having a Pap smear, or by any sexual activity, they can be diagnosed mistakenly with "yeast infections" and/or bacterial infections. Those types of infections rarely cause the severe pain and inflammation experienced with those individuals suffering with vulvodynia or "provoked" vestibulodynia.
Various oral medications to help quiet the nerves firing off in this very sensitive area are similar to medications used to quiet other hypersensitive nerves (neuropathies), in other parts of the body. These may include combinations of low doses of tricyclic antidepressants such as imipramine, amitriptyline, and nortriptyline, as well as medications used in pain management for nerve related pain such as duloxetine, gabapentin, pregabalin and others. There are also various prescription ointments such as 5% Lidocaine ointment, and compounded ointments that can include medications such as amytriptyline, baclofen and gabapentin that can be helpful for some, but not all women. You can also find over the counter soothing creams, such as Medicine Mama’s V-Magic, Neogyn Cream, coconut oil, etc. Find a specialist to assist you by visiting NVA.org the web site of the National Vulvodynia Association.
In addition to medications to quiet the nerves, the brain also needs to be retrained to not perceive gentle touch as a threat. You can accomplish this by use of vaginal dilators starting with a very small dilator to allow for touch and insertion and movement and gentle pressure in the vaginal canal with low to no pain. We would recommend seeing a women's health PT to instruct you how to use the dilator to decrease the tension in your pelvic floor muscles as this can also play a role with your "ramped up nervous system". Once your muscles are more relaxed and there is increased blood flow into the vaginal region and decreased pressure placed on the nerves, then the vestibule is allowed to be less sensitive.
In addition to utilizing dilators and physical methods of retraining the brain and nervous system's responses, we recommend seeking psychotherapy with someone who specializes in treating trauma with neuro-therapies, such as EMDR (Eye Movement Desensitization and Reprocessing), EFT (Emotional Freedom Techniques), and Mindfulness-Based Stress Reduction. Neurotherapies help retrain the brain to get out of "fight, flight, or freeze" mode that is the body's normal response to stress and trauma. Addressing and healing past traumas are integral in the healing of the nervous and immune systems.
Entrance Pain: Vestibulitis (Vulvar Vestibulodynia)
Vaginal penetration pain, or vaginal entrance pain. Pain in this region when "provoked" (trying to insert any object into the vagina) is most commonly due to a condition popularly known as vestibulitis. Vestibulitis is thought to be caused by highly sensitized nerve endings being contributed to by other pelvic pain triggers. This condition is frequently misdiagnosed as vaginal infections.
But let's back up. What do we call the vaginal opening anyway? If I had known more terms in my own research for answers, I may have gotten a bit farther a bit sooner.
Vocab Lesson 1: What is the vaginal opening? The vaginal opening is known as the vestibule. The vestibule contains large amounts of pain receptors.
Vocab Lesson 2: So then where is the vagina? The vagina is actually muscular tubing inside the female reproductive system that runs from the external genitalia to the cervix.
Vocab Lesson 3: If that's the vagina then what do we call the external genitalia? The entirety of the female external genitalia (including the vestibule) is called the vulva.
Vocab Lesson 4: So if I have pain at the vaginal opening... ahem.. I mean the vestibule... then what is that called? Pain in the vestibule is called Vulvar Vestibulodynia or Vulvar Vestibulitis (or you might hear it called just vestibulitis).
Vocab Lesson 5: What if my pain occurs in other areas "down there" or seems to be spontaneous instead of provoked? Chronic pain anywhere in the region of the vulva (as far back as the rectal opening and as far forward as the clitoris) is known as vulvodynia. Vulvodynia has two categories.
1: Vulvar Vestibulodynia (see Lesson 4) and
2: Generalized Vulvodynia
Generalized Vulvodynia is unprovoked pain. It is relatively constant and often described as burning or sore. It can occur in just one specific area or in multiple areas around the vulva. It is less common and more difficult to successfully treat. Pain emanating from the pudenal nerve may be a significant contributor to this condition in some cases (pudendal neuralgia).
So that's the vocab lesson for now in vaginal penetration pain, or vaginal entrance pain. Want to understand more pelvic and genital pain related vocab? Go to the Glossary.
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.