Sexual Abuse & Vaginal Nerve Pain

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.

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