Girlfriend's mysterious, not-going-away pain during sex

March 25, 2009 3:06 PM

My girlfriend has had internal pain during sex since a couple weeks after we got together 5 months ago. She's been to two doctors, with multiple visits and we still don't have a solid diagnosis. History and details follow...

At first, she thought it was just a yeast infection and went to see her doctor. They agreed and gave her Diflucan and a course of Monistat. That didn't seem to clear things up, so they had her repeat the same treatment which cleared up the yeast infection, but she was still having pain during intercourse and returned to her doctor. They did tests for chlamydia, gonorrhea and trichomoniasis, although they were pretty skeptical that she had any of them. As expected, none were found and they went on to treat her for bacterial vaginosis (and they said it would treat trich too, just in case) with metroconizole. This still did not alleviate the pain during intercourse.

Again, she returned to the doctor who at this point was pretty stumped and called in another doctor, who was also stumped. They gave her azithromycin for chlamydia (in case it had been a false negative, and because it was a wide-spectrum antibiotic that would possibly kill whatever it was that was bothering her). At that point, she was clear for yeast, but they had her take super-doses of acidophilus and inserting yogurt "just in case." At this point, we hadn't had sex in a month because I was traveling, so we know there was no cross-contamination. I got tested for chlamydia and gonorrhea and treated for trich, just in case. We also both got tested for HIV and we're negative.

Next, she decided to try another doctor and went to the gyn listed in New York Magazine's "Best Doctors" issue. At this point, my girlfriend also thought the yeast had come back a bit. The doctor agreed and took a yeast culture in addition to a urinary tract infection culture, pap smear and "generic" culture to see what was there. All results normal and did not show yeast. This doctor's diagnosis of the pain was that the nerves had been stimulated by an infection and even though the infection is now gone, the nerves don't realize it. She gave her a cream: Nystatin and Triamcinolone Acetonide, which is an anti-inflammatory and antifungal. That hasn't helped either.

My girlfriend and I had had (a lot) of pain-free sex for the first 2 weeks we were together, so we don't think it's an allergy to condoms, lube, etc or a just a factor of being with a new partner, and we're monogamous. The pain starts when I'm about halfway in. It seems to decrease once I'm fully inside, but doesn't go away.

She has another appointment with the New York Magazine doctor in a few days for additional cultures. In the meantime, it's been 5 months of this and we're both worried and frustrated and feel like the doctors are just throwing darts blindfolded at this point.

Does anyone have any thoughts to share? Anything you would suggest she gets tested/cultured for? Anything I should get tested for to help diagnose her? Thanks so much!

posted by The Dutchman to health & fitness (24 answers total)

Oh, by the way (just in case you needed a bit more information), she's not on birth control and we use both regular and non-latex condoms (and she's never had problems with any condom before).
posted by The Dutchman at 3:12 PM on March 25, 2009

Could you be hitting her cervix during sex perhaps? Also, allergies to lube/condoms can build up gradually, try using some different types (non-latex condoms, non-spermicidal lube) and see how it goes.
posted by teraspawn at 3:13 PM on March 25, 2009

"Pain" encompasses a lot of things. If you could get her to describe (to us, not you) the pain, that might be helpful, to whatever extent random people on the internet are more helpful than professional healthcare providers.
posted by DarlingBri at 3:22 PM on March 25, 2009

Has endometriosis been considered?
posted by jimmythefish at 3:23 PM on March 25, 2009 [1 favorite]

I came to mention endometriosis, but jimmythefish beat me to it. So, seconding checking that out, especially if she has pain during her periods.
posted by phunniemee at 3:27 PM on March 25, 2009

What about a mild bacterial infection? (not an std, just something of the usual variety) That was an issue for an ex. Antibiotics cleared it up quick.
posted by zeek321 at 3:30 PM on March 25, 2009

nthing endometriosis.

Vaginismus (a spasm of the vaginal muscles) can also cause pain -- often debilitating pain -- during intercourse, but this doesn't sound like the classic case.
posted by anastasiav at 3:32 PM on March 25, 2009

Reading up on endometriosis, it seems to not quite fit. She only experiences pain during sex and doesn't have any of the other symptoms.

DarlingBri: "It feels almost like a wall of pain, like there's a barrier to entry. Like it's fine and then hits a wall. More dull than sharp pain, but not like a cramp. On a scale of 1-10, with 10 being most painful (e.g., appendicitis), then this is a 4."
posted by The Dutchman at 3:42 PM on March 25, 2009

Adenomyosis is a possibility.
posted by jgirl at 3:48 PM on March 25, 2009

Jesus fucking H Christ She has been prescribed way too many things by a set of docss practising defensive medicine in my personal opinion.

First, take the pressure out of this and improve the general probiotics in her diet. I knew a person once who had never in her life had sex (I'm Irish, really, stay with me here) and had thrush whenever she drank White Martini. Thrush can be diet related, especially if there is a lot of antiobiotics happening.

Secondly maybe you are a bit too big so you guys need more lube. Make sure y'all wash your hands beforehand, yeah?

She may simply have a tear from a previous session that has not healed properly for a variety of reasons.

And finally I'm sorry to say this but many cases of unexplained vaginal pain on intercourse (once all the relative physical exams and tests are done) relate to childhood trauma or non-consensual sex trauma.
posted by Wilder at 3:48 PM on March 25, 2009

there should be other physical symptoms of adenomyosis and/or endometriosis.
posted by Wilder at 3:52 PM on March 25, 2009

OK the response to DarlingBri is interesting. Appendix is about a 5 until it is about to burst, then the vomiting causes more issues/discomfort than the pain. Renal colic, gallbladder colic, childbirth all of these rate a 10, mainly (everyone's pain threashod varies, for me unassisted childbirth was a 5 while migraine rated a 10)

This dull pain plus the breaking though analogy suggests a cramping, spasms type experience. Is she atending a cousellor who might help with this? Is it possible to raise this with someone like that delicately?
posted by Wilder at 4:00 PM on March 25, 2009

The second GYN's comments are pretty much the standard gospel on vaginismus--basically, once you have a few occasions of painful intercourse, your autonomic nervous system can "flinch", so to speak, in anticipation of the next intercourse, which tightens things up and makes that occasion painful, and so on and so on in a self-reinforcing cycle. So even after whatever caused the first owies has been cleared up, your vagina doesn't get the message, and so causes further owies with its pre-emptive defensiveness.

I would encourage your friend to check out the articles and forums at the Vaginismus Awareness Network site. There may be some leads on treatment and strategies for her--if nothing else, she'll learn that there are bazillions of women who have faced the same issue.
posted by Sidhedevil at 4:29 PM on March 25, 2009 [1 favorite]

I can understand why they prescribed the probiotics "just in case" with the wide-spectrum antibiotics. Antibiotic use can cause or contribute to yeast infections. Then if you overdo it with the yeast medications, the vaginal flora can go the other way and you get a nice case of bacterial vaginosis. Fun for everyone!

Is it possible that some of the ongoing pain (not necessarily the initial pain) is from anxiety? She could be involuntarily tensing up. The frustration of not finding a medical answer for the problem could be making that worse. Obviously she is experiencing real pain here - not saying it's in her head - but saying that the anticipation of the pain may be causing her to tense up some, thus leading to more pain. (On preview: also, what Sidhedevil said, because she said it much better than I did.)

She could be tested for endometriosis and adenomyosis but both of those usually involve additional pain during menstruation, not just during sex. Ovarian cysts crossed my mind too, but she would likely be having pain at other times as well. I'm kind of stumped. Of course, I'm just a layperson with a bunch of uterus problems, not a doctor.

I've got a pretty awesome gynecologist in NYC though, if you want to go for a third opinion. MeMail me and I'll give you his contact info (if she prefers a female gyno, his wife works in the same practice and is equally good.)
posted by bedhead at 4:37 PM on March 25, 2009

I had a similar pain due to a ovarian cyst, so an ultrasound might be something else to look into.
posted by lemonwheel at 4:41 PM on March 25, 2009

Should have read Bedhead's answer first, but like endometriosis, an ovarian cyst would involve pain at other times (also particularly during menstruation) and other symptoms. Is she having pain at any other time?
posted by lemonwheel at 4:45 PM on March 25, 2009

there should be other physical symptoms of adenomyosis and/or endometriosis

Agreed, but they may not be as severe yet.

Yet.

Get an ultrasound or a CAT scan.
posted by jgirl at 4:49 PM on March 25, 2009

Good point, jgirl. When I really think way back, before I had all the other symptoms of adenomyosis, I had pain during intercourse. Not every time and not the same way that the OP's girlfriend describes (i.e., it was random positions and times for me, not at the halfway point of insertion), but I did have that before I had the rest of the horrorshow.

May as well get an ultrasound to check it out. They can look at the ovaries and uterus in one ultrasound session, and check for ovarian cysts and adenomyosis.
posted by bedhead at 5:04 PM on March 25, 2009

I agree with fully describing the pain better and maybe seeing a rheumatologist to see if it's nerve pain. Nerve pain can be really weird and suddenly crop up, making previously comfortable stimulation painful. I have recently been diagnosed with allodynia of the mouthg. After brushing my teeth for twenty-odd years, recently started getting horrible pain from any brushing sensation and had to stop brushing my teeth until I saw a dentist. They couldn't find any reason I've become so sensitive. Don't have sensitive teeth or any tooth decay/infection-- brushing just makes my mouth insanely tingling, burning, shooting pain. No problem until 2 months ago and now I have to brush very lightly with a dry tooth brush and use anesthetizing mouth wash.

The nervous system is wacky. A room mate of mine suffered from vulvodynia, which is what I've been experiencing when it happens in the genitals. I know it was really hard for her partner and that it was hard to treat it except with medications to curb nerve pain. (Neurontin, etc).

It's probably not a mechanical problem; it sounds a lot like nerve pain to me.
posted by heathred at 5:10 PM on March 25, 2009 [1 favorite]

She should request a vaginal ultrasound, and she should insert the wand herself!!!

She should not let anyone insist that she doesn't need a vaginal, and ... oooh, I'm getting worked up over my first one ... she should not let anyone, any health care "professional" blow her off about any discomfort!!!

(A veteran of four vaginal ultrasounds here. The good news is that the wands keep getting thinner.)
posted by jgirl at 5:16 PM on March 25, 2009

Sent you memail.
posted by fructose at 5:41 PM on March 25, 2009

Possible bruising or swelling. Try not going quite so deep.
posted by turgid dahlia at 6:48 PM on March 25, 2009

My mom had severe endometriosis and didn't have any idea (She had none of the excessive pain that is usually associated with it.) until the doctor found it during surgery for something else. It can't hurt to get checked, just in case.
posted by chiababe at 6:49 PM on March 25, 2009

Could it be vestibulitis?
posted by ydontusteponit at 6:35 AM on March 26, 2009