Help with vaginal pain during intercourse?

December 29, 2005 1:13 PM

I posted this question a few months ago about pelvic (specifically vaginal) pain during intercourse. It's still happening, and it's starting to have a serious emotional toll on my relationship. Please help!

I finally saw a gynecologist. He ran every test under the sun for STDs/infections and, as previously, all tests came back negative. (We did find out, however, that I have a small and apparently benign cyst on my right ovary. We also determined that this is not the source of pain, as the pain in question is located very near the vaginal opening, primarily on the left side. The pain is also NOT related to my cervix.)

Based on the location of the pain, he hypothesized that I might have a slightly infected duct in that area that was causing nerve inflammation and spasm. He put me on a short course of antibiotics a little over a week ago; the pain seemed absent for the first couple of times we had intercourse after that, and then it returned with a vengeance, to the point that I was literally crying from the pain and my bf is becoming afraid to touch me.

Obviously this has become a huge stressor for us, emotionally and physically. I think it's pretty clear that whatever the original/underlying problem is, I've developed a fear/trepidation of being hurt that's now adding to the vicious cycle -- I'm tightening up muscularly "down there," I'm holding my breath, etc., all of which probably makes it that much more likely that I'll feel pain. (And as a really dirty trick, it's now becoming more difficult for me to have an orgasm even when I'm not feeling in pain -- which is disorienting to me, as I've always been pretty darn orgasmic.) If anyone has any suggestions/techniques for how they've dealt with this in their relationships, I'm desperate to hear it. I'm getting so frustrated and scared and depressed about this -- it feels sometimes like this isn't even my own body -- and my boyfriend's being as patient as he can be, but it's taking its toll on him, too.

(Sorry if this is long or rambly or whiney. Thanks for your patience, too!)

posted by fizzyliftingdrink to health & fitness (24 comments total)

sorry, I linked to my comment in that thread, rather than the question itself.
posted by fizzyliftingdrink at 1:15 PM on December 29, 2005

Where do you live? Just, it helps in case I know of an excellent doctor. I know a few extraordinary ones, who make it their business to know rare diseases, and odd, hard to find general medical knowledge. And also, don't lift their eyebrows at you when every test has come back negative and they think it's just in your mind.
posted by joaniemcchicken at 1:30 PM on December 29, 2005

Well, if it was OK for a few days and then came back, obviously the short course of antibiotics weren't enough and now that the weak biotia has been killed off, the more aggressive of whatever's causing the problem has come back with a vengeance for it's lost bretheren. Hie thee back to the doctor, or another doctor if you didn't trust the first one!
posted by SpecialK at 1:33 PM on December 29, 2005

Something that wasn't talked about in the prior thread, though you've probably considered it: Is the pain only during vaginal intercourse, or is it during any stimulating activity? It might be helpful to know if it were a result of pressure alone. Similarly, is the spot/area sensitive or painful to the touch apart from intercourse? The answers to those questions might shed light on the vaginismus theory.

Also, it's possible the antibiotics were ineffective against the infection, whether because of the particular type of bacteria involved or because of resistance. You might inquire about using a different class of antibiotic.

Lastly, have you considered talking to a second doctor or going to one of the pelvic pain centers mentioned in the other thread? It may be a bit expensive (as you mentioned 'finally' going to a gynecologist), but if it's taking such a toll on the relationship, it may well be worth it.

In the meanwhile, frankly, I think you have to be pragmatic about it and forego vaginal intercourse until you get the problem sorted out. Clearly trying to 'work through the pain' is only making things worse, emotionally if not physically, and there are other (although perhaps less satisfying) ways of being intimate with your partner.
posted by jedicus at 1:37 PM on December 29, 2005

An Infected Bartholin's gland?

Fibromyalgia? (I knew a woman who had vaginal pain caused by fm.)

There's another possibility that I heard about when I was working for V-Day, which was typified by excruciatingly sensitive labia, but I can't remember what it was called.
posted by alms at 1:37 PM on December 29, 2005

OK. I don't know. But you need to google a thing called "vulvodynia" right away. See if it rings a bell. If you have ever been diagnosed as having fibromyalgia, you need to google that and "guafenesin" right away. Maybe even if you haven't, if vuvlodynia rings a bell.

I have actually had that forever, (meaning many decades) and they kept saying it was yeast, and it wasn't. I finally found some spot on the 'net that recommended guafenesin (which is cough syrup, it won't hurt most folks, they give it to babies) for this, and it cleaned it right up. Not only did I never have it again, it sort of fixed my immune system and I never even caught a cold again. YMMV. That response seems to be specific to FM.

Most of the things they do for this involves surgery, and then it's a crap shoot whether it works, so anything you try first that's less invasive is a plus. I am mentioning this only because your description of the pain is similar to vulvodynia. If nothing else, ask your doctor if that could be what you have.

IANAD, and if you try any of this and a body part turns green, you are on your own. All I'm actually advising is that you might see if this looks worth asking of a medical professional. (I'm paranoid.)
posted by deep_cover at 1:40 PM on December 29, 2005

Did you discuss whether or not low estrogen levels could be causing vaginal dryness? I never would have believed that's what was wrong with me (after all, I didn't *feel* dry; I was still producing lubrication), but vaginal estrogen suppositories have been the only thing that relieved my pain.

Yes, I did a course of the antibiotic Flagyl once; it relieved the pain for about 2 weeks, and then it came back. I had no bacterial infection; the how's and why's are a mystery to me. Maybe it was a placebo effect.

My doctor also suggested using a KY product (or similar) designed for post-menopausal women experiencing dryness. There's a gel type stuff you insert at night to add moisture to that area. You could try using that for a few nights, then have sex, and see if it's made an improvement.

After my own bout with pain during intercourse, my doctor was afraid that I'd develop the sort of "fear of pain" symptoms (there's a name for those, but it escapes me now) you describe. He suggested using a lot of lube, and to do "excercises" where my husband would insert his fingers slowly and gently, so that the muscles could "get used" to the sensation, and associate it with a pain-free experience. I think the best way to get over the involuntary clenching is slow and gentle practice, but nothing you do is really going to be effective until you're truly pain free.

Your frustration is totally understandable; I spent nearly a year trying to deal with my symptoms. Email's in profile if you'd like to discuss further.
posted by junkbox at 1:51 PM on December 29, 2005

Visit a physician/clinic/nurse practitioner that specializes in sexual dysfunction. They can look at the entire situation -- both the organic problems (such as an infection) as well as the psychological ones (the vaginismus induced by the painful intercourse -- the "vicious cycle" you mention) and recommend a course of treatment.

You may also need your partner to be tested; some infections (not necessarily STDs) can be carried by others which will re-infect you and cause the issue to start up again. A fellow with a yeast infection may not know he has it, and if you fool around you can be reinfected.
posted by macadamiaranch at 2:11 PM on December 29, 2005

Have you consdered hypnosis? It is very effective for pain related disorders, whatever the diagnosis.
posted by blueyellow at 2:11 PM on December 29, 2005

From the Merck Manual:

Hypnosis helps relieve pelvic pain due to functional causes unamenable to surgery.
posted by blueyellow at 2:28 PM on December 29, 2005

Fizzyliftingdrink,

From your description it sounds as if your doctor has ruled out any serious cause of pain. Frankly, and unfortunately, we rarely can deduce the specific source of pain in most instances, regardless of the locale, but I do have some suggestions.

I am assuming that if there are deeper psychological issues at work here as far as your sexual function then you are addressing those, as they would automatically take precedence over any other medical advice. One consideration I would offer to discuss with either your gyn, or better yet, your internist/FP, may be to see a pain specialist do discuss a nerve block. The point being that there may not be anything 'wrong' per se, with the pelvic tissues themselves, but rather there may simply be an irritated nerve that is innervating the vaginal opening and could just as easily be located anywhere but, sadly, is in this difficult place.

Nerve blocks can be very useful in situations like this, where other etiologies of pain are ruled out. Some limited research into Reflex Sympathetic Dystrophy also gives merit to the notion of stopping pain via local blocks before the nerve starts to become so sensitized that the pain behavior starts becoming harder to correct.

FWIW, this doesn't sound at all like fibromyalgia.
posted by docpops at 3:09 PM on December 29, 2005

These folks specialize in vaginismus/vulvodynia, and are supposed to be very good at what they do.

On a related note, I just read a book by Susanna Kaysen (author of Girl, Interrupted) in which she describes her experience with pelvic pain. The book is called The Camera my Mother Gave Me. It's somewhat dark, but you might find it interesting, as she mentions all the sorts of treatment that she underwent.

Good luck!
posted by greatgefilte at 3:25 PM on December 29, 2005

I haven't experienced the internal/pelvic pain you describe but had other difficult/painful symptoms related to too much friction during intercourse. I found that emptying my bladder just before sex, using a generous amount of lubricant and then emptying my bladder again immediately after helped a lot. Do you have any other symptoms? Itching/burning? If so it could be vaginosis which can sometimes be cured through the application of plain live-culture yogurt (externally, twice a day for 10 days, no sex during this period). Heck, I would say take a break from sex for 10 days anyway. Let your body rest.

I would second the suggestion that if the antibiotics worked a little at first it could be some sort of infection or angry duct that may require treatment with another/stronger drug. But note that antibiotics also throw off your natural chemistry and kill off the "good bacteria", which can lead to vaginosis and yeast infections (which can be very painful and sometimes have pelvic pain symptoms). Perhaps the antibiotic did it's job but messed up your vaginal chemistry. Try the yogurt thing. The coolness will feel good and it won't do any harm, even if it doesn't cure your discomfort. Good luck! I hope you feel better soon.
posted by turtlegirl at 4:03 PM on December 29, 2005

the kaysen book is very good. you might also seek a second opinion from another gynecologist (maybe try a woman doctor?) and/or a pelvic pain specialist. a good friend has significant vaginal muscle & nerve damage as the result of an injury, and she has also had some good results with acupuncture, electrical stimulation therapy and steroid shots. good luck.
posted by judith at 4:33 PM on December 29, 2005

Thanks so much for the input, everyone. It helps me feel not quite so scared.

A few answers to some specific questions/comments:

- the pain mostly occurs only with intercourse (it happens nearly every time, from mild to excruciating), though I have felt it a few times when my boyfriend uses his fingers and once during a pelvic exam. (That was the most recent one, which was when my gynecologist was able to isolate the spot -- he didn't say specifically that it was Bartholin's gland, but judging from that link, that appears to be what he meant.)

- so far, I like this gynecologist and am happy with him; he seems genuinely sincere and gentle about wanting to help me. I've only seen him twice -- my (female) primary care physician has handled my yearly pap smear/pelvic exam for the past 6 or 7 years -- but I will keep in mind the idea of finding a pelvic pain specialist if he and I can't figure out a solution together.

- the low-estrogen issue related to birth control pills seems to me to still be a viable consideration; I mentioned it to my gynecologist and he wanted to rule out the infection/STD issues first. The next time I see him (hopefully within the next few weeks, depending on when I can get an appointment), I will bring up the question of of estrogen cream. I will also bring up the question of a nerve blocker.

- No history of fibromyalgia, nor of traumatic sexual experiences. In fact, I've always been the "lusty" one of my gal pals -- love sex, always have, and my current partner's awesome in bed. (That's part of why this is so weirdly disorienting to me, I think: I've never had a sexual problem before, and aside from a few yeast infections over the past 15 years or so, never had any pain or infection in the region at all.)

And now, two more questions from me:

- In googling around and following several people's links (thanks!), there seems to be some suggestion of a low-oxalate diet being helpful. Anyone know about this?

- I'm currently on the low-estrogen Pill -- could switching to a progestin-only Pill be helpful (particularly if using an estrogen cream doesn't help)?

- for docs reading the thread: what does a "nerve blocker" entail? Is that the same as steroid shots, as other posters have mentioned?

Thanks again for the suggestions and kindness.
posted by fizzyliftingdrink at 5:48 PM on December 29, 2005

actually, that was 3 more questions from me, wasn't it?
posted by fizzyliftingdrink at 5:49 PM on December 29, 2005

It's possible that the pain is due to an undiagnosed medical condition (any of the ones already mentioned -- vulvar vestibulitis is another one to consider), but given your history it's likely to be secondary vaginismus. From the tags on this question I can't really tell if you know, but remember vaginismus can be considered a condition itself, rather than just a symptom. (All of what follows is advice to someone with vaginismus. If you don't have it, then don't worry about this)

With this in mind, vaginismus can be cured. A sex therapist (preferably one with a medical degree) can help here. If the diagnosis is vaginismus, therapy is intensive and can be quite lengthy (=expensive). If this is an issue, take your medical records with you from whichever doctors have investigated this pain so the therapist will know what not to waste her time on and explain your situation. Ask what exercises can be done at home, since you can't afford a string of appointments with her. I say "her", since female doctors tend to be better for this.

The recommendation will probably be along the lines of what junkbox said. Either using fingers, or dildos increasing in size from very small to normal-sized, to gradually and gently re-establish the idea that vaginal penetration doesn't have to be painful. It's best if you start off doing this by yourself, and then when you're ready, your partner can do this with you. You both need to know that "stop, it hurts too much" means stopping, no questions asked. Do this 2-3 times a week. More if you're okay with it. But not less -- you're trying to retrain a physical and psychological reflex here, so you have to be consistent. A person isn't going to quit smoking by taking a night off cigarettes every now and then, for example.

Every time you do the exercise you don't have to go up a size. Don't move up a size until you're 100% comfortable with the current size. Aim to not go down a size rather that aiming to go up sizes as fast as you can. If you have to go down a size, it's not an indication that you're failing or that you'll never get over it, it's just an indication that you're going too fast. And for goodness sake, don't try and have intercourse until you're comfortable doing exercises with a penis-sized object.

You've gotta be really focused and determined. It takes a sustained effort, and much of that isn't fun. It sucks that you have it; most people don't and they never have to worry about putting this huge effort into something as taken for granted as sex. It's not great, but it's just what has to be done. You can do other stuff in the mean time though, you don't have to become a nun or anything :)

Every relationship takes some work, vaginismus makes it a bit more work. I know from experience (as the boyfriend). The worst part is when neither of you know what's wrong, and you're repeatedly being let down, having your patience stretched, or the worst -- seeing your girlfriend in pain, and then feeling bad about being in pain. It's heartbreaking. Once you identify what's going on it can become easier. The two of you have a goal you can work towards, and you can help each other through the worst of it. Agree at the beginning about what you're going to do. Don't get into the pattern of keeping the exercises going for a while, then stopping, then getting back on. If you do that has the potential to cause disappointment and resentment, that's what makes it relationship-threatening. There's no shame in being on the same size exercise for a while.

Okay I've gone on way too long. Email me (in my profile) if you have any unanswered questions -- I just really wanted to get through the idea that if it is vaginismus, it's not the end of the world. Best of luck.
posted by teem at 6:11 PM on December 29, 2005

I don't have any real suggestions, other than the book "The Camera My Mother Gave Me" By Susanna Kaysen (she also wrote "Girl Interrupted".

The entire book is a biographical account of the severe vaginal pain she suffered for a very long time that many specialists and doctors were unable to relieve. She's a fantastic writer and reading this might at least make you feel better or give you ideas for treatment that you hadn't considered.
posted by hermitosis at 10:17 PM on December 29, 2005

fizzy,

It looks as though you've got lots to go on here. I'm probably not the best one to comment on what a nerve block entails, though essentially it would involve taking an extremely narrow -gauge needle and inserting it into the nerve trunk upstream from the terminus of the nerve, and temporarily deadening it with a novocaine analogue, and typically a small amount of a cortisone derivative is added as well, in the event that the only real problem is that for some reason or another the nerve itself, through some minor trauma, etc. became irritated. Nerves heal so slowly that a neuropraxic injury could last months and yet still have a normal, excellent prognosis. It sounds like your Gyn is doing a great job.

Perhaps someone could shine the ikkyu2 signal...
posted by docpops at 7:09 AM on December 30, 2005

Whoops-- well, I'm glad the other posters mentioned it first. It's worth adding my recommendation as well-- interesting read.
posted by hermitosis at 12:25 PM on December 30, 2005

Vulvodynia
posted by IndigoRain at 6:17 PM on December 30, 2005

I think you need to go back to the antibiotic therapy-with a different antibiotic in case resistance has developed- and this time HAVE YOUR BOYFRIEND TAKE IT,TOO!! Very likely, you were cured, but then your boyfriend re-infected you.
posted by jamjam at 3:11 PM on January 25, 2006

Just to follow-up, in case anyone's still checking the thread:

Estrogen cream worked wonders for a few weeks - the first time we had intercourse without me having any pain, we both nearly cried from relief and happiness.

A raging yeast infection (perhaps triggered by the estrogen cream or a brief course of antibiotics that I had to take for completely unrelated reasons) brought all that to a halt - I had to stop using the cream while I treated the yeast (this time I went with acidopholus instead of Monistat), and wasn't comfortable with intercourse.

After getting the yeast under control, we had (very gentle) sex with plenty of lube but no estrogen cream (I was worried that the estrogen might trigger the yeast again, so we thought we'd see what happened). Intercourse was fine a few times - then suddenly last week caused such horrific pain that I had to go to the urgent care facility the next day. The doctor who examined me said I had the kinds of bruises and abrasions she'd only seen in sexual assault victims - or women who had developed an unusual and sudden thinning of the vaginal tissue due to hormonal disruptions.

So that seemed to seal it: it's not an infection, it's the pill. At her suggestion, I decided (with boyfriend's total support) to go off the pill immediately, use condoms once I feel comfortable having intercourse again, and give my body a few months to adjust back to its own normal hormonal levels. At which point I'm willing to try one more hormonal method (the Nuvaring), and if that doesn't work, we'll explore other options.

Thanks again, everyone, for your suggestions and kindness!
posted by fizzyliftingdrink at 3:46 PM on February 9, 2006

Sounds like you've gotten closer to figuring this out, but it's so familiar to me I though I'd let you know my story, briefly, in case it could be of use:

I had your exact problem -- I was taking low dose/low estrogen pills (alesse) and developed pain specifically during intercourse just at the entrance of the vagina, largely on one side. After the whole battery of tests and inept doctors, I finally figured out on my own that it was Vulvar Vestibulitis (which describes the condition but not the cause).

In the end, I'm not sure what was responsible for it going away -- my doctor did a series of painful interferon shots in the affected area which seemed to be the cure at the time. However, like most gynocologists, he knew very little about the condition, and it was not until much later that I learned of this study showing that the exact type of pill I had been taking for a year before the treatment increased one's chances of developing Vulvar Vestibulitis.

So it could have been the shots, or it could have been that I went off the pill right before I got them. There is more evidence for the latter theory: I went back on that pill about a year ago (since I wasn't sure if it was the culprit) and sure enough, within 2 weeks I was having pain with sex again. I went off it immediately, and the pain went away.

I hope that going off the pill does help you -- I found that I still get the pain sometimes right before my period (it's as if I've been left more sensitive by having taken the pill in the past). A lot of lube helps during those times.

I've found it also continues to be sensitive to some health and beauty products, like soap with a lot of perfume in it, and propylene glycol, found in lubes like KY. We just use almond oil now as a lube and it works well.

Here's to your healing...
posted by waxwing at 3:56 AM on April 30, 2006