Save my sex life.

December 17, 2007 8:32 AM

Sex is painful. I've been to the doctor, I've done what they told me to do. Sex is still painful. I know you are not a/my doctor, but please try to help me save my sex life. It's a long-ish one inside.

Background: I have been sexually active for about ten years. I am STI free. I have never been raped or abused. I have been in a healthy monogamous relationship for about a year and a half and we have been having sex for about a year. He is of average size and his size has never been an issue. We use Astroglide every time we have sex. I am on Nuvaring (have been for about two years) and we do not use condoms.

About two months ago, sex started getting painful. It would hurt upon insertion and then continue to be painful for most of the actual intercourse and then I would be sore for a little while afterward. It wasn't cervix-hitting pain, but rather a pain at the entrance to the vagina that feels similar to tearing or burning, although no tearing actually takes place. It was by no means an intense pain, but definitely enough to affect my enjoyment and to remove my ability to orgasm (which I generally don’t have a problem with).

I went to the doctor and was diagnosed with a yeast infection and bacterial vaginosis, both of which could have been causing the pain. I was treated for both and told to not have sex for the next two weeks and come back for a check-up. (I was also tested for STIs here, so I’m really sure that that’s not the problem.) When I went back in for the check-up, I was told that the medication had done its job, but that I had a second, different kind of bacterial vaginosis that was sometimes seen in women who have been treated for yeast infections. I was given a different medication and told to wait two more weeks before having sex again. My doctor also asked me if I had ever been able to have sex without it hurting, to which I replied with a relatively puzzled ‘yes,’ letting her know that I had been sexually active for years without this problem. She said okay, and gave me some liquid lidocaine to use topically just in case I kept having the problem.

About when we were able to have sex again, my partner got called out of town for business. He got back over the weekend, and we excitedly hopped into bed to have non-painful haven’t-had-sex-in-ages sex. But…it still hurt. The pain is absolutely enough to affect my sex life, and I’m not willing to numb-up my vagina with lidocaine every time I want to be intimate with my partner.

I am going to go back to the doctor, but I’m a bit frustrated with the medical world at the moment and am in search of information or other experiences.

Has anyone else ever experienced anything like this? Any ideas what it could be? Any ideas on what could relieve it other than numbing agents, which are, in my opinion, really not a solution? Really…any thoughts at all?

throw away email: [e-mail]

posted by anonymous to health & fitness (32 comments total)

At risk of committing a Male Answer Syndrome offense: I don't have an answer for you, but if you are looking for a good sympathetic read and interesting ideas on the subject, you may want to check out Susanna Kaysen's book The Camera My Mother Gave Me, a compelling memoir of her attempt to cope with (and ultimately solve) a mysterious pain in her vagina.
posted by hermitosis at 8:44 AM on December 17, 2007

Definitely get another opinion, just to be on the safe side. Also - did your partner get treated as well? He should probably go to the doctor as well. It is possible to pass yeast infections back and forth. That could be what's happening here.
posted by pazazygeek at 8:45 AM on December 17, 2007

Your partner might want to get checked out too - it's possible he's got some kind of infection that doesn't cause symptoms in him, but keeps re-infecting you.
posted by restless_nomad at 8:45 AM on December 17, 2007 [1 favorite has favorites]

Is it possible there's something he's started using on his skin that irritates yours? A new kind of soap? Detergent or dryer sheets when he washes his undies? Straight-up chemical irritation of the skin can sometimes give infections a toehold, and can definitely cause the sort of burning pain you're describing.
posted by nebulawindphone at 8:49 AM on December 17, 2007

(Sometimes I wish there was a way to post anonymous comments...)

Are you sure there are no tears? Even really really hard to see, tiny almost paper-cut like micro tears anywhere on the outside? Does it occasionally hurt to pee? I get these tears with yeast infections, and they range from being a mild discomfort to hurting like hell with me crying in pain. My gynecologist says that this is really common, and recommended that I take acidophillius daily in pill form (they're the good bacteria that prevent the yeast from going crazy) and to use barriere cream, a silicone cream that provides a protective barrier to the ouchy areas. (You can find it in with the baby diaper creams and such.) The acidophillius has definitely reduced the number of yeast infections I get. The cream sometimes helps (not always, tho) but is worth a try for some non-lidocaine protection. I don't recommend anybody tasting it, tho.
posted by cgg at 8:50 AM on December 17, 2007

Googling "Nuvaring" and "side effects" gets more than a few accounts of multiple infections, stinging and pain associated with that form of birth control. I'd say it's the obvious factor to rule out as soon as possible.
posted by xo at 8:56 AM on December 17, 2007 [1 favorite has favorites]

I guess it's possible you've developed an association of sex with pain, and it's now become psychosomatic. But after such a short period of time that's probably not likely.

Have you been tested for a urinary tract infection? Also, treatments for yeast infections and bacterial vaginosis can last FOREVER, as the antibiotics that give you BV can kill off the good bacteria in your vagina and bring about the yeast infection, thus creating a horrible BV/yeast cycle. Same goes for UTIs and yeast infections, unfortunately.

I say go back to another doctor. A quality ob-gyn or nurse practitioner, and get tested for BV, yeast, and UTIs. If you get put on antibiotics, follow the do-it-yourself yeast infection treatments detailed here, along with the meds. Stick garlic cloves and yogurt or acidophilis capsules up in there, douche occasionally with DILUTE hydrogen peroxide, go commando as much as possible, take as much cranberry supplements as you can handle, etc. The point is to keep the yeast from coming back while you're on antibiotics. Seriously, read through the entire site, it's full of very valuable, quality information.

If you have yeast though, and you find fungicidal methods aren't working (like using chlotrimazole medications like in Gyne-Lotrimin), then you may need to go on a serious fungicidal pill.

But if none of that's the case, you may want to reconsider the NuvaRing. I have heard it can increase the likelihood of getting yeast/BV infections, and it caused me burning pain and discomfort during sex if I didn't take it out beforehand. The pain-with-sex also started pretty abruptly, I was on it for a few months before I ran into that problem. You can technically leave it out for three hours without loss of birth control--plenty of time for most sex activities--but if you don't love it otherwise you may just want to go off it.
posted by schroedinger at 9:02 AM on December 17, 2007

I think it's probably the NuvaRing. You're the third person I've known (okay, I don't know you, you know what I mean) to have Mysterious Vagina Problems after going on this method.

I would also probably try to find a different doctor, as and gave me some liquid lidocaine to use topically just in case I kept having the problem. strikes me as exactly the wrong approach to take.
posted by thehmsbeagle at 9:10 AM on December 17, 2007

I think it might be worth considering the possibility of lichen sclerosus. Someone I know was diagnosed with this after examination by a dermatologist.

My internet crank theory is that there's weakening of the skin caused by suboptimal hormone levels, which in turn are caused by stress. If you're not feeling particularly stressed at the moment you can obviously rule that out, but if you are then it could be another reason to make some positive life changes.
posted by teleskiving at 9:23 AM on December 17, 2007

i don't know anything about vaginal pain, but maybe this is an opportunity to explore exciting and mutually satisfying non-penis-in-vagina sex.
posted by geos at 9:34 AM on December 17, 2007

Get rid of the NuvaRing. I was on it for a few months and sex was horribly painful (specifically burning). Maybe it was causing yeast infections, maybe it was changing the acidity of my vagina, I don't know.

BUT I got rid of it and low-and-behold, sex wasn't painful.

Check out the Nuva Ring LiveJournal group.
posted by k8t at 9:40 AM on December 17, 2007

Sounds like the NuvaRing is our top suspect, but I would also suggest trying another type of lube. I have had burning from lube in itsy bitsy tears before... unfortunately my limited experience there means I can only recommend sexy, sexy slobber as an alternative.
posted by Ambrosia Voyeur at 10:18 AM on December 17, 2007 [1 favorite has favorites]

I had a problem like this until I threw out a particular pair of underpants in my collection. It was a green Wal-Mart thong with an anchor on it. Have you made and recent underwear purchases that chafe? I find if it ouchies down there now it’s normally due to stupidly designed ladies pants.
posted by Phalene at 10:27 AM on December 17, 2007

Nuvaring. I'm having the exact same problem.
posted by idle at 10:29 AM on December 17, 2007

I went thru allof this a few years ago. Finally, after cycling through various brands of the pill, the patch, and Nuvaring, I went off hormones entirely. The pain, recurrent infections, and wild mood swings -- all of which had evidently mystified my doctors for about six months -- cleared up within a couple of weeks.

The side effects of hormonal bc really can sneak up on you (my nurse practitioner told me that precisely the same thing had happened to her a few years back, after having been on the pill without problem for close to a decade) but it's too often assumed that if you don't experience the side effects in the first few months on hormones, that you'll never experience them.

Hormonal bc can be really convenient (which is why I was intially reluctant to give it up), but sometimes, our bodies just rebel against it.

And as for lube, whether you go off hormones or not, switch from Astroglide to something that's glycerin-free (check out Babeland or good vibrations for brands) -- glycerin is a sugar, and can generate yeast infections like nobody's business.
posted by scody at 10:40 AM on December 17, 2007

The nuvaring is sounding likely. Also, cut out the astroglide and get a lube that isn't made of glycerine, just for yeast infections' sake. I'm very yeast infection prone myself and the glycerine is just sugar-like enough to make them more common. I've had fewer since I switched to Liquid Silk (which also has the advantage of never getting sticky and having virtually no taste). Whenever I've had a yeast infection, the potential for irritation or pain during sex lingers for at least a week after the infection itself has cleared up. I think it's just traumatic on the tissues and makes them more sensitive for a while.
posted by mostlymartha at 10:45 AM on December 17, 2007

Have you tried Replens? It's a treatment that you insert daily to moisturize the vagina, rather than using lube as needed (or along with lube). It is available over the counter, and I had very good results with it. (Warning: the first few days you are on it will be a bit... gross... down there, because it helps to shed dead cells or something. But once you get that part over with, it's great.)

When this happened to me, it turned out that I was very sensitive to hard water. It developed after a few weeks of moving to a location with very very hard water, and went away when I moved away a few years later. But since you don't mention moving recently, it sounds like the nuvaring is more likely to be the culprit.
posted by happyturtle at 10:53 AM on December 17, 2007 [1 favorite has favorites]

Vestibulitis? Also called vulvodynia. That was one of the first links that came up, but some googling will bring you more information. Not the most helpful of diagnoses, since there's no clear idea about the cause, and no perfect treatment either. You've already tried some of the options, like the lidocaine, and found them not helpful. I had a friend with this (really!) and she and her boyfriend went through a lot of struggles trying to deal with it. I wish you luck and an easy resolution of your symptoms.
posted by gingerbeer at 11:05 AM on December 17, 2007

I get a really, REALLY bad pain if I'm overstimulated (ie too much blood in the area). High blood pressure can contribute to that. It's very sad that people jump to the 'it's all in the mind' conclusion just because there is so little research regarding pelvic/vulva pain. Don't bother going back to your doctor or an ob/gyn, track down a specialist in this sort of pain. There were some fascinating programmes on Channel 4 in the uk recently, one of which featured someone in your situation. On the show there was an orgasm coach called Dr Betty Dodson who was baffled by this woman's pain, but managed to track down a specialist. Sorry but I can't recall the name, but maybe her website has some info.
posted by gatchaman at 11:13 AM on December 17, 2007

i was going to suggest vestibulitis as well. another thought is vaginismus, which is where the muscles contract involuntarily (like blinking when something gets too close to your eye). sometimes it's a nerve issue, but it can also develop after repeated painful sex, as a protective mechanism. in otherwords, if you had painful sex a few too many times in a row, you may have accidentally "trained" your vagina to close off. the conventional wisdom is that you have to retrain yourself to relax.
posted by thinkingwoman at 11:15 AM on December 17, 2007

Just wanted to chime in and say that yeast infections really can come back like this. You'll think you've got it fixed, then you hit some other point in your cycle or something and bam. It may be that the NuvaRing is making you more suceptible, but I wouldn't automatically assume that. As others have said, try switching out your lube. Also, try sleeping w/out panties if you can do that.
posted by wyzewoman at 11:17 AM on December 17, 2007

er, susceptible.
posted by wyzewoman at 11:18 AM on December 17, 2007

It is possible to pass yeast infections back and forth. That could be what's happening here.

Yeah, it's happened to me, and it's AWFUL. Also, yeast infections tend to make you susceptible to, you guessed it, more yeast infections.

I've been having a few sensitive issues with the girl-parts, and after a course of antibiotics (which can trigger more yeast infections!) to rid a nasty UTI, I've found that lots of yogurt (both topically applied to itching & burning and just eaten the old fashioned way to get some extra "good" bacteria) and cranberry pills help keep the system in working order.

A good friend recommended cranberry pills to me as opposed to just drinking cran-juice because the juice contains sugar, which bacteria LOVE. The pills are cheap and taking a few every day seems to be keeping any irritation from the urinary system away, which makes things in the nether regions that much more comfortable.

Also, drink A LOT OF WATER. Flushing out whatever is in your system and staying hydrated will make everything better.

This is just general good advice for a happy vagina. In your case, it sounds like the NuvaRing could definitely be a problem - you can become allergic to anything over time, especially if it's something that's hanging out in your vag all day long. Talk to your doctor specifically about the ring - perhaps s/he didn't make the connection the first time.

As for lube: anything with glycerin is going to make bacteria happy, happy campers. Astroglide is pretty ok, but the best lubes for sensitive systems are the ones that are pretty much ingredient-free. Liquid Silk is about the greatest thing since sex itself, and Slippery Stuff is also quite good (and vegan! whatever that means!). They're a little pricier than Astroglide, and not typically available in drugstores, but worth the investment.

(Uh, hi. My name is grapefruitmoon and I know a lot about vaginas. Vaginae. GIRL BITS.)
posted by grapefruitmoon at 11:23 AM on December 17, 2007

It sounds like your hormonal birth control could very well be the culprit - changing my own method (not Nuvaring) is the the next plan of attack in my own ongoing saga with perpetual yeast infections. You could also try changing your lube type, and since this is a recent development - try to track down any recent changes in household chemicals that could be coming in contact with your nether regions. New detergent, hand soap, bath salts, whatever. And get your fellow checked out too!

On another bent entirely though: has there been any thought that you might be colonized with yeast, or have a systemic yeast infection? Basically your personal flora is so out of whack that traditional treatment is only knocking the bad stuff down to a minimum level, from which the population can flare up during the hormone flux of your period. This is exactly my problem: I've become a sentient, self-infecting, yeast colony - whee! My gyno and I had developed a solution that was working (after rounds of the "traditional" solutions failed) - a weekly dose of Diflucan for six months to wipe the slate clean. Pretty brutal stuff, but it was really helping. Unfortunately after 2.5 months our major success was discovering I'm severely allergic to that whole group of antifungals. Joy.

A non-medication solution I'm looking at, after more discussion with my doctor, is going full bore on the yeast diet. I tried it for one week on my own and it was just so hard to follow as a vegetarian, that I want to be sure it's worth it and could actually help before continuing. As my boyfriend described it, it's Atkins for diabetics. I DO NOT reccomend it without support of your doctor, but it could certainly something to bring up if she thinks you might have a systemic infection. You can find a basic overview of it here. The basic idea is to starve the yeast of all sugar, and not introduce new yeast or yeast supporting foods into your body.

Best of luck to both of us, I wish you all the best in finding and fixing the source of your pains!
posted by malacologist at 11:30 AM on December 17, 2007

See here and here for more discussion of similar issues. The short version is that (among other potential side-effect of your BC) low-dose birth-control like NuvaRing can lower your estrogen levels so far that you develop vaginal dryness similar to symptoms of menopause, causing pain during sex. (And even though you might not feel like a desert down there, you can still be dry enough to make sex uncomfortable.) I was treated repeatedly for yeast infections, and found that my symptoms subsided -- only to come back again almost immediately. But I didn't have a YI at all -- the glycerine the medicine is suspended in was just moisturizing my girl parts and easing the discomfort.

My gyno ran me thru every medical test in the book and found nothing. She was about to go "exploring" for endometriosis when I finally got a second opinion from a doctor (a surgeon, actually) who realized exactly what was going on. If you down have the bad smells or funky discharge associated with yeast infections, then try the Replens for a couple of weeks. And find yourself a new doctor. Estrogen creams or supplements, or going off hormonal BC altogether may be what you need. Good luck!
posted by junkbox at 11:34 AM on December 17, 2007

Apologies, if necessary, for not reading all the above posts.
If you have an infection in the vestibular glands and it doesn't respond to antibiotics, a minor out-patient procedure is available to remove the infected glands. That may do it. Good luck.
posted by JimN2TAW at 12:07 PM on December 17, 2007

I would ask your doctor to look into vestibulitis, as mentioned in a couple of previous responses. The pain you are describing sounds very close to that condition.
posted by DrGirlfriend at 1:26 PM on December 17, 2007

First of all, don't panic, and don't let your partner panic -- you will figure out what is going on, and this is a solvable problem.

(Also, IANAD.)

You have several issues going on here:

1) Bacterial vaginosis – the treatment for BV is antibiotics, right? And that can throw your chemistry out of whack, which can kill the good bacteria and lead to an overgrowth of yeast, which can make conditions down there more moist and sticky than usual, which can lead to…BV.

2) Yeast infections – the treatment for which is that sticky, often-painful Monistat. Which can make conditions down there moist and sticky, which can lead to BV, for which you’ll need antibiotics, which can kill the good bacteria and lead to an overgrowth of yeast…aargh.

3) Hormonal contraception, which can really help the yeast infections along in some, but not all, ladies.

4) Vulvodynia, vestibulitis, pain during intercourse, which could be caused by any of the above three, or even none of the above three.

Here is a possible course of action – this is based on things that have worked for me and women I know:

1) The BV – Monitor your discharge for a funny smell or consistency. If you suspect that it has come back, you will unfortunately need to go back to the MD, let them test it, and wallop it with antibiotics if it is BV. If you get antibiotics, make sure you finish them all, and don't drink while you're taking them. (also, do ask your MD if the antibiotics affect the effectiveness of your hormonal contraception.)

2) The yeast infections – There is a lot of advice out there for fighting yeast infections. My suggestion to you is to gather all of the advice there is, and follow all of it at once, for at least a month. This means: wear 100% cotton underwear (or none), eat lots of yogurt, consider acidophilus suppositories, consider tea tree oil suppositories (They sound weird, they make you smell like a carolina pine forest, but they are the only thing that works for some), eat a clove of garlic every day, eat way less sugar, drink a lot of water, take a multivitamin. Stubborn, persistent yeast infections can be a monster to get rid of – my advice is to try everything you can, all at once. Also:

a. Your partner may have to treat himself as well – follow the directions on the monistat label, only smear it on, rather than put it in.

b. Use name-brand, seven-day monistat. Do not use the three-day or one-day versions, do not use the cheaper generics. I hate that this is true, it is a pain in the ass, but it is the only, only thing that works for me and lady friends I know.

3) The hormonal contraception – you might try using condoms for a month, while you do all this. It couldn’t hurt, might interrupt both the yeast infection-reinfection cycle and the hormones-feeding-yeast-infections cycle.

4) The vulvodynia – if the above does not work, or if the above does work and gets rid of the BV/yeast problems but you still have pain with intercourse, then visit your MD and get a referral for a physical therapist who specializes in women’s health. They treat vulvodynia a lot.

Best of luck to you. I know how frustrating this can be.
posted by jennyjenny at 4:24 PM on December 17, 2007

Former -- *former* -- NuvaRing user here. Talk to your doctor about an alternative method of birth control for a few months and try ditching the ring for a while. I'd bet a fallopian tube you'll solve the problem.
posted by _Mona_ at 4:24 PM on December 17, 2007

I also agree that you should get off Astroglide. I was recently involved with a woman who found it quite irritating (she accused me/it of giving her an instant yeast infection). She liked ID. Glycerine=bad.
posted by rocket_johnny at 4:47 AM on December 18, 2007

I am having precisely the same problem as you, except that I've been on the NuvaRing for about 4 years and the problem only started a year ago. My GYN said it couldn't be the NuvaRing (which I LOVE otherwise), but I have been suspicious that the NuvaRing is the problem for almost as long as I've had the problem. When I first told the GYN about it, she tested me for a yeast infection and I had a very mild one, and I was treated for it. But the pain continued. She told me to use that refresh stuff, and it felt could at the time, but the sex was as burning painful as ever. I didn't have sex for 2 months when I was away from my boyfriend, and it hurt just as much as ever. The burning is slightly cyclical - sometimes it has been agony, sometimes quasi-ok. And we have started taking the ring out when we have sex, which does help but not nearly enough to matter.

I'm not sure if this is a factor, but I have had difficulty inserting the Ring around the same time the pain started. I'm not sure why it would have suddenly started to be difficult to keep the ring in place, but it happened.

This is all a shame, because otherwise this is by far the best birth control I've ever found. Sigh.... I'm glad you asked, though.
posted by n'muakolo at 10:33 AM on December 24, 2007

Just one follow up - I spoke with my new GYN about this, and she said that, as a scientist, she had to insist that I realize that I these exact symptoms can be caused by any combination hormonal birth control. I ended up switching off the Ring to an entirely different kind of birth control, but that was her response.
posted by n'muakolo at 6:53 AM on February 9, 2008