sex hurts

March 2, 2008 9:32 AM

Ladyparts, sexpain filter: I am a female with vulvar vestibulitis. Help me figure out how to have happy sex with my boyfriend. This is getting ridiculous. (NSFW, duh)

I adore my boyfriend. He's sexy and fun. I want to bang his brains out, but I can't, because every time he tries to enter, I get this overwhelming (cross your legs, ladies) sensation of tearing, ripping, and burning that doesn't go away until he's out (and even then I'm a little tender for a day or two).

This happens with everything, not just him. I usually have to use pediatric-sized equipment and get an ultrasound during my GYN exams because the doc can't get in far enough to examine me normally.

He's not overly large, I'm not overly small. The vulvar vestibulitis diagnosis was by default after ruling out other irritants, diseases, psychological hangups, etc. Standard medical advice has been 1. more foreplay, and 2. more lube. Neither help much.

I'm more than happy to perfect my blowjob technique, but a little face-to-face sex every now and then would be nice. Also, it would be nice if he could approach me without this overwhelming fear of hurting me.

After reading on the internets (I know, smart), I'm wondering if a pre-sex NSAID and/or muscle relaxant would help. Are some positions better than others? Any other tricks?

I understand this is actually one of those common but unspoken problems among women, so I'm hoping the hivemind can help.

posted by anonymous to health & fitness (10 answers total)

Is masturbation pleasurable? Are you able to use tampons? Dildos? Have you tried starting with a finger, then working your way up to small dildos and then larger ones? Whatg about being a little drunk or high beforehand to relax you?

I would say, whatever else you try, make sure you're masturbating regularly, and work up to using penetration on yourself. This will at least keep everything in good order and keep the association of lady parts = good times.
posted by schroedinger at 9:56 AM on March 2, 2008

I'm so glad you asked this question. Ask Mefi was one of the first places I looked when I was diagnosed with vulvodynia last fall and while I did find a couple helpful comments, a thread like this would have been really useful.

I'm not sure what kind of treatment you have, but my doctor has me applying estrogen cream (mixed by the pharmacist, Estradiol 0.01% in Galaxal) nightly and I've also gone off the pill. This seems to have made things a lot better; I no longer have as much external pain (ie I can usually handle fingers and oral sex focused around my clitoris). But I do still have a problem with vaginismus. Another thing he said has you really don't to keep doing things that hurt as there's a feedback cycle where knowing something is going to hurt causes the vaginal muscles to contract, which makes it hut more. He has me doing the following exercise: using lube, put one finger inside myself, then tighten the muscles there around the finger, then relax and use finger to stretch the muscles a bit, visualising all the time. Then when I'm comfortable with one finger I'm supposed to more on to two, then three, then put my boyfriend's penis just at the opening and tighten and relax, then about one inch inside, then all the way in but with no movement. He also gave me a topical anesthetic (Xylocaine 2% jelly, which is lidocaine hydrochloride jelly, USP) to apply to around the opening 20 minutes before if I needed help getting past that initial pain to start the exercises, but I haven't used it yet. The only thing I know about muscles relaxants is that my cousin, who seems to have exactly the same thing, was prescribed a muscle relaxant and it didn't seem to help that much.

My concern with muscle relaxants and anesthetics is that they don't address why you have this problem in the first place. From my research, the four main things I thought might be causing my problems were: 1) birth defect (especially if you are sensitive around your belly button) 2) reaction to hormonal birth control 3) food sensitivity 4) sensitivity to things like pads and laundry detergent and soap. If you have any more questions, mefi mail me and I can send you the list of links I put together for my cousin. I'm really glad you're asking about this. I was amazed when I started talking to people how easily between a half and a third of the people I told , both men and women, had experienced pain during sex. I'm so glad my doctor didn't just tell me that I needed more foreplay and lube. I think it's ridiculous that I should have to be really wet and turned on before I can ride a bicycle.

Bearing in mind that both my boyfriend and I are still virgins, here's what we do for sex. Basically we just have fun for as long as we want with oral sex and hands, with him mostly focusing on my breasts. Then when we're about finished, I usually just put his penis between my legs and he comes that way. That last bit doesn't really do that much for me, honestly, other than it's nice being really close to him, but he's always very attentive the rest of the time. It's still kind of frustrating, but being creative and trying not to see intercourse as the only object of sex is the only way I've been able to deal with this.

I hope you get better soon.
posted by carolr at 10:07 AM on March 2, 2008 [4 favorites]

If you're using hormonal birth control (pill, patch, or ring), go off it. As carolr mentions, hormones can absolutely cause this sort of pain.
posted by scody at 11:44 AM on March 2, 2008

IANAD(yet) but in the gyne clinic where I worked we had a large number of patients with vestibulitis/vulvodynia and did have a few more things to offer than the things already mentioned above:

(1) Some of the medications used for treating neuropathic pain seem to work. Nortriptylene (a TCA) or gabapentin (anticonvulsant) have shown some efficacy.
(2) As mentioned above, topical lidocaine applied 15-20 minutes before intercourse can help.
(3) Physiotherapy using biofeedback is helpful if there is an element of vaginismus - high muscle tone/spasm in the pelvic floor.
(4) Topically applied estrogen.
(5) Relaxation techniques using progressively larger dilators (essentially dildos) may help for spasm/vaginismus. Use small dildo/dilator, leave it in, concentrate on relaxing with it in, when this is comfortable move up one size.
(6) Vulvar care: Avoiding scented pads, soaps, laundry detergents, bubble baths, synthetic fabrics etc.

Best of luck to you. I'm sorry I don't have more to offer. It may also help to find a gynecologist who specializes in vulvar vestibulitis. I know, easier said than done.
posted by madokachan at 12:47 PM on March 2, 2008

Standard medical advice has been 1. more foreplay, and 2. more lube. Neither help much.

This is bullshit. Has a doctor diagnosed you with vestibulitis, or is this a self-diagnosis? I suffer from it as well, and once I found a doctor who believed me and knew that this wasn't something that would be solved with foreplay or KY or relaxing (like so many other doctors told me), we were able to work together to fix it.

Here's what we did:

First she put me on a low-dose anti-depressant to dull the pain sensors going to the brain. Then she gave me a numbing gel (lidocaine) to apply to my vestibule 5 times a day.

After a while of that helping a little bit, she sent me to a physical therapist who specializes in vulvodynia. The PT had me work with some bio-feedback machines to help me control what is going on with my vaginal muscles. A big part of my problem was that those muscles were perpetually tight, like how your shoulders get tight. That reduced the amount of oxygen getting into the muscle tissue, which made them hurt. Then any amount of pressure on the muscles and they hurt more.

After many PT sessions and at-home exercises, I was able to go off of the numbing gel, stop taking the antidepressant, and have for-real pain-free sex. I cried the first time it didn't hurt, then I went into my PT and gave her the biggest hug. I now have pain-free sex probably 90% of the time, and it even feels good - I never imagined penetration would ever feel good.

I would highly, highly suggest finding a doctor who knows something about vulvodynia. Call the office and ask the head nurse if you can't talk to the doctor before making an appointment. I know it's difficult to find a doctor like that, but it can mean the difference in your sex life and your relationships. You are worth it.

I'm also available over MeMail to answer questions and provide more details about my PT and at-home exercises.
posted by rhapsodie at 4:04 PM on March 2, 2008 [1 favorite]

Topical estrogen, in the form of Estradiol or Premarin (which gets a bad rap from some women, including women in my family, but is what worked for me).

Also, you can use something like Replens, which mirrors your body's natural response and lasts for a while, before you get to the actual foreplay, rather than having to stop what you are doing to apply lube.

Feel free to Mefimail me if you want to correspond privately about this.
posted by misha at 4:37 PM on March 2, 2008

Just thought of a book that really helped me before I found a doctor who took my vulvar pain seriously: The Vulvodynia Survival Guide. It was a really big help to me when I felt crazy or the only woman going through this.
posted by rhapsodie at 7:14 PM on March 2, 2008

Hi ladies. Fellow recovered vulvadynia patient here. I've been well for years now, and enjoy a happy and normal(!!) sex life.

For everyday pain management I used Aloe with lidocaine for numbing the burning pain, and SBR Lipocream for the skin tearing pain. On my worst days I also used ice cubes.

I had biofeedback treatments, which were great for showing me how weak my muscles were when I started and showing my progress on slow- and fast-twitch muscle control and strength. Kegels good.

I had physical therapy, which helped get me used to being touched in addition to stretching the muscles on my pelvic floor. My PT showed my boyfriend how to stretch me out too. Bonus!

I had my hormones balanced (which is not the same as birth control) and took tricyclic antidepressants and copious amounts of Calcium Citrate. All of those were marginally helpful.

I was on a low oxalate diet, which was difficult to maintain but even harder (mentally) to quit. I was afraid I would relapse completely -- I didn't.

I had acupuncture, which was helpful in immediate ways and long term ways, but required regular visits for awhile.

All of these things helped me for different reasons at different times, and combining them was the key for me. That's the long way of saying that recovering from it entirely is what you're aiming for.

In the interim, try using the Solarcaine as your lube, and take an ibuprophen or other anti-inflammatory a half hour or so before having sex. But remember that you can cause damage without feeling the effects immediately because of the numbness. Be careful.
posted by nadise at 11:25 PM on March 2, 2008

My friend has this and started a whole organization, here. Good luck!
posted by yodelingisfun at 8:49 AM on March 3, 2008

Oh, I forgot when I was explaining that exercise for regaining control of your vaginal muscles, there is a middle stage where I'm supposed to use one, two, then three of his fingers before trying to insert his penis.

Also, this isn't an answer to your question at all, but I've been completely converted to cloth menstrual pads. I know they sound really gross, but it's not that bad, really. They feel so much drier and less gross when you are wearing them then disposable pads, which where my only previous option since tampons and diva cups are out. And I haven't had a yeast infection in 5 months, whereas I used to have one after every period. I know they seem kind of expensive upfront, but a friend of mine uses old face clothes secured with a safety pin and I made a bunch more once I'd discovered that I like them. Once you start paying attention to vulvo-vaginal health issues, they make a lot of sense.
posted by carolr at 1:18 PM on March 6, 2008