Posts Tagged ‘vaginal pain’

Echo: that pain in your vagina is NOT in your head!

Monday, September 27th, 2010 by Shannon Bertha, ACS, PhD

If you search our archive, you will find a number of blogs discussing this topic.  Although this subject has been touched upon, we continue to hear it from our patients each and every week, and not only are patients getting frustrated, but I am too.  How can any practitioner, therapist or doctor see an ulcerated vagina and conclude that the pain and discomfort the woman has been suffering from is . . . drum roll please . . . in her head?

It’s not in her head . . . there are physical symptoms!  Now, of course there is a connection between what goes on in your brain and how that translates to your body and psychosomatic symptoms, but this is not always the case.  But when there is a physiological symptom, why would anyone recommend  cognitive therapy to treat a raw, irritated vagina?  If I broke my arm snowboarding, would the treatment be to go to therapy to see why I decided to go snowboarding to begin with . . . or would the treatment be to set and cast my arm?  It never ceases to amaze me how when it comes to female sexuality, we forget the biopsychosocial approach and just treat the woman as an emotional creature or think psychologically she is being affected.  What happened to the biological component??? 

Therapists can be quick to find that red flag, that ah ha moment, the root of a particular emotional response to a given situation.  But most therapists work in the psychological realm, talk therapy, and I have yet to meet a therapist who can “talk” to anyone’s vagina and rid them of rawness and irritation.  Although therapist’s intention is to help, I wonder if gynecologists realize how recommending talk therapy when a painful situation exists affects the patient or client. 

Do these women believe it is indeed in their heads and therefore can never be cured?  Do they rack their brains trying to find that one instance that caused or triggered the problem and in essence blame themselves?  Many of the women I see at the Women’s Center are suffering from various issues including low desire, trouble with arousal, difficult time achieving orgasm and pain.  In every category, I’ve heard a woman say, “My doctor said it must be in my head”, when there is clearly a real physical issue going on.  I think that is the benefit of a place like the Women’s Center.  You get the chance to work with both a sexuality therapist and a nurse practitioner who are both trained in sexual issues.  So if you would like to explore your situation beyond “it’s in your head” make an appointment so we can treat all of you, not just one part.

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On Trusting Yourself.

Tuesday, June 1st, 2010 by Bat Sheva Marcus LMSW MPH PhD

We saw two patients in two weeks who had severe vaginal pain. In both cases the pain started 3- 6 months after starting a new form of birth control pill. In both cases the patient felt that it was related to the birth control pill and asked their prescribing physician about it. In both cases they were assured that it had nothing to do with the new birth control and they recommended that the patients stay on.

The sad part is that in both cases the patients were absolutely correct and could have saved themselves a great deal of pain and sadness. Each patient steadily got worse for 2-3 years and underwent treatment after treatment until each found her way to our center. They both needed to get off the offending drugs and then do some rehab. But, they are both doing well now.

So my message is important. Trust yourself. If something feels wrong – test it out. Doctors are not infallible. We all make mistakes. More importantly, even if something is not reported in medical literature, you are unique and you know your body best. So listen to your body, trust your instincts and heal thyself.

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On pain…

Tuesday, May 5th, 2009 by Bat Sheva Marcus LMSW MPH PhD

If one more patient comes in and tells me she has spent a year with a therapist talking about the pain in her vagina and low and behold she still has the pain… I will get up and scream. Really. I promise.  I can’t stand it. I can’t stand the ridiculous notion that “it is all in your head,” except it isn’t. I have a secret for you… generally a horse is a horse, not a zebra and generally pain is pain… NOT “your vagina telling you you don’t want to have sex.” Let’s try another one… maybe it’s your vagina telling you THAT IT HURT G-D DAMN IT!!  Whew… I feel so much better.

And here’s another secret: often pain isn’t so very hard to treat, if you know what your doing — a little stretching, a little biofeedback, a little estrogen cream, a better lubricant, sometimes a medication and voila — MOST pain can be treated successfully.

So listen to me. If you have pain, don’t let anyone tell you that you don’t or it’s not real just because they can’t “see it.” The fact that they can’t see it is their problem, not yours. So get help. Real help. And make that pain go away.

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Newsletter Brings Vaginismus into the Open

Friday, September 26th, 2008 by Ilene Rosenthal, Marketing

The Medical Center for Female Sexuality remains on the cutting edge of female sexual concerns with the latest issue of its newsletter, Sex for Women Today.  The September issue is dedicated to vaginismus, a rarely discussed disorder identified by pain during intercourse.  Women are finding there is a solution and they no longer need to suffer through it.  You can also subscribe to the newsletter and have it delivered directly to your email inbox.

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one man's…

Monday, May 12th, 2008 by Bat Sheva Marcus LMSW MPH PhD

It never ceases to amaze me… one day recently I had two back to back vaginismus patients. “What’s vaginismus?” you ask. It’s a condition (not that rare at all mind you) where a woman can’t get a penis into her vagina. It can be severe. She can’t get a finger or a tampon in. Or it can be mild. She can get the penis in. It just hurts like heck. Anyhow, back to my story. The treatment that we use for vaginismus (put a bit oversimplified) is to introduce progressively larger “dilators”  (hard plastic cylindrical inserters which look very medicinal) into the vagina to relax it and to stretch it. Once we get to the largest dilator, we then move on to penis shaped vibrators or dildos. When asked if their partner had helped put the dilators in: patient #1 responded that her partner had been horrified at the penis shaped vibrator and was only willing to use the “dilators” since they didn’t look like sex toys. Patient #2 responded that her partner didn’t like the medicinal looking “dilators” and was waiting for those fun dildos. Okay. Once again we learn that …. hm… one man’s dildo is another man’s dilator?

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Lichen Planus and vulvodynia

Friday, March 28th, 2008 by Bat Sheva Marcus LMSW MPH PhD

I just read a moving and sad article in Self Magazine about lichen planus and vulvodynia. A young women talks about her vaginal pain and how it has shamed her and ruined her sex life. Vaginal intercourse became excruciatingly painful and none of her gynecologists could see any problem and so everyone thought it was in her head. Over the years she became more and more avoidant and the lack of sexual contact with her partners ruined a number of relationships.

I have so many thoughts.

1. I think it was very brave of this woman to describe her situation which has caused her so much shame, self doubt and pain. I think it’s an article worth reading if you are in her situation. (Even though I’d argue that perhaps more could have been done to help the pain.)

2. I can’t help but wonder how many more women have been told that their pain is “in their heads” because a physician wasn’t able to identify the problem.  I wish more mds would be comfortable saying, “I’m sorry. I just don’t know.” As a practitioner it just makes me so mad. If I had a nickel for every women we have seen who we have been able to help through  physical/medical/behavioral interventions who had spent years in therapy with little to show if it, I’d be rich! I think most women have a gut feeling whether the problem is physical or psychological. We should trust them. And more often than not, pain is PHYSICAL.

3. Our view of sex as having to revolve around penile/vaginal intercourse is perhaps the single most limiting and misleading element  of our current sex education. There are many kinds of sex. There’s oral sex, manual sex, anal sex. There is sex using every potential part of your body. If you can’t have sex one way…. there are so many other ways!! Why does someone who can’t have vaginal intercourse feel as though she should be embarrassed to discuss this? And why does she feel like her sex life is over??? I had a patient who had vaginismus (a condition in which you can’t get a penis into the vagina.) She was married for 3 years when I saw her. (And yes, we helped her!)  She had one of the best sex lives I’ve seen. She was having sex with her husband about 3 times a week, in various way. She had an orgasm (or more) most every time they had sex.  She was having fun. Now— do I think she’s probably having more fun now that they are having vaginal intercourse? Yes. Probably. (Although she’s quite clear that intercourse is not her favorite sexual activity.) More options is usually better. BUT do I think someone’s sex life should be over because they can’t have vaginal intercourse?! No way. And I think we’d do ourselves, our daughters and our partners  a big service if we put vaginal intercourse into perspective.  Would her husband be having a grand old time if he was having sex 2 times a week with a happy, excited, willing partner who was the queen of blow jobs (kind of how she describes herself) , who brought him to orgasm with her tongue, her lips, her breasts, her feet, her butt, her anus? Would her husband be having a grand old time if hew was having sex 2 times a week with a happy, excited, willing partner who was having orgasms using his hand, a vibrator, his mouth. My guess is yes. Would he miss vaginal intercourse? Probably. Is that a price he would pay to be with a woman he loves? Would it be that be so very different from a guy who is heartbroken because his wife won’t go down on him and he loves oral sex? Perhaps not so very different.

So here’s advice if you (or your friend or your partner) has pain with intercourse. 1- Get help. 2- It’s probably not in your head 3- Try to build a fun, happy sex life anyhow. You can do it.

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