Guest Post: On sexual pain, consent & treatment

08/09/2011 at 10:51 pm | Posted in Uncategorized | 10 Comments
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[Dear internet, we have a guest poster today! The following was written by someone who prefers to remain anonymous. A trigger warning applies, for questions of sexual consent and rape.]

I offered about two years ago to make a guest post on this blog, then tried to actually write it, and vanished into thin air because I was so uncomfortable with the issues it was dragging up. I was trying to write something hilarious, and political, and historically enlightened. But it turns out that the only important thing I need to share right now is what happened to me.

This is a post about feminism, sexual pain, and consent.

Here’s what’s wrong with me: I have a pelvic floor dysfunction. It’s originally a muscular problem: it means that somewhere along the line, I got the habit of carrying tension in my pelvic floor the way other people carry it in their shoulders. I get vaginal muscle spasms the way other people get neck cramps. They could get set off by any kind of anxiety, such as direct stimulation of an already-painful spasm, leading to a godawful feedback loop called “secondary vaginismus”—a conditioned psychological response of increased painful spasms, and aversion to sex, due to the association of vaginal penetration with intolerable pain. The happy ending is that my primary dysfunction was treated by physical therapy, which gave me strategies for combating the muscular issues; and the secondary aversion went away because the association was broken. The physical therapy process took about 3 months. I wasn’t able to find it for 9 years.

The horrible thing about getting to the correct therapy for vaginismus was that even reasonably well-educated doctors seem to routinely believe that the only way a woman gets a conditioned aversion to sex is rape, or a fundamentalist upbringing that teaches that sex is dirty. I have had fruitless arguments with puzzled GPs who, I believe, left the encounter convinced that I had somehow buried sexual abuse trauma somewhere in my brain—when in actuality, the genuine traumatic moments of my life had been occurring on their own gynecological exam tables. And all in the name of getting my poor, long-suffering boyfriend laid.

To say that this sort of thing breeds resentment is just a little bit of an understatement.

Here’s the thing of it. Since I had my first orgasm (clitoral, manual), I never really saw the big deal with getting my twat all stretched out into fighting shape. I liked sex, I was fully capable of climax, I could make my partner climax, and as the pain mounted, I was increasingly convinced that there was no logical need for vaginal intercourse specifically. The boyfriend didn’t share this analysis. At his urging, and my initial gameness to experiment, we tried, and failed, and tried, and failed.

Maybe it’s really bad for all girls, but they put up with it better than me. I’m a spoiled, privileged elite wimp. I need to grit and bear it before I can get the good stuff. “Our Bodies, Ourselves” taught me sex was supposed to be fun for me. Was that just rose-tinted glasses?

The more we tried, the less it worked, and the less I wanted to have sex at all. I went to the gynecologist. I grit my teeth around the speculum, was told I was “small” and needed to stretch, was handed a plastic dilator and sent home. I couldn’t look at it. I put it under the bed.

I am lazy. I am a coward. I am frigid. Did feminism make me frigid?

(Years later, on vaginismus support groups, I would encounter all these women who described their boyfriends as saints. Soooo patient, soooo understanding. Here’s the thing, ladies: he’s not the one suffering dysfunction and pain. That’s you. Him? He’s horny. It’s not a martyrdom. Last resort solution: he whacks off.)

I am denying sex to my boyfriend. Every day we are together is an archetypical punishment for him. If other people knew, they would think he was crazy to stay with me. I can’t tell anyone this is going on.

He stopped requesting that we try, but everything had already turned into guilt. Without really knowing why, I no longer wanted to have sex with him. He would ask, and because I felt like it was ungenerous not to, I would whack him off. I let him touch me only when I wanted it, because that’s what a good feminist does, and that was less and less often. I was frigid when he was home, and I masturbated when he went away. This went on gradually for about six years. It was some kind of screwed up, semi-coerced, semi-consentual sex; nobody made me do what I didn’t want to, but I didn’t want to. The logic goes something like this:

1) Who would ever date someone who can’t have intercourse? Such a person isn’t a functional woman. Such a person isn’t a whole woman at all.
2) Therefore, this is my only option for a life partner. I have to make it work.
3) He wants consentual sex with me. So we will have (unwanted) consentual sex.

(All the while I’m angry as hell, on some level, and undermining the situation like mad.) I sought treatment again, and was referred twice to a psychiatrist for vaginismus, which was described as a mental condition caused by the aforementioned rape or ignorance. I threw the pamphlet away in disgust. St. Boyfriend became depressed, I was pretty sick of it too, and he broke up with me. In the desperation of feeling like I was defective—which I felt very deeply and very abstractly and clinically—I finally went to a psychologist, who confirmed that the problem was physical and not psychological, and referred me to a specialist in pelvic pain, who referred me to a physical therapy specialist in pelvic floor dysfunction. Three months later I was having intercourse.

Here’s the kicker, though. I went through the therapy process because I felt defective without the capacity for PIV intercourse—even though I thought, all the while (and I still think) that this is a nauseatingly offensive and wrongheaded idea, and that all those quiet thoughts I had between the lines of what happened were horrible and wrong and poisonous, untrue things. And I got desperate enough to fight my fear and pride and begin the therapy process because I believed that no matter how poisonous I knew they were, precious few men would be enlightened enough to date someone incapable of intercourse. I might even be right about that. But I don’t think I’m ever going to be quite reconciled to the fact that even though a streak of self-destructive pride kept me from seeking treatment in time to quench the lust of my own St. Boyfriend, I did finally seek it for the sake of the hypothetical St. Boyfriend of my future—not for my own sexual needs. Now every time I give consent, no matter how willing, it’s always going to be tainted by that history. And that strikes me as very unfortunate.

Vulvodynia will be appearing on TV shortly

07/31/2009 at 8:59 pm | Posted in Uncategorized | 1 Comment
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Set your TIVOs & old timey VHS decks to record this:

According to His & Her Health forum,

Be sure to tune into 20/20 next Friday [August 7, 2009 -K] at 10pm ET, when Dr. Timothy Johnson, ABC News’ Chief Medical Editor, will discuss the diagnosis and treatment of sexual pain disorders and vulvodynia with Andrew Goldstein, MD, and Amy Stein, MPT. Dr. Goldstein directs the Center for Vulvovaginal Disorders in Washington, DC, and New York City. Ms. Stein, a New York-based physical therapist, specializes in the treatment of pelvic and urogynecological pain disorders. The segment will also feature the stories of two women with sexual pain, as well as an interview with Christin Veasley, NVA’s associate executive director, and her husband Melvin.

More of the same @ alternate link

You’ll definitely want to check your local TV listings to find out what time & channel it will be airing for you. The description also mentions, “Sexual pain disorders,” so it sounds like we may hear a few words on some other related conditions.

I hope they get it right this time. I’m a little apprehensive after what happened the last few times vulvodynia was on TV.

Probably the first time vulvodynia was mentioned on TV was during Sex & the City, which generated some attention & discussion, but the topic was handled flippantly. There was that episode of Private Practice (Season 1, “In which Addison finds the magic,”) which was a little more complicated & in depth, but still not 100% satisfactory. I don’t believe that Oprah ever aired that episode about vulvodynia the producers were recruiting for about a year or two ago. I don’t think that show was aired in Fall 2008. If it was, I must have missed the post-show discussion that was surely generated online.

At this point, there is little influence any of us can have on what happens during the show. I’m hoping that since the Goldstein, Stein & Veasley are familiar with vulvodynia, the discussion will be accurate and professional.What’s been said has been said, so it’s up to the editors now.

Here’s hoping it goes well.

Back on the saddle again*

07/03/2009 at 6:43 pm | Posted in Uncategorized | Leave a comment
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Wow if I ever thought I’d be able to take a vacation from dilating for a few weeks, I was completely wrong. I’m really not going to be able to let up with this for the rest of my life am I?

I went to PT again this week. Since it has been a few days since I finished both medications for the vaginal infections, and I was feeling better, I felt ready to start up with the internal work again.

That was one of the more difficult internal work days I’ve had in a long time. Before the infections, I had been able to handle the largest dilator comfortably, and quite a bit of pressure on the tissues. It’s more uncomfortable now. I’m not reset back to zero, but I definitely fell back. No tearing or bleeding, and things were within my tolerable range, but just barely. I had to start off with one of the smaller sizes and I’m definitely not ready for the big one yet. I’m being paranoid about germs even though I washed my gear, so I’m insisting on covering the dilators with a condom for awhile. I probably don’t need to. They’re not made of porous materials and I don’t share them with anyone.

Once again I left wondering what, exactly, the biggest component of the discomfort was. Was that the vaginismus acting up? Definitely; the muscles were tensing & haven’t been worked much for a few weeks. Was some discomfort the residual vestibulitis? I don’t know but I hope not. That area of redness I noticed during the infection is better now but still not the same shade of pink as the rest of me. Could there still be some infection left? Maybe; although the sensation of intense heat is gone, and I’m not registering anything else out of the far-reaching realm of normal for me, my infections don’t like predictable textbook cases. HOW WOULD I KNOW??? If it looks like I’m shouting, it’s because I am. Not knowing is frustrating. I’m getting frustrated when I read comments online that talk about how women need to learn what normal is & what infection symptoms to look for. Mine’s not working like that.
Or maybe some discomfort is just due to me approaching my menses. I’m a bit low on some hormones.

This current discomfort is actually something I’m less pessimistic about. Right now I’m not as worried as I thought I would be. Since I’ve felt worse before, and the residual pain post-surgery responded well to PT and at-home pelvic floor & dilator exercises, I feel confident that I may be able to get the tissue supple again over time. The PT wants me to pick up with the dilators & at-home exercises again ASAP.
Of course only time will tell if my optimism is warranted.

I’m still disappointed though – I guess I won’t be able to take a break for more than a day or two for awhile. I was going so well too, I could skip 3 or 4 days without losing much ground. I was maintaining. But two weeks is just too much. I’m interpreting this difficulty with inserting things as a sign & a reminder that I am going to deal with this pelvic floor dysfunction, residual vulvodynia, vaginismus, for the rest of my life. It’s better than it was, no doubt. But some residual may be lurking under the surface long term.

*Sigh* what did I expect? I know vulvodynia is a chronic condition. Vaginismus is going to take a long time for me to address, too. I spent at least several years at least living with chronic vulvar pain. There’s a possibility that there may have been something going on longer, even before I became sexually active. It’s not going to go away overnight.

This could get awkward down the road. How am I going to do this if I have kids? I’ll need to maintain my exercises through pregnancy, certainly. But then what? I can see it now, the baby starts crying and mommy has to struggle to get up off the floor, clean herself off and pick up the baby. And it’s just going to be a mess. Or maybe mommy can shout at daddy and tell him to go pick up the baby, mommy’s in the middle of something. Or something is in the middle of mommy, as the case may be.

Then what if I have a major pain flare while I’m working and being a mom… I don’t think I want to think about that right now.

Welp. Looks like I’ve still got some work to do.

*Metaphorically speaking only. Yeah right like I’m ever going to ride on a normal saddle again. Guess I won’t be going horseback riding or biking in the mountains any time soon. I guess the sybian is out of the question for me too. Oh well, that’s all out of my price range anyway.

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