Goldstein Visit #3

Well, I don't even know where to start.  There is a lot of information to share.  It helps me to break it into categories so that's what I'll do:

The Vestibule:

It appears that my vestibule is pretty well healed.  I didn't really have much pain with the Q-tip test, so that's good news.  Dr. G said he may take me off of the Estradiol, but he wants to learn the results of my hormone test beforehand.  I would be shocked if my estrogen is where is should be, but according to my vagina - Dr. G thinks I have some good estrogen down there.

Hormones:

I'll get the results back next week, but like I said, I just don't think there's any way my hormones are where they should be.  Dr. G did prescribe Testosterone gel that I am supposed to apply daily to my legs.  He also said that I should rotate the spot of application because it can make me hairy!  (yikes!)  He said it also might cause more acne.  But he also said that it could help with my libido and give me more energy, so that is a trade I'm willing to make.  Depending on the results of my thyroid test, we might just stick with the testosterone gel for now before trying other methods to increase my energy.  He said he doesn't want me trying too many new things at once - and I agree.   

The new (or is it?) problem:
Lately during PT, I've been feeling pain at the 12 o'clock spot, but not in the pelvic muscles - it's actually where my urethra is.  I told Dr. G about this and he went in there, and it was, in fact, quite painful.  He's not sure what to do about this, but he mentioned seeing a urologist (great, another doctor).  However, like I said earlier, he doesn't want me doing too many new things at once, so the urologist idea is tabled for the moment.  This problem actually made Dr. G question himself - he said "is this new or did I miss it the last time?".  I don't know the answer to that question either.  Maybe it was there, but the other problems were more prominent.  I don't know.  But it's definitely there now.


The burning is back:
My vagina has been burning on and off for about the last two weeks.  Dr. G actually has no answer!  He says from a visual standpoint, everything looks burn-free.  He actually admitted that he wasn't sure what to do about that.  In a way, I'm disappointed that he didn't have a solution for me, but it also makes me trust him more.  It's hard to trust someone who thinks he knows everything, and now Dr. G has proven that he doesn't think that - that there are things he doesn't know.  And to me, that makes him a better doctor.  With that said, I hope he/we can figure out what all the burning is about.


The discharge:
I told Dr. G how I've been having rivers of discharge for the last three weeks and he said, "yes!  Your ovaries are working!".  Apparently, normal women have a lot of discharge and it's nothing to worry about (however it is quite bothersome).  But it made him very hopeful that my estrogen levels have risen because now my ovaries are doing their job.  In his words, "most women are dry as the Sahara because they are taking birth control.  This is not normal".  So okay, my leaky vagina is normal.  Yes! One point for me!  I used the word normal in the same sentence as vagina!

Estradiol info:
I found out exactly what the base was in my new Estradiol gel - it's Acid Mantlebase - Dr. G says that it can be less irritating for some people because it has lipids to hold in moisture and act as a barrier and that it has an emollient affect.  My original Estradiol base was Methyl Cellulose, which is basically water, which is why he usually prescribes it because it tends to be less irritating, but I needed something more.

Anxiety Meds:
I plan to talk to my psych about changing from Clonazepam to something else because I'm just too tired.  Dr. G said that meds like Prozac and the like do have a libido side effects, but that it would be okay to try them for now if I need to get my anxiety down.  He also wants to consider a Diazapam suppository, which is basically Valium to help relax my pelvic floor.  But we're waiting on that as well.  Not too much at once.  He said anal suppository and I was like, "what what?!  You want me to put it in my butt?"  I do not want to put things in my butt.  But he said that he usually says to put it in the vagina, but since mine is so sensitive he worries that there will be a negative reaction.  So, I might have to put a suppository up my butt.  I'll do it, but I won't like it.  However, if it helps, I'll like the result.

Well, I think that's all.  We really did a lot yesterday and my brain was so fried I couldn't write this entry last night.  So I'm writing it now at work instead of doing work :).  Please ask any questions.  It's a lot of information.

The big appointment.

Well, after many months of anticipation, my appointment with Dr. Goldstein has come and gone. I have a lot to say, so hopefully this post will not drone on for too long and make you lose interest.

Obviously this is a big deal. After so many years of half-assed treatments or no treatments at all, after a year and half of physical therapy, which has helped but not completely solved the problem, deciding to go see Dr. Goldstein was a big decision (not to mention an expensive one too). I tend not to get too nervous about things ahead of time, but instead reserve all my nervousness for the day of, at which time I get sick to my stomach and just want to lay down I'm so nervous. It wasn't any different this time. I woke up on Tuesday just feeling nauseous. I know it's just a doctor's appointment, but you know, it's hard. It's hard to talk about, especially to someone new, having to explain the whole situation over again. And I also felt some anxiety about what would he say, would he know what's wrong with me, would he be the big jerk that I've read from other people online? So I was nervous.

Let me mention now that on Sunday I went to the bathroom and low and behold, the toilet paper was pink. Great. My period started a week early two days before my huge vagina appointment. I freaked out. I didn't know if the doctor would even still see me or not. I know that doctors aren't bothered by it, but I wasn't sure if this type of appointment needed a blood-free vagina. However, I called and they said it was fine. But man, worst timing ever right? I felt like crap, I had cramps, and I was really tired. Great way to go into my appointment.

So on to the appointment. Basically the appointment was broken into three segments: consultation, exam, consultation.

Pre-exam consultation: We went into Dr. Goldstein's office and started going over the paperwork that we had filled out prior to coming, about my history and my symptoms. Dr. G asked many detailed questions and was very thorough. I thought that we were prepared, but he asked some questions that I really couldn't answer. Like did they look under the microscope when I was being diagnosed for all those yeast infections during college? I'm really not sure. What were the names of all the yeast medications I took? Again, really no idea. When you're in college and you have a yeast infection, the last thing you're thinking is, "I better write this down because in a few years I'm gonna need to know what I took when I inevitably end up at the vagina doctor".

But all in all, the conversation was relatively painless. Don't get me wrong, any time I have to talk about this stuff it's hard and I cry. But it wasn't too bad. And despite the many negative reviews I've read of Dr. G, he was compassionate, straightforward, and nice. He is as arrogant as they come, there's no denying it, but he wasn't rude nor was he a bully, like I feared he might be. He does, however, think that most doctors are complete idiots, which he never specifically said, but it was clear that he thought so. The only thing he really wasn't open to was my psychologist's recommendation that I start taking anti-anxiety medicine. He felt that since I don't have anxiety in my normal life and I only have it related to this subject, that it really wasn't necessary. We'll see how my therapist feels about this.

The exam: The fun part. Well, the first thing I saw when I walked into the room was a camera and a big computer screen and I thought, oh lord, I'm going to have to look at my vagina on that screen. I was right. My vagina was triple sized and we had live action shots of the whole exam. As you can imagine, I was not super excited about this. No one wants to see their vagina on screen. But I have to say, once I got over the initial humiliation of sitting in a room where four people (me, Dr. G, my husband, and nurse) were looking at my vagina on screen, it was actually quite interesting and informative. He very thoroughly touched each part of my vagina with a cotton swab and asked me questions about how it felt and the level of pain. He showed me the different parts of the vagina and explained them.

Then he sprayed my vagina with vinegar. Yes, you read that right. He sprayed my vagina with vinegar! Never in a million years did I ever think that one thing he might do is spray my vagina with the main ingredient in Italian dressing. He did this to check for skin problems - I guess the vinegar makes them show up or something. But I have to say, that vinegar stung like hell. It was like my vagina was on fire. But fortunately it was only for a couple minutes and then he rinsed it with water. Both Dr. G and the nurse said that it was hard to read me because even when I was describing my pain as a 7 out of 10 I really didn't react in an outward way. They called me stoic. I can tell you that I am an expert at stoic. How do you think I had painful sex with my husband for so long without him knowing just how horrible it felt?

Again, during the exam, Dr. G was very sensitive and supportive. He wasn't a jerk and he didn't make inappropriate jokes (another thing I read somewhere else). His nurse was also very supportive. I can tell that her job is basically to make the patient feel as comfortable as possible. I had my husband there with me for support, but that nurse made me feel like if he wasn't there, she would have given the support I needed. She was there right next to me the whole time, she had her hand on my arm and she was very encouraging, both in what she said and how she acted.

Post-exam consultation: A huge difference between this appointment and most doctor appointments that I've had in my life is that there was absolutely no time constraint. We never once felt like we were being rushed and Dr G took time to explain everything thoroughly. At this point, Dr G was ready to give his diagnosis. So here it is, drum role: I have Vestibulodynia! Dr G then went on to say that this really isn't a diagnosis because it's just like saying I have knee pain. The word dynia means pain in Greek, so vestibulodynia means that I have pain in the vestibule (see diagram to find out where the vestibule is). Makes sense. But he went on to tell me what he believes are the causes of this pain. He believes that there are two:

1)Atrophy of the vestibule tissue - most likely caused by the use of birth control pills. As he explained, birth control pills intentionally lower your estrogen and testosterone, but this can have very negative effects on your vagina (it effects everyone differently so it's basically just a coin toss). The vestibule needs these hormones and without them it goes into atrophy, which causes pain. He has prescribed a gel that he wants me to apply to the area for 3-6 months.

2)Pelvic floor dysfunction - tight muscles. This is what I've been working on at PT and I already know a lot about. But Dr G believes that the reason that PT has only worked up to a point is that I really need to treat the atrophy first before treating the muscles, or else a lot of that muscle work will be useless. This makes a lot of sense because my muscles have made great strides over the past 1.5 years, but I'm still not better. So he recommends that I treat the atrophy first with the gel and then in about 3 months start back up with aggressive PT when my vagina is more ready to receive it. He says that I should be able to have pain-free sex by the end of this year. Then he said, "I know that's a long time..." and both my husband and I were like, "dude, it's been years. If you're right, a few more months is really insignificant."

So there it is. There is more to say, but honestly, this post is getting too long, and I hate reading super long posts. My final thoughts are these: Everyone has different experiences and I certainly don't want to discount the women who said that Dr. Goldstein was horrible. Maybe he was horrible to them, but that was not my experience. For me he was empathetic and supportive and my overall feeling when I left there was a positive one. However, I'm not quite ready to shout his name from the rooftops yet either. I have my diagnosis and I have a plan of attack. I'm not going to say how super-awesome he is until that plan works. When I am having mind-blowing and pain-free sex with my husband, then I'll start singing Dr. Goldstein's praises. Not at the same time. First I will have earth-shattering sex, and then later, when my clothes are back on, I will praise Dr. Golstein! Until then, I will continue working really hard and doing whatever I can to heal my vagina.

Phew!

The Naked Cuddle

In our quest to bring some comfortable intimacy back into our relationship, my husband and I have tried many things. When we first started seeing the psychologist we had to go through a sort of trial and error period before we found what really works for us.

We started trying to bring back intimacy by watching erotic videos, doing massages, blindfolding and tickling with a feather, and playing naked Twister. However, we eventually

discovered that we really weren't advanced enough for this stuff. Watching the erotic videos made me so discouraged because even though they did make me a bit aroused physically, I felt nothing emotionally. I found it so hard to explain, but as women, being turned on is not just about the physical, we have to feel it in our heads too. And I just don't feel it.

The massages, feather, and Twister were all kind of similar in that they were sort of fun, but just weren't exactly what we were looking for. Emotions are so hard to explain, but I guess I still felt some sort of resistance (and sometimes dread) with those things.

Even kissing was off the table at one point. Which reminds me, I should tell you that since the beginning of therapy, touching genitals has been off the table as well. I just can't handle it. It's not that it hurts to be touched there, not physically at least. But it just tears me up inside that being touched there does absolutely nothing for me mentally. It just makes me uncomfortable. We're slowly bringing kissing back in, but so far we don't use much tongue. When I write it out here, it almost doesn't seem to make sense. It's like, well, if you're comfortable kissing without tongue, what's the difference if you just add the tongue in? I don't know! I'm just not ready! It's like I'm a teenager experiencing all of this for the first time. It breaks my heart that I cannot give more, but I just can't. When we first started talking about taking away certain activities I would burst into tears. Even though I felt a huge sense of relief when we decided not to touch genitals, and then later not to kiss certain parts, it also hurt me so much that even something as simple as kissing had to be removed because of me, and that taking it away made me feel relieved. I felt like I wasn't even worthy of being a wife if I couldn't even bring myself to kiss my husband.

So on to the naked cuddle. After many months of trying different things, we have landed on the naked cuddle. It is something that we are both comfortable with and it does not give me that feeling of dread or discomfort. Basically it started with just getting naked and laying there cuddling. Over time we are gradually adding in other activities to the naked cuddle. We started with kissing the arms and we've progressed to stomach, back, chest, neck, and ears (this was over many weeks). So that's where we are now.

My husband is so wonderful with all of this. Sex and other sexual activities really are off the table for him. Obviously he wants those things, but he is fully committed to my healing process. He gets excited for the naked cuddle just like he would if it were sex. We are making slow progress and I want it all to just be fixed, but I have to be patient and celebrate the small steps. I have to keep reminding myself to celebrate the small steps.

My vagina is killing my dreams

When I was a freshman in college, a former Peace Corps volunteer came to one of my classes and told us about her experience volunteering. Ever since then I have wanted to join the Peace Corps. I knew it was a big decision and I did a lot of thinking about it. I also wanted my husband to go with me, so we waited until we got married to talk about applying. Seven years after that first inspiration, my desire to go was even stronger, and we finally took the first steps in applying to the Peace Corps.

We applied in November 2008 and everything was looking great. Our interview went really well and finally in March we heard back that we had been accepted and we even knew what part of the world we would be going to. We were told that we would be leaving in March 2010. I was going to teach English and my husband was going to do something with business. Of course, being "accepted" to the Peace Corps does not mean that you are going to go. Then come the medical and legal evaluations. At the time that I filled out the medical evaluation (which is incredibly in depth and takes about a month) I was actually in remission with my vagina problem (well to be honest, I was more in denial than in remission, but on paper, I was in remission) so my medical part was fine. It took forever, but finally in August we heard back from medical that there were a few things missing. Okay, we went in search of these things. In the meantime, though, we started to really think about my vaginal issues. We started seeing the psychologist and I started going back to the physical therapist because my problem had never really been solved the first time. We were both stressing and worrying about the Peace Corps and our time limit in getting this vagina problem solved, but neither of us said anything for a long time. I think we were both afraid that saying it would make it real and that we would have to make some hard decisions.

Well we finally had to face reality. This problem does not care about my time constraints. This problem does not care that I want to live in another country for 2 years. We finally had to decide that we just could not do the Peace Corps right now because we have got to solve this vagina problem first. It was one of the hardest decisions that I have ever had to deal with. I know that it's the right decision because I certainly don't want my problem to get worse in a country with limited health care, and I know that for our relationship it is a priority to fix this problem. But I am heartbroken. I have been dreaming about the Peace Corps for 8 years and now my dream is over. The time was now. There is no other time. It's not like we can wait a few years and apply again. In a few years we want to have kids, we want to have a house. The time is now. And it's ruined.

I just can't believe that with all the problems my vagina has caused: pain, no sex, no desire to have sex, low self-esteem, frustration, stress - that it still hasn't stopped. Now it's the reason that I cannot fulfill one of my lifetime dreams. I am so devastated and I don't know if I will ever get over it.

My husband and I talk about perhaps still moving to another country once this problem is fixed, and without the constraints of the Peace Corps. We could have kids and still live in another country. But it's not the same. I wanted the developing country experience. I wanted to learn about how people live in poorer countries. I wanted to help people. And even if we did move to another country at some point, it would not be the Peace Corps experience. My husband says that it seems like I don't even want to do that anymore, and I'm not sure I do. It's like my dream has been ruined and there's no way to get it back. Plus, I guess I'm afraid to get my hopes up again. I mean, what if we decide that in 2 years we're going to move to Switzerland? What if in 2 years I'm still struggling with this problem and it's still not a good time to go? I do not want to deal with this heartbreak again.

Bloody Bladder

I must tell you about what happened several months ago when I was out of town to visit my friends. I had been feeling for a few days like I might be developing a yeast infection. My vagina was burning more than normal. So when I was heading out of town on Friday morning, I stopped at CVS to buy some Monistat. I bought the 3 day ovule, which I've never tried before. Side note: the 1-day dose, ovule or cream, does not work. I know it sucks, but you have to get at least a 3-day dose.

So anyway, I drove about 7 hours to have a girls weekend with all of my college friends. My vagina continued to burn, but I figured it was just a yeast infection. That night, we hung out in a hot tub. I know, those of you who know about yeast infections are screaming, why? Why would you get in a hot tub?! I guess I just wanted to be normal and to enjoy normal things like normal people do.

Before I went to bed that night I inserted the first of the 3-dose ovule to hopefully start killing the yeast. That night was the most painful night that I have ever experienced in my life. My vagina burned like nothing I have ever felt. It was so intense and I hardly got any sleep. I suffered throughout the night just waiting for morning to come; it was like torture. I finally got up around 5:30 (one friend had a baby and was up as well). I told her how much pain I was in and we started looking up what clinics were around that I could go to (remember, I was out of town and unable to call my own doctor, plus it was the weekend). The clinics all opened at 9am so I was planning to wait until then, but the pain continued to get exponentially worse.Then I went to the bathroom and my urine was pink! At this point I completely freaked out. I tearfully told me friends that I was peeing blood and that I could not wait until 9:00 to go to the clinic. My friend took me to the emergency room. By that time my condition had worsened still and the urine sample that I gave them was completely red and mostly blood. It turns out that I had a bladder infection that was so bad that my bladder was actually bleeding. I have had a few bladder infections before, but never ever like this. I've never had blood or this amount of pain before. So anyway, the doctor gave me a prescription for pain pills and antibiotics (the bane of any yeast sufferer's existence). I also demanded a prescription for Diflucan because there is a 100% chance that if I take an antibiotic I will get a yeast infection. I will say now that the fact that I used Monistat had nothing to do with my condition worsening. Monistat normally is very affective. I just self-diagnosed incorrectly and the Monistat was not what I needed, so it would have gotten worse either way.

So of course the ER takes forever, but approximately 4 hours later I was finally on my way back and approximately 1 hour after that my pain was significantly alleviated. However, it was not even close to gone and I was still in a lot of pain and discomfort. All the other times I've had bladder infections, the pain medicine has done the trick, but this time I guess it wasn't quite enough. And I actually went through the 3-day supply of pain pills and was still in significant pain so I asked my doctor for a refill. When I went to refill it, the pharmacy wouldn't do it because I had gotten the prescription too recently before that. I understand that they have to follow strict drug rules so I do not blame them for that, but that night was really painful for me. Luckily it subsided the next day.
I asked the doctor if he knew of any reason why this might happen and he said it was kind of just like a perfect storm. It had already been building when I got in the car for 7 hours of sitting and not drinking enough water, then I got in the hot tub, and on top of all that I'm very susceptible to all "down there" problems. And then the next day I had to drive back another 7 hours. It sucked, but I did try to stay hydrated and just make more stops to use the bathroom.

I'm so glad my friend was with me at the hospital. Obviously my husband was not there because I was out of town, so I was really glad that at least I was with very close and supportive friends. She also brought some much needed humor to the situation my naming my condition "bloody bladder", which really made me laugh.

So, yeast infections, bladder infections (sometimes bloody), pain with intercourse, burning vagina. This is my life. It's always something. Maybe this was just an anomaly, but I find that hard to believe. They have to all be connected, right? It's just a little too coincidental.

Dr. Susan Kellogg Spadt

Has anyone heard anything about Dr. Kellogg Spadt in Philadelphia? She works for the Pelvic and Sexual Health Institute. Do you know if she takes insurance?

Dr. Andrew Goldstein

I have made an appointment (or should I say, my husband made an appointment because I'm too emotional to get through those kind of things without breaking down) to see Dr. Goldstein in April. He owns the Center for Vulvovaginal Disorders and has offices in D.C., New York, and Annapolis. Has anyone gone to this doctor or heard anything about him?

All doctors are not created equal.

I realized that in my original post, I did not mention the drama I went through to find a doctor that actually gave me the time of day. All the yeast infections started when I was in college so I went to the on campus clinic for treatment. I probably saw 5 different doctors in my years at school who treated who knows how many yeast infections. At the time, I guess I just thought that I was susceptible to yeast infections, but I never really thought that there could be something else going on. And neither did any of the doctors I saw. Either they didn't care, all college girls have 4 thousand yeast infections, or they were incompetent. I really don't know.

After college I moved to a new state and went in search of a gynecologist. I didn't know anything about any doctors, being new to the area, but someone recommended a certain practice. I went on their website and read the profiles of all of the doctors in the practice. I decided to go with the doctor who's profile mentioned that she focuses on gynecological issues because I thought maybe she would be more open to dealing with all of my problems. So I went to my appointment, and, of course, burst into tears when explaining how it was painful to have sex. Well guess what her recommendation was? Take 4 Advil before having sex. That's it. No really, that's it. And, surprise surprise, 4 Advil makes absolutely no difference at all in the vagina area! She didn't offer to look into possible treatments or diagnoses. She offered no other help. I felt so defeated that I couldn't even muster the strength to look for another doctor or make any further steps toward fixing my problem for at least a year.

My boyfriend finally said enough is enough. I was suffering too much and I needed to find another doctor. So I tried another doctor in the practice; no good. Then I went to the 3rd doctor, and finally, she cared! She was concerned! She actually did a little research and called me back! Then she told me she was moving away. I was devastated. I had finally found someone who cared and seemed like she was open to investigating until she found an answer. But she did have a recommendation for another doctor in a different practice that she thought I should try.

When I called this doctor, she didn't have any appointments available for new patients for several months, but her physician's assistant was available soon. I was desperate and I wanted an in so I made the appointment with the PA (cue angels singing). I want to cry when I think about how lucky I was that the doctor was booked up! The PA is wonderful! She cares so much and she does outside research talking to other doctors and looking things up. Every time I see her she not only offers new information, but she also offers much needed support. And she is the reason that I even know that pelvic pain physical therapists even exists.  She is the one that recommended I start going to PT.  Before I met her I'd never even heard of such a thing.  She doesn't make me feel stupid for crying and she also doesn't act like she has all the answers. She continues to try and learn more about my problem and she doesn't try to make me feel like it's not a big deal. And she is completely supportive of my desire to see a vaginal pain specialist and has offered to do whatever she can to help that process along. I am so thankful for her. We may not have found a solution yet, but at least I have a doctor who cares and continues to search out new solutions. All of you who have had this issue can understand how wonderful it feels to have this small victory. Thank you Dr. Elizabeth! I can't tell you how much your support means to me!

Other Helpful Blogs

I've read a few other blogs on the subject. Some of them are more helpful in just being able to know that we are not alone, and others have good suggestions on different topics and problems. These people don't necessarily have the same exact problem as me, but I would say that if you're writing about pain in your vagina, I know that there's something that will help me.

http://www.pudendalpain.blogspot.com/
http://vulvodyniasucks.blogspot.com/
http://natalie-bug.blogspot.com/
http://vulvarvestibulitisrelief.com/
http://vulvarvestibulitis.blogspot.com/
http://feministswithfsd.wordpress.com/
http://myvajayjayisbroken.blogspot.com/

let me know if you all know of any more helpful blogs.

Anxiety medicine?

We also went to the psychologist last night. Lately we've been talking about how much anxiety I feel surrounding this whole ordeal. I get so upset that it's hard for me to talk and I just break down into a crying mess. The best way to explain it is a feeling of pressure. When I get really upset, I feel like there's all this pressure in my body - my chest, my throat, my head. It just feels like there's something pushing me from the inside out and it just wants to burst. Apparently this is called anxiety.

I was resistant at first when anxiety medicine was mentioned. I don't like the idea of taking a drug that alters my mind; that is scary to me. I also worry about what kind of side effects the drug might have, and wouldn't it be the worst thing ever if this drug had some kind of side effect that made the whole vagina problem worse? But my therapist convinced me that we would talk to the vaginal pain specialist about it before doing anything so that he can make sure to prescribe a drug that does not have those specific side effects. She also talked to me about the fact that it might just help me be able to get through this better. I mean it would be nice not to feel like I'm going to explode from the inside out every time someone tries to talk to me about this problem.

It would be nice to feel a little less worried all the time about what if I never get fixed? What if I can't have children? What if my husband is stuck with me forever because he loves me so he wouldn't leave me, but he'd live a life that is sexually and intimately unfulfilled? It would be nice to feel a little less of all of that. It's a lot for one person to worry about all the time.

So anyway, if the doctor agrees, I am willing to try the anti-anxiety medicine. I'll let you know how it goes.

Nerve Endings

Yesterday I went to the physical therapist and we were talking about what we can do to solve the mysterious burning problem. She says that there are several nerve endings right around the pelvic floor area. And when I sit for long periods of time, those nerve endings can get irritated and sensitive. So she did what I guess you would call nerve stretching exercises.

The first one she did was to hold my leg up and push on my butt bone in different directions. Then she put a finger in my vagina and pushed the nerves around in different directions. I definitely felt pain while she was doing this, and she apparently was doing the light version because she said she didn't want to exacerbate the problem. Right after I left, I felt a lot of discomfort while I was sitting in the car driving away, but the pain subsided in about 30 minutes. And I didn't really feel any burning the rest of the night. I woke up this morning with no pain, but I have felt a little burning here and there so far today. We'll see how this nerve stretching works, but hey, I'll try anything at this point.

I also got hooked up to the EMG (don't know what that stands for, sorry) machine at my appointment. This machine measures how hard I clench my muscles and how much I'm able to relax them. I had two probes stuck to the inside of my butt cheeks (to measure my pelvic floor muscles), one on my hip, and one on my abdomen.

The abdomen probe was sort of like a control and was supposed to stay at a steady pace to show that I don't flex my abdomen muscles when trying to flex my pelvic floor muscles. I'm happy to report that at least I'm doing that part right. My abdomen muscles stayed very steady.

Apparently the resting number for the pelvic floor should be around a 3 (I can't remember the units, so sorry the number 3 doesn't have much meaning) and the first time I did this, my resting number was 10. This means that even when I was trying to relax my muscles, "relaxed" for them was really quite clenched. This time around my resting number was at 7, so I have made some improvement, however there is more to go. We did some muscle relaxing exercises (basically kegels) and I was able to bring that number down to a 5 in about 5 minutes. So that is encouraging to know that even if I am quite clenched, I do have the ability to make my muscles more relaxed.

For those of you who may have this clenching problem, it really does help to squeeze all those muscles down there for about 5 seconds, then release completely and do a pelvic drop, which is basically beyond release. My PT says it's like an elevator, when you release the muscles it goes down to the ground floor, but when you do a pelvic drop, it goes below the ground floor. Try it, I can really feel what she talks about. Anyway, do the clenching and releasing at least 3 times and your muscles will relax some. And the more you do it every day, the more you will have control over the ability to both squeeze and relax your muscles.

How to Prevent a Yeast Infection

Being someone who has had to deal with numerous yeast infections over the years, I have a lot of good advice on things you can do to prevent them.

-I use a PH balanced body wash called Very Private to clean "down there". You can order this body wash online. Before I learned of Very Private, I used Dove sensitive skin unscented soap. The key is to use something very gentle and with no fragrance.

-I try to avoid using tampons unless I'm in a swimsuit and I always use fragrance free tampons on those rare occasions. I know some women think that pads (again, fragrance free, of course) are gross, and I agree, it does put all your business right there for you to see, but tampons have been known to increase your chance of getting yeast infections. Plus, when your vagina is as sensitive as mine, it's really quite uncomfortable to have something even as small as a tampon in there.

-I blow dry my whole crotch area on the cool setting of the hair dryer when I get out of the shower. Yeast thrive in a moist environment, so it's important to keep the area as dry as you can.

-I take Probiotic Acidophilus in a pill form every day (you can buy it online or in health food stores) - it is the live bacteria found in yogurt that can fight yeast.

-I also eat yogurt frequently for the live bacteria.

-I take a garlic supplement every day (I recommend a small dosage so you don't end up burping up garlic all day - I take 100mg)

-I only wear 100% cotton underwear.

-No tight pants. Let the girl breathe.

-I drink lots of water. I find that on days when I get a bit dehydrated, that's when my vagina starts to burn more.

-When I do my dilator exercises, I use lubrication that is glycerin free. One of my physical therapists is actually studying the affects of yeast infections on vaginal pain and she says that you absolutely must use a glycerin free lube. Apparently, glycerin can really irritate a sensitive vagina. I use either KY Sensitive Jelly or Slippery Stuff Gel Lubricant.

-I use fragrance free detergent and dryer sheets.

-I have read and heard of several studies that show that oral birth control can be a contributor to both vaginal problems and reduced libido, therefore, I have stopped taking it. I mean, I can't have sex anyway, so what's the point?

All of these things are so second nature to me now that I don't even really think about having to do them anymore. It sounds like a lot, but once you get used to it, it's just normal life. If I think of any more I'll add them in.

I still get yeast infections. I don't know why, the doctors don't know why. But these things above do help, so try them out. If you have any additional suggestions, please leave them as a comment on this post.

The burning problem

Literally. I have a burning problem. My vagina burns for hours, sometimes days, with really no explanation. I noticed it most when I was out of town for Christmas and spent many hours sitting in cars, sitting in restaurants, sitting in movie theaters. Whenever I sit for long periods of time, especially on hard seats or in seats where I can't move around very much, my vagina starts to burn. Even though I say that it happens mostly when I sit for a long period of time, it also happens at completely random moments (or so far as I can tell) when I haven't been sitting. And there's really no explanation for it. Naturally, I'm paranoid about getting yeast infections, so sometimes I think I have a yeast infection. I'm starting to be able to tell the difference though. I can't explain it, but the burning problem is not the same as a yeast infection.
I told my physical therapist about the burning problem and she has made two suggestions:
1) Put an icepack right on the area kind of like you're icing a pulled muscle, and 2) put lidocaine in my vagina twice a day. Lidocaine is a gel that is supposed to numb the area. At first she wanted me to try soaking a cotton ball in lidocaine and putting that in my vagina. That just did not work for me. It felt like my vagina was being plugged up and I could not stand it. So now I just put it in with my finger. The downside to this is that I have to wear a pantyliner or I'll get gel all over my underwear. The intent of using lidocaine twice a day is more of a long-term goal. It's supposed to make me less sensitive over time, so it's not necessarily supposed to work right when I put it in.

Do these methods work? I don't know. The icepack feels good at the time, but when I take it away, the burning is still there. I haven't been doing the lidocaine for very long, so maybe it's affects have not shown yet, however, it's supposed to be numbing right? Well when it's in there, I don't feel numb at all. Is that normal?

Anyone else have this unexplainable, indescribable burning vagina problem?

What I do at the physical therapist

When I go to the physical therapist we do several things. So far my problem has been diagnosed as vaginismus, although who knows what the heck that means? What we are trying to tackle at the physical therapist is the tightness of my pelvic floor muscles. The tightness is caused by two things: 1- a physical problem (vaginismus? maybe.) and 2- it's also a mental thing. When something try's to go in down there, I can't help but clench. I've been training my body to do it for several years now. I'll take you through an appointment:

First I undress from the waist down and I lay on a giant heating pad for about 10-15 minutes. The heat is supposed to help relax the muscles and I do believe that it does help.

Then the physical therapist comes in and uses an ultrasound machine with a small probe that she puts in my vagina and pushes it around the muscles - they call these muscles the pelvic clock. She goes around the clock holding the ultrasound probe onto the muscles until they relax.

Sometimes she will follow that up with her own finger so that she can feel what the muscles are doing. (See what I mean about other people being down there more than my husband?)
Then I have a lot of homework:1) Every day I'm supposed to use dilators to do the work that the ultrasound machine does. Dilators are basically different-sized dildos. I use the small one to push on the muscles around the pelvic clock and then I use a larger one for the "prolonged stretch", which is basically just sitting there for 10 minutes with a large dilator in my vagina. This is supposed to help stretch the muscles.

2) I also have to do kegel exercises, but they aren't just your regular kegels. I have to do "quick flicks" and "long holds". Quick flicks are hold for 3 seconds, relax for 3 seconds and long holds are hold for 10 seconds, relax for ten seconds. I have to do each of these about 3 times in about 6 different positions - standing, indian style, laying on my stomach, yoga bridge. You might be thinking, if her vagina's so tight, why is she trying to strengthen her muscles? Well, I have learned that it's important to have strong muscles down there even if you have my problem of clenching too hard because it's just as important to be able to relax those muscles as it is to be able to flex them. So I do the kegels to train my muscles how to relax.

3) I also have to do leg stretches. I know! Why? I am really inflexible and this part is not fun. But all of the muscles in your legs are directly connected to your pelvic floor muscles so it's important to stretch them as well.

Well, I'm exhausted from all this explanation. I hope someone reads this and finds it helpful. Please feel free to comment on the post if you have any questions. Coming next: why I think I need more than a physical therapist - the burning problem.

It started with a yeast infection.

Well, actually, it would be inaccurate to say a yeast infection. It was more like a hundred yeast infections or one giant unending yeast infection that lasted for over two years. I'm still not sure which.

When I was in college I decided to start having sex with my boyfriend of three years. At first, it was good, and then I got a yeast infection. How was I to know that that yeast infection would still be hurting me 8 years later? We went to different colleges in different states, so I guess I partly didn't realize how serious it was because we hardly ever saw each other anyway. But if I'm being honest, when we were together, I didn't want to hurt his feelings or make him feel rejected, so I continued to have sex with him even though it was very uncomfortable and sometimes painful. We had a long distance relationship for 5 years so I guess I thought I could deal with the discomfort since it happened so infrequently. Little did I know that I was setting myself up for years of pain and sadness later.

After I finished college, I moved in with my boyfriend. And then it became a game of what kind of excuses can I come up with to avoid having sex? It was awful. He felt rejected and confused and I felt like I was broken. At this point it was not just about sex being painful and uncomfortable, now I honestly did not want it at all. I was repulsed by it and had absolutely no sexual desire.

And then we got married. I should point out that my now husband is the most wonderful and supportive person I could ever hope for. Through all of this he has never let me down and has never purposely made me feel guilty for not being able to give him what a wife should be able to give her husband. I don't need him to make me feel guilty, I feel guilty enough on my own. I've been married for two years, I'm in my twenties, and I have absolutely no desire to have sex with my wonderful, handsome husband.

I hope that this blog will help other women out there know that they are not alone. This isn't something that people talk about much and sometimes we even feel like we have to hide it. My husband gets very frustrated with the shame of it all. He says that there's nothing to be ashamed of and it's just like having any other physical problem. Intellectually I agree, but it's still hard to talk about. I am completely heartbroken and I break down crying every time I have to talk about it.

Currently I am seeing a vaginal physical therapist (who knew they existed?), a gynecologist, and a psychologist. I'm also planning on going to see a vaginal pain specialist soon, so I'll let you know what I learn when the time comes. My husband and I go together to the psychologist because she thinks that my non-existent sex drive is an us problem, not a me problem. I'm not sure if I believe that, but I hope it's true. It would be nice for this problem to not be completely about me. My next posts will update you on what I do at the physical therapist and at the psychologist. Hopefully you'll get some helpful information, or at the very least, a virtual shoulder to cry on.