Which Estradiol Gel?

Well who knew there were so many choices?

Dr. Goldstein prescribed Estradiol gel to me in April.  As I've said before, the gel at first was very irritating. Over time I got used to it more, but it still irritated me sometimes.  At this point my gel was 0.03% estradiol and 0.1% testosterone in a cellulose base.  I started reading on other blogs and on my vaginismus yahoo group that some people have Estradiol gel with an Emu oil base.  I called Dr. G. to find out more about this. His office called their pharmacy and the pharmacist explained that many people find the emu oil to be more soothing, but not necessarily for the right reasons.  It turns out that the emu oil absorbs more of the estrogen and testosterone, making less of it actually absorb into your skin, making it less irritating because it's the hormones that are irritating in the first place.  So I didn't want to go with emu oil because I want as many hormones as possible getting into my body.  They did have one other suggestion - to use the same ratio of estrogen and testosterone in a different base - I wish I could tell you exactly what the base is, but on the bottle all it says is "ACID MA# 100".  I have no idea what that means exactly, but the word "acid" sure is scary.  However, I do like this version better.  It is less irritating and thicker.  I still get irritated sometimes, but it's less than with the cellulose-based Estradiol.

So there's the rundown on Estradiol options.   Please let me know if you have any questions.  When I go see Dr. G. on October 21, I'll find out exactly what that "acid" base is.

Book Review: Completely Overcome Vaginismus

Like many of you I'm sure, I've read tons of books on the subject of vaginal pain and how to treat it. I thought it might be informative to write about these books in case you're in search for some good vaginal reading material. I will start with the latest book I read called Completely Overcome Vaginismus: The Practical Approach to Pain-Free Intercourse.

First I want to say that I really like this book. It is actually a set of two books - Book 1 is the book I read and will be talking about here, and Book 2 is the personal journal and workbook that is made as a companion for Book 1. It uses a 10-step plan and I personally find plans to be much easier when there are well-defined steps. The steps start with being able to properly identify your PC muscle group, learning how to control those muscles, and slowly building to inserting things into the vagina (by things I mean fingers, dilators, tampons, etc). They also include some steps that involve emotions and trying to figure out what events happened in your past that contribute to the involuntary muscle contractions.

Because I've been going to the physical therapist for so long and I see a psychologist every week, I have already done most of these steps, however I still think that this book has some value for me. My personal focus will be on the last few steps, which walk you through the transition from dilator to penis. I had said in an earlier therapy session that even when I am physically ready to have a penis in my vagina, the thought of it is terrifying. How could I go from putting plastic dilators in my vagina and then just one day jumping onto a penis? My therapist assured me that there would be steps in between, but I didn't have a clear idea of what those were until I read this book. There are, in fact, many steps in between dilator and penis and I will be sure to refer to this book when I get to that point.

I am going to especially recommend this book to anyone who, for whatever reason, can't go to a physical therapist. I get most of what this book offers from the PT, but if you don't have insurance or you just can't afford a PT or whatever your reason is, you should know that there are still things that you can be doing to get your body on a healing path. And this book is a much less expensive way of starting physical therapy without actually going to a PT (we're talking $34 for Books 1 & 2 versus thousands).

I will say that the emotional stuff in this book is not enough for me. It might be for you, but I am so screwed up in the head that I need more than a book and some daily affirmations (one thing that the book recommends you do) to get my mind on a randy path. I know that for a lot of you out there, you are ready and horny and can't wait for your vagina to get better so you can get some! For me it's much more complicated and reading 100 books would not give me what I need (hence the reason I see a psychologist every week). But, like I said, I still really like this book and I think it's a valuable read.

Please let me know if you have any questions about this book by replying to this post or emailing me at thegirlwithpaindownthere@gmail.com.

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.