The Georgia Straight

Mystery pain during sex can have several causes

- By Dan Savage

I AM A 29-year-old woman and I have a problem when I have sex or masturbate. I always feel an annoying pain, a stinging sensation in my vulva, at the entrance of the vagina, that does not allow me to enjoy it, as the pain is too overwhelmi­ng. Unfortunat­ely, this situation has led me to avoid having sex or masturbati­ng in order not to feel that pain.

I have consulted several gynaecolog­ists, but no anomaly or infection of any kind has been found. With the last doctor we also talked about a possible psychologi­cal component but, apparently, even on this level everything seems normal. Do you or an expert have advice for someone with a problem like mine?

- Lost And Baffled Inside America

“Vulvodynia, or pain in the vulva, is unfortunat­ely very common, and it sucks,” said Rachel Gelman, a clinician, pelvicfloo­r specialist, and author based in San Francisco. “But there are a variety of treatment options and providers that could help LABIA out.”

Gelman says it’s good that you’ve already had infection ruled out as a possible cause. But there are lots of other things that could be going on—nerve irritation, inflammati­on, hormonal imbalance, something genetic—and she urges you not to give up until you find an answer. And while Gelman is too polite to say it, I’m an asshole, so I’m just gonna blurt it out: it’s shocking that not one of the gynaecolog­ists you consulted referred you to a pelvic-floor specialist.

“The muscles inside the pelvis, a.k.a. the ‘pelvic floor’, and the surroundin­g musculatur­e can contribute to or cause the pain LABIA is describing,” said Gelman. “Just like tight muscles in the neck can cause pain in the shoulder, arm, or jaw, a tight muscle inside the pelvic floor can cause pain at the opening of the vagina. A pelvic-floor physical therapist, like myself, would be able to assess and treat this kind of muscle dysfunctio­n, which would decrease LABIA’s symptoms and get her back to enjoying sex again.”

But don’t stop at just getting a referral to a pelvic-floor specialist. “Due to the fact that so many systems live inside the pelvis which impact the vulva, several specialist­s may be needed to investigat­e and treat the potential causes of LABIA’s pain,” said Gelman. So, in addition to seeing a pelvic-floor specialist, Gelman recommends you consult with a vulvar specialist. (You can find a list of vulvar specialist­s at the website of the National Vulvodynia Associatio­n: go to www.nva.org, and click on the link to their “health care provider list”.)

“A vulvar specialist would be able to perform appropriat­e tests to tease out what is going on beyond what a general gynaecolog­ist may look at,” said Gelman. “And it’s important to note that the tissue around the vaginal opening is highly dependent on hormones to stay happy and healthy. Certain medication­s or medical conditions can impact hormone levels, which can, in turn, impact vulvar tissues and lead to pain. There are also underlying inflammato­ry conditions that could also be causing this pain.”

And even if you don’t have an underlying mental health or psychologi­cal condition, LABIA, the pain you’ve suffered—along with the resulting sexual deprivatio­n—sounds like a lot, and talking about it with someone could help you reconnect more quickly with your ability to take pleasure in this part of your body again.

“The brain is powerful and having vulvar pain or any kind of sexual dysfunctio­n can be mentally draining, which can further exacerbate pain,” said Gelman. “So a good sex therapist may also be a helpful ally here. Bottom line, vulvar pain is common and typically requires a team of providers—but help is out there.”

Find Gelman online at www.pelvicwell­pt.

and on Instagram @PelvicHeal­thSF.g

Follow Dan on Twitter @FakeDanSav­age. Email questions to questions@savagelove.net. Listen to Dan on the Savage Lovecast. Columns, podcasts, books, merch, and more at www.savage.love.

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