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Too Young for Sexual Pain?

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I can't precisely say when it started.

I can't have been older than 13 years old, sobbing in the bathroom as I desperately tried to insert a tampon before heading with my family to our annual 4th of July pool party. Same as always: the burning pain that felt like I was being ripped apart. My parents had implanted into my head that tampons make you lose your virginity, and I'd always known THAT had to hurt, so I wrapped up the failed product in vast amounts of toilet paper, tied it in a plastic bag, and carefully buried it in the wastebasket to avoid detection. “Just forget it.. I'm on my period,” I grunted, and stayed poolside, morosely eating hot dogs later.

Upon my discovery of the Internet, I learned a great deal about my anatomy over the years, and decided to try tampons and vaginal entry with my new boyfriend at the age of 16. I did it all; the hymen "stretches," making sure I wasn't “tensed up”, using lubricant. Nada.

The entrance to my vagina has always felt like a ring of fire, ready to flare if disturbed. I gritted through penetrative non-intercourse activities out of desire for normalcy; there can't be anything wrong! I wanted to be the goddamn happy, carefree, giggling California girl on TV and all around me, uninhibited by pain, freely expressing her full sexuality which the media attaches so much worth to. I tried to enjoy penetration, and sometimes it did feel sorta good, but I'd have hell to pay with days of stinging and burning for 10 minutes of feeling alright.

Understandably, I both looked forward to and dreaded my 18th birthday, when my boyfriend and I agreed we'd feel safe, legal, and prepared for full intercourse. I simply couldn't imagine my first time being less than a nightmare; my vagina being a source of pain is all I had ever known. On the advice of Scarleteen, I headed into my gynecologist prior to this fateful day. That went nowhere.. for the first 4 visits.

“I really don't know what to tell you,” she said. “I can give you another prescription for Diflucan.”

“But.. is it a yeast infection?”

She replied with a shrug.

“I've had three prescriptions for Diflucan, and I haven't had any symptoms of a yeast infection..”

She relented with a sigh, and allowed me to undress so she could examine me. She came to the conclusion that I was too tiny for penetration (an absolute myth) which was causing tears, and to apply Neosporin for a month. Aside from that, she said, there was nothing that could be done.

My birthday came a few months later, and the day was great. Intercourse, however, was the failure I imagined it to be. My partner was instantly turned off by my pain reaction, and we both ended up laying naked in damn near a pit of despair. A month later, I received the then-horrid news that my 16-year-old sister had been successfully having intercourse, apparently to the point of becoming a mama. Suddenly, condoms didn't seem like enough protection alone, despite the fact the act of impregnation was happening rarely at best, so I flocked to the local health department to get back on birth control pills at my mom's urging.

Gotta love the mandatory exam! Out came the speculum. Ow, ow, OW, OWWW!

“Stop it, no, no, no,” the practitioner cooed, hoping words would soothe my spasming vagina. “You've had a penis in here, this little speculum is NOT hurting you.”


I believed it, or I tried. How many times had I heard it from people much more intelligent and rich than me? All my friends told me to keep having sex; it hurt for them the first, fourth, tenth times, and then just got better on its own. Try different positions. More lube. Stretch your hymen. Is he just too big?

 

I Googled the hell out of my problem until I came upon a curious condition called vulvodynia, or more specifically, vulvar vestibulitis syndrome. Something clicked, the symptoms there.. that was me, those stories were me! I brushed it off again as my mind being overactive and diagnosing myself with something that didn't exist – isn't that what hypochondriacs do, cruise the Web looking for obscure problems with big names for every little symptom?

I kept trying to have sex; I gritted, I groaned, and though the pain DID seem to reduce a little with time, it still prohibited sex on most occassions. My partner felt insanely guilty and tried to shy away, but I'd assure him it was alright, and it was ME who initiated sex most of the time, just out of my desire to feel normal. After months of the same thing, I made an appointment with my new primary care provider.

This was the worst experience yet. She coldly walked in, asked what the problem was, and hassled me immediately about how much lube I was using, if I was fighting with my partner, and even suggested I might be feeling pain because I'm not supposed to be sleeping with him. Out came the speculum, but this time, there was no reassurance as she swabbed for infection. I gritted my teeth and moaned as the searing, tearing pain radiated through my genital area, and it felt like nothing short of bliss when she released my vaginal walls from that steel grip. She told me if the infection screen came out clear, I should dilate my vaginal opening with my fingers and reassure myself that sex is okay, to tell myself over and over that sex is okay, to tell myself over and over that there is no pain, no need for there to be pain. Finally, I found my strength and got angry.

“I HAVE been telling myself this past YEAR that sex is okay, that it will be alright. This is real; telling myself the pain won't happen doesn't make it stop. I've read about vulvody-”. She cut me off and ripped into me.

“Vulvodynia means it's in your HEAD. “Dynia” is the medical Latin term to mean “psychosomatic pain”, see. I see TOO many women coming in here who just need to learn to relax, use lube, or get a more supportive partner, it DOES go away if you let yourself relax. Stop reading that nonsense. You're too young for this; just relax.”

Offending me by assuming I didn't know basic “medical Latin” aside, how dare her? I'm too young for this; as if I didn't know that already, through all the media showing teen women being sexual, carefree beings who are so often measured by their sex appeal, their “doability” instead of their brains or even, lord help us, natural beauty? By the young women around me, talking about their wonderful romantic weekends, hearing about the wonders, likely exaggerated aside, of vaginal intercourse. By friggin' Dawson's Creek, The O.C., every teen show on the face of the Earth that centers on the magic of the first time, the necessity to "complete" a relationship to make it officially serious? I left the office in tears, and my mom was dismayed; that was her physician, and she had assured me she was good.

I decided; screw this. Screw being told there's nothing wrong. There is. It's real, and I need a real physician to treat it.

I researched vulvodynia again, and my suspicion was confirmed in that the guidelines for diagnosis was an absence of any other physiological cause, which had certainly been ruled out. I called the doctors covered by my insurance and hung up on any of them that wouldn't let me speak to a nurse or doctor before making an appointment; I was sick and tired of wasting money to be told lies. Finally, I reached an NP who said she sees vulvodynia/VVS patients. I knew on the day of my examination that this would be different.

“Hi, Lauren. It's a pleasure to meet you, but your problem sounds distressing! It says here you've had painful intercourse for over a year, and painful insertion since first tampon use? Definitely sounds like a vulvar pain disorder, here's how it works and what we're going to do...”

I was so relieved. She didn't think I was crazy, and she was clear and concise. She did the infamous Q-tip test, and when I yelped and leaped confirmed my suspicion of VVS. My first treatment was lidocaine gel, which didn't give me satisfactory improvement, and I knew deep inside that this problem was too long-lasting for likely any but the more dramatic measures. Her colleague, a gynecologist specializing in surgery, described a procedure called vestibulectomy, in which the outer mucosa of the vestibule along with the minor (and possibly major like the Skene's and Bartholin's glands, depending on the extent of inflammation or damage) vestibular glands are removed, and the internal vaginal tube extended outside the body and sewn in place to cover the defect. I was frightened by the description, but when he described the 90% success rate, I was on board immediately.

As of this writing, I'm exactly two weeks away from having the procedure done. I'm happy to report that I've told my family about my condition and the surgery, and they're rallying behind me 100%. I feel a sense of optimism, somehow knowing that this likely will mean the end of my pain forever. No more fear of tight jeans or intercourse. I might finally have uninhibited intimacy with my partner, with neither of us afraid to “keep ourselves in check” so that it doesn't lead to disappointed feelings. I've learned to hold my head up high and ignore the projections of the media onto myself and my relationship; we've survived fine with no intercourse, and I consider myself blessed to have someone so compassionate and understanding on my side all this time. In turn, it's something to say for HIM, for resisting the media painting him as a young guy who can't exist without heterosex, as well as one who is entitled to it in a relationship. Big shout-out, and I know that's lame, but I wouldn't have had the heart to seek help for my problem if it weren't for his unconditional support and understanding.


Want to find out more about vulvodynia and vulvar vestibulitis?Check out OBGYN.net's fantastic and in-depth lowdown on this issue here. This is also one more reason to always keep up with your sexual health: it's thought that vestibulitis may often result due to previous or current infections, so as ever, you'll want to be sure to get regular sexual healthcare, every year, without fail, and keep up your safer sex practices. And don't delay when you have any sort of genital infection: even chronic yeast infections may contirute to vulvodynia and other long-term effects or conditions, like PID.

Having pain with vaginal sex, but don't know why? There may also be other reasons: have a look here. - HC


I'm writing about this to raise awareness, especially among young women. For example, are you aware that 15% of women in a clinical setting reporting dyspaurenia have vulvodynia? For how common this problem is reported, the lack of physician awareness, not to mention treatment options, are worrying. Even more so is the fact that VVS often does strike younger women, even some who are prepubescent, and yet still many are told they are too young to be in pain. VVS has been strongly linked to use of oral contraceptives, especially when prescribed to teen girls under the age of 16 years, or used for a period of more than 2-4 years. Numerous studies have linked decreased mechanical pain thresholds in the vestibular tissue of women taking the pill, as well as decreased androgen and estrogen receptor activity. It is not a far cry to suggest that the surge in VVS cases among young women could be influenced by the fact that oral contraceptives are being prescribed to women at dramatically younger ages, often for non-contraceptive reasons, and is often pushed as a first, or, indeed, only choice of birth control.

It is my hope reading this has been of use to someone. There is no reason for any woman of any age to suffer from sexual pain, and it is inexcusable that it continues for so many.

9/17/2007 - Unfortunately, I report that the surgical procedure was not successful. Then again, that is not atypical with women with the condition; most need continued management rather than receive a cure. My search continues for relief, but I remain relatively cheerful and happily supported.

10/15/2007 - I'm even less happy to report that the surgical procedure has caused worsened pain which has interfered with more activities than intercourse. I am in the process of locating an expert who can hopefully repair the damage done and who knows of other treatments.

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