Vulvodynia is a name given to chronic and intense pain in the area pertaining to the vulva. This pain consists of extreme sensitivity, burning, stinging, throbbing, irritation and rawness. Sadly, there are many women experience and put up with this condition for many years before it is finally diagnosed. It would seem that public awareness of this condition is limited, with many women living with Vulvodynia leading a life of discomfort and pain, limited daily activities, sexual dysfunction and psychological distress.  According to the amazing interview (shown below) originating from New Zealand, medical help that was sought in this interview did not lead to any further understanding.  It would appear there was/is very limited knowledge amongst health professionals and scanty information made available through various sectors of sexual health. Accordingly, it is not unusual for many women with this condition to consult several physicians before being diagnosed.

Vestibulitis Syndrome is a common form of Vulvodynia that has been described as one of the most common causes of genital and sexual pain in women. The vulvar vestibule is the area within the inner labia surrounding the vaginal opening.

Upon diagnosis of Vulvodynia, the painful tissue may look essentially normal under examination, or it may whiten when swabbed with a vinegar solution. Biopsy may show chronic, nonspecific inflammation. Whatever the initial cause, it seems possible that for some people pain pathways are activated that do not deactivate when the source of irritation has been removed or ameliorated.

Awareness of aspects of daily life that may be contributing to this condition have been known to reduce the severity of pain, such as taking precautions with clothing, wearing cotton underwear and loose fitting long pants.  It is possible that various foods may contribute to sensitivities, especially when stinging is apparent after urinating.  Washing the entire area of the vulva with water after urinating may help and it is paramount to avoid the use of scented soaps and toilet paper.  It is also clear that laundry powder can be problematic, as well the use of bubble bath, shaving gels and body washes, especially those containing high amounts of fragrance, glycols, parabens, alpha-hydroxy acids such as malic acid, glycolic acid and lactic acid as well as  alcohol.

Deactivating the pain pathways is possible using anaesthetic gels (lidocaine), topical steroid creams pain medications, even low doses of antidepressant (sometimes given with an antispasmodic) have all been used.

Dr Glazer, a Clinical Associate Professor at Cornell University Medical College/New York Presbyterian Hospital, has discovered that there is a relation to abnormal muscle function in the pelvic floor area that relates to Vulvodynia.  Through measuring the break down in muscle function with electromyography, which is non invasive, the depth of abnormality can be measured.  Then through a series of individual programs using electromyographic biofeedback, Dr Glazer corrects muscle abnormalities.

With increased blood flow there can be a restoration of vulvar tissue which then leads to pain relief.  Dr Glazer's treatments have resulted in massive reductions of ongoing pain in 80% of the women who have used this process finding relief from Vulvodynia.  A much better option possibly, than steroid creams, anti depressants and anaesthetic gels!

Take a look at this amazing interview. It is a powerful documentary because of the openness and honesty of the woman who is interviewed. Prepare to be moved and at the same time filled with admiration for a woman who has been to hell and back living with Vulvodynia. The shocking thing though in this documentary is that so many health professionals seemed to be ignorant to this condition.

http://tvnz.co.nz/20-20-news/v-word-13-19-video-4232132

Any comments and feedback would be appreciated.

PART TWO of Sassy Chat Blog on Vaginismus

Treatment for Vaginismus can have many factors and the good news is that Vaginismus is usually 100% treatable. First, the psychological issues that accompany it must be treated. If a woman has been sexually assaulted, traumatized or abused she must work through her feelings about that experience in therapy. Having sex used as a weapon to harm you can have devastating affects and it takes time through therapy to work through all the issues and feelings associated with that and be able to return to thinking about sex as something pleasurable instead of harmful.

If a woman has been taught that sex is dirty, bad, sinful, and shameful and that her body or genitals are ugly, dirty, smelly, not to be touched etc. then it is easy to internalize negative feelings about sexuality. This is also something that needs to be discussed with a therapist so she can understand that sex is natural, pleasurable, and a wonderful expression of love and intimacy and that her body is beautiful and nothing to be ashamed of.

What else will happen in therapy?

The therapist, along with helping the woman to deal with the psychological issues she is facing, will also use other techniques to help with woman be able to relax and be able to have vaginal penetration. Women get “homework” and are assigned exercises to do at home between therapy appointments.

The techniques for treating Vaginismus include:

•       Relaxation exercises. Learning to practice deep breathing from the belly, meditate and relax the entire body will help learn how to relax the body and mind during sexual activity.
•        Pelvic floor exercises. Exercises such as Kegel exercises which not only strengthen the pelvic floor muscles but also control them. The best way to understand how to do Kegel exercises is to start urinating. In the middle of your flow of urine, squeeze your pelvic muscles until the stream of urine stops. Hold this for a few seconds and then release the muscles and start urinating again. Whilst this is the correct muscle to exercise it is not recommended that you repeat this pattern each time you go to the bathroom. If you are able to put lubricant on your 1st and 2nd fingers and slide them about an inch into your vagina and squeeze and draw up on your fingers, you are doing well, as that is the correct action. You may need to start with one finger. As you build up your pelvic floor muscles, the amount of time you can squeeze and hold them will increase. After a few weeks, you should see a difference. Learning how to identify your pelvic floor muscles as well as control them, also retrains them and helps reduce pain and tolerate penetration.
•       It is also helpful to use restraining devices when doing pelvic floor exercise, such as a Vaginal Barbell, or the Fun Factory Teneo Smartballs.  There are double and singles balls which are weighted, that helps the brain remember to squeeze.  It is recommended that you insert and do exercises for at least 15 minutes each day.
•       Sensate Focus. Invented by Master’s and Johnson, Sensate Focus exercises are designed for couples to learn about touch without sexual intercourse. Through a series of controlled touch exercises where the body, apart from the genitals are touched, stroked and caressed, couples can increase intimacy and trust, take the pressure off of expecting sex, and build an understanding of what the woman needs to progress through treatment and get to the point where she is comfortable attempting intercourse.
•        Masturbation.  While it is true many women who suffer from Vaginismus have issues with their genitals, especially touching them, masturbation is a key component of overcoming the problem.  Masturbation is a normal, healthy sexual activity and it can help someone learn about their body, from basic anatomy to what is pleasurable. Women who experience Vaginismus will be asked to masturbate to help them become comfortable with being touched in the genital area, which will also help overcome feelings of guilt and shame about their bodies and sexuality and prepare for the next phase of treatment. Vibration gives increased sensory input to muscles. There are many women who have discovered the benefits of using a vibrator when masturbating.  A variety of clitoral stimulators are available without having to use penetration.    

Vaginal Dilators

An important aspect of treating Vaginismus is the use of vaginal dilators. These are used at home, alone at first and then with the woman’s partner. There is a series of dilators that range in size with the smallest one being about the size of a pinky and the largest one being about the size of an average penis. The woman starts with the smallest one and works her way up over several weeks to the largest one. The woman attempts to insert the dilator into her vagina slowly until it is all the way in. Usually lubricant is used to help make it easier and the woman does the deep breathing and relaxation exercises to try to relax the pelvic muscles and reduce anxiety. She does this every night for a week and the next week starts with the next dilator in size. This pattern is continued until the woman can successfully insert the largest dilator all the way into her vagina. Vaginal Dilators trigger pelvic floor muscle reactions and women can learn how to control these reactions and redirect them so they respond correctly to penetration. At each stage, if the vagina starts to clench or anxiety increases, the woman should stop, try to relax and start again. It may take several attempts or several sessions of trying before it works but if the woman does not give up, success can be attained in overcoming Vaginismus.

Bringing in the Partner

Once a woman is able to successfully insert the largest dilator with no problems, her partner enters the exercise. Each night they spend some time with the dilators. First the woman will insert the dilator in front of her partner. This not only shows him how to do it and allows her to control the speed and depth of penetration, but also helps reduce anxiety, embarrassment, guilt and shame the woman may be experiencing. When this hurdle is cleared and penetration with the dilator is successful, the next step is letting the woman’s partner insert the dilator.  Her partner should take care to go slow, pay attention to any anxiety she may be feeling and stop immediately if she tells him to stop. As with the solo exercises, it may take several tries before penetration can be achieved but this is the time for patience and understanding.

Progressing to Intercourse

The next natural step in the process is attempting intercourse. It is important that the woman feels she is ready to try having sex, both physically and emotionally. She should be sure to use lubricant, go slowly and have plenty of foreplay. Relaxation exercises should be done and this is something couples can do together. The first time intercourse is attempted the woman should be on top so she can control the depth of penetration and proceed to deeper penetration at her own pace. Couples may have to start and stop more than once in the middle of sex to deal with anxiety and tightening of vaginal muscles.

Sometimes couples get discouraged if they are not successful on their first try but again, patience and understanding are necessary as is good communication. As the woman becomes more comfortable with each sexual encounter, couples can try different sexual positions to see which works best for them.

A word about Communication

By far, the most important aspect of overcoming Vaginismus is good communication between partners. A woman must be able to express her feelings about what is happening to her physically and emotionally. Her partner must be able to do the same. Couples with good communication have better tools in their relationship to deal with whatever problems they face. Good communication facilitates healthy relationships, trust, comfort and intimacy.

Other treatments

Some women report successful treatment of Vaginismus with Acupuncture. The use of Botox injections in the vagina to relax muscles is a relatively new treatment and is still controversial in acting as a cure for Vaginismus.

Good overall health, regular exercise especially those that focus on strengthening the pelvic floor and trying to reduce overall stress can also help with Vaginismus.

The most important thing is to understand that there is help available. Women do not need to hide in guilt and shame. Instead they need to take control of their sexuality and seek out treatment. Women have a right to be sexual, experience sexual pleasure free from pain and love their bodies.  There is no reason with the right treatment Vaginsmus cannot be cured and instead of suffering in silence, women can experience happy, healthy and pleasurable sex lives.

Copyright © 2011 Marie-Elise Allen

Permission is granted to copy and redistribute this article on the condition that the content remains complete and intact, and that full credit is given to the author(s), that a link is provided to the author(s) website, www.sassyvibes.com.au and that the information is distributed freely.

Prostate cancer is the second most common cancer in men (after skin cancer), with around 12,000 new cases diagnosed each year. Men’s overall risk of contracting prostate cancer before the age of 74 is 1 in 11.

There are 3 main treatments for prostate cancer; a surgical Radical Prostatectomy, pelvic brachytherapy (the implanting of radioactive seeds in the prostate), and hormone treatment that deprives the cancer of the testosterone that feeds its growth.

Prostate cancer treatment damages nerves and blood vessels, so getting aroused can take much longer, orgasm may feel different and ejaculation may be different or missing. It may affect the rigidity of erections, how long the erections last and the ability to get an erection in the first place.

Diagnosis alone can cause erection difficulties. 70-90% of men have erection problems for some time after treatment and 40-50% of survivors continue to have ED (erectile dysfunction) in the following years.

In addition, concerns about incontinence, fatigue, depression, the cancer recurring and a lack of sexual desire make sexuality a huge challenge for survivors and their partners.
Delving deeper than the obvious mechanical changes, research by Barbara Bokhour in 2001 identified 4 areas affected by erectile dysfunction that impact on quality of life.

The quality of sexual intimacy
Without reliable erections, men feel anxious about their ability to satisfy themselves and their partner sexually. They feel hesitant to initiate emotional and physical intimacy, as in the past this usually led to intercourse, now a potentially awkward and embarrassing experience. What was once comfortable and familiar can feel unnatural if they have to use artificial assistance to achieve erections.

Relationships with Women
Erectile dysfunction also affects the way in which men relate to women outside their intimate relationship. Where previously they would have been aware of the potential for sexual intimacy with women they met, that loss of potential now defines him and those interactions as non-sexual. Even though they might not have been actively pursuing a relationship, there had been a sexual undercurrent; the absence of that element in their everyday social interactions with women compounds a lack of confidence.

Sexual Imaginings

Part of being a man means being aroused by the sight of an attractive woman and fantasy is a part of most men’s everyday lives. There is a profound sense of loss that they can no longer imagine themselves as potential sexual partners and this is enhanced by a distressing lack of physical or emotional arousal. Many experience nostalgic feelings and a deep sense of loss over the demise of this small ordinary pleasure, even those who weren’t sexually active at the time of diagnosis. “It’s a capacity you’ve had all your life and then it’s gone.”

Masculinity
These changes undermine men’s masculine identities. The inability to connect with women sexually and the knowledge that they’ve lost their sexual capabilities leads to a diminished sense of oneself as a whole man. Sexuality is seen as a substantial part of what defines an individual as a man and men who have lost sexual functioning find themselves challenged to redefine themselves as masculine in our society. The ability to project self confidence depends on that underlying sexual capability.

As men have a tendency to do, many suffer these feelings in silence, not knowing how to talk to their wives or peers about it, and not seeking help from their doctors. Their wives feel bewildered and powerless; their husband’s have survived the disease but have withdrawn from them. They don’t want to pressure but mourn the loss of intimacy.

Orgasm is possible without an erection or an ejaculation, a fact often met with scepticism. For many men, an act without penetration and erection is not sex. Their partners say it’s not the lack of penetrative sex but the shutdown of sexual intimacy and sensual touch that they miss so much.
It is common to feel helpless but there are many avenues for assistance. Approach your doctor. They can give information about support groups or individual survivors who have experienced the same things.

The Cancer Council (at least in Victoria) can also refer you if you phone them. Seeing a sex therapist can help you reconnect with your partner to rediscover sexuality and intimacy. This can be a golden opportunity for couples to work together toward a much better sex life for both of them.

As always, wishing you happiness and great sex

Lynda Carlyle RN, MHSc (Sexual Health)

Ripponlea Medical Centre
100 Brighton Road, Ripponlea, Vic, 3185
Ph (03) 9525 6200