“If you'll place your feet in the stirrups…”

There are a number of reasons I consider my time at the University of Virginia a gift, but near the top is Dr. C, even though she represents hours and hours of having my feet in the stirrups. Not only did Dr. C extensively research the symptoms I described, but she also called doctor friends and colleagues who are specialists in the field of female sexual issues. After spending hours on my case, she took time to explain to me in precise, comprehensible terms what my body might be doing and gave me a choice of treatment options without pushing me in any particular direction. Two diagnoses were possible, and we had to decide which it was before we could design a viable treatment plan.

The first possibility—the one we were both hoping it wasn’t—was vulvodynia. Vulvodynia is chronic vulvar pain, and there’s no cure. The pangs can be anywhere from dull to crippling, and they attack you as you drive, swim, run after your children, wash clothes, and everything in between. While sex of course intensifies the pain, it’s more or less always there when vulvodynia is the culprit. The “treatments” are pain management programs, not cures, and many of them are, honestly, creepy. One commonly invoked method is a topical ointment featuring capsaicin, the active component of chili peppers. Chili peppers. That’s right: we’re talking feeding puréed chili peppers to my lady parts. Quite literally spicing up my sex life. The idea behind capsaicin—which, by the way, is every bit as much of a skin irritant as you’re imagining—is that you shock the nerves. Eventually, the nerves will calm themselves when they get over the pain spike. It seemed like thinly veiled, sarcastic masochism to me. “You think you’ve got pain right now? Wait’ll you feel this, dollface.” Cue the chili peppers.

Another treatment possibility is a vestibulectomy. I will explain as gently as possible. A vestibulectom-ist (that is not a real word) excises the really egregiously painful tissue in the vaginal vestibule, scooping out all the skin and tissue with the overactive nerves. To re-cover the excised area, a vaginal extension is performed, pulling vaginal skin forward over the area and securing it. Crossing your legs yet, women? The short version is that the surgery pulls out painful skin and covers it back up by using your lady parts like a rubber band sewn in place. The problem with this treatment—I say that as though there’s only one—is the formidably low success rate. As in, 50-60% according to most doctors. I’m sorry, but if you’re going to stretch my lady business, I’m going to need a higher chance of success than eh, maybe.

Other less invasive options are practiced. Dr. C offered me tricyclic antidepressants, for example. They are meant to affect the mental patterns of pain your brain creates. Despite how desperately I wanted to be cured, the idea of using antidepressants to alter receptors in my brain just so I could enjoy getting frisky seemed like regret waiting to happen. I did use Lidocaine, a topical numbing agent, for a while. But you might imagine the (viable) complaints my husband had about numbing ointment. Plus, it worked about as well as I imagine the chili peppers would. So Dr. C and I decided to rule out vulvodynia and assume my pain was vaginismus instead.

Unlike vulvodynia, vaginismus is not chronic. It is vaginal pain triggered by certain activities or movements. Also unlike vulvodynia, the pain is muscular rather than nervous. While vaginismus is certainly the root of much dysfunction and emotional and physical pain, the splendidly good news is that muscles can be trained in a way that nerves cannot. So if vaginismus is the problem, it is possible to be completely cured by working on the muscles. (I will talk more about vaginismus in the future.)

I am happy to report that my problem was in fact vaginismus, correctly diagnosed for the first time by Dr. C in October of 2010. We were finally, after two and a half years, on the right track. As I left her office, I could feel it—hope.