Survivor

Friday, November 12, 2010

Question

My wife has vulvodynia. When we first got together, I knew that something was bothering her during sex, but it took a while for her to be truthful with me about how bad the pain was. And it took two years for us to find a doctor who gave her a diagnosis instead of just telling her the problem was all in her head, she needed to relax, she needed anti-depressants, blah blah blah.

At the time, it was easy for me to accept the fact that our sex life would be minimal. I was actually kind of relieved because I had issues of my own. My sex abuse history is horrendous. I was raped by several male and even female relatives. This went on from early childhood until shortly before I left home. But once I got out of danger, I was smart enough to read books about healing from abuse, join a support group for men who had been sexually abused, get into therapy, and stay there until I could stop being hypervigilant and having nightmares. All the other wonderful symptoms of PTSD  haven't gone away 100%, but I am no longer triggered by sexy images on  television or a come-on from a colleague.

Now my therapist agrees that I am ready to be more sexually active. I am more in touch with my own body. I'm able to have sexual fantasies of my own that aren't about re-living any of the awful things that were forced on me. I don't blame myself for what happened, and I am pretty secure about how my masculinity is expressed and perceived by others. So I want a closer relationship with my wife.

My attempt to talk about this did not go well. She got frightened and upset, and withdrew from me. Now if anything we are even further apart because she believes that if she is affectionate with me, I will want sex. She doesn't seem to understand that my definition of "sex" is pretty broad, and that I never want to do anything to hurt her. It was several years since we got her diagnosis, and I wonder if there are more treatment options today. Is there any reason why she would not want to get the vulvodynia treated?

We clearly need some counseling but I was hoping you'd have some concrete, practical ideas that would help us in the meantime. Any improvement in communication or any change in our marital relations is welcome!

Answer

I want to acknowledge the hard work that you've done to cut ties to the past so you can have a life of your own. It is especially heart-warming to hear from another man who experienced sex abuse. This awful crime happens much more often than people will admit. I hope things continue to get easier for you, and that happiness comes your way.

Vulvodynia is a single term that may cover a bunch of different problems that cause pain in the outer female genitals, the vagina, the cervix, and the perineum. The rectum can also be affected. The level of pain, its duration, and the location vary greatly from one sufferer to the next. This area has a lot of neurological connections, and the cardiovascular system is also a part of sexual sensation and functioning. Doctors are having a difficult time figuring out exactly why one woman might experience stabbing pain when she urinates, yet be able to have intercourse, while another woman can't tolerate sitting in a chair. Sex is impossible for her. The variations on this condition are too numerous to describe here. Funding to research vulvodynia is almost nonexistent. The people who suffer from a medical problem need to form special-interest groups and lobby for research funds. But this is a condition that people feel reluctant to speak out about in public.

In your case, it is important to point out that other problems can co-exist with vulvodynia. Not everyone who has chronic genital pain wants to have an active sex life. This may be because of a low libido, a strict upbringing where sexuality was condemned, or a value system that forbids acting on passion. Women with vulvodynia may have had good, active sex lives before the condition got too bad to make sex possible, or they may never have enjoyed sex. Again, the range of actual experience and attitudes toward sex are broad. Knowing more about your wife's background would be helpful. If she's never or rarely had genital stimulation that wasn't painful, she may understandably want nothing to do with sex.

Getting your partner to talk to you in more detail is the first step. Find out how you can set up a conversation that feels safe to her. Would it help to promise her that you will not use this discussion as an excuse to proposition her? In fact, you might suggest an agreement that there will be no sex for a certain period of time, until the mutual interviews and questions are done.
The purpose is to understand each other better, not gather hints to further a seduction. Both of you can share what you were taught about sex and your early experiences with it. What was your best experience to date? If each of you could have a perfect sexual relationship, what would that be? Share these ideals. Remain patient, calm, and in good humor. Have compassion for one another. Sex is one of the most vulnerable areas of our lives. An off-handed comment that is not intended to hurt can resonate and cause damage for years.

This may help you to understand what all the barriers are to a better sex life. I have a hunch that even if you could take your wife to a doctor, and he could miraculously take away her pain, she would still be sexually inhibited or disinterested. But I do hope I am wrong about that, and that this incompatibility will be easier to resolve. Making love could include giving each other a massage, holding one another, and touching erogenous zones that are pain-free. Many women with vulvodynia find that they can touch themselves if they need to have an orgasm, and this for some reason provokes less pain. Mutual masturbation can bring a couple very close together. If intercourse won't work, perhaps you both would enjoy intercrural sex (your penis would be inserted between her thighs). Oral sex is also an option. A mutual agreement to communicate pain or anything triggering, and stop so you can take care of one another, is important. A lack of pressure to do any specific challenging act will help to build trust.

Treatments for vulvodynia include treating the pain with analgesic cream or ointment, pain medication taken by mouth, biofeedback, relaxation exercises and meditation, and acupuncture. Unfortunately, some of the medication given to people with chronic pain can also dull the libido. Perhaps your doctor can prescribe an alternate treatment. Some body workers claim to be able to relieve the pain. Western medicine's most extreme treatment suggestion is to identify the nerve(s) responsible for the pain, and cut them, so that the area is numb. Reports on the success of this method vary from "it doesn't help at all" to "the majority of patients got relief." I'm not sure who to believe.

If you are going to pursue new treatment options, the two of you will have to repeat the process that you went through to get her diagnosis. Start looking for specialists. Figure out how to afford the travel and consultation fees. This process is difficult for both of you, but I think it puts your wife in an especially fragile place. Getting treated like a lab rat, poked and prodded by strangers, and having to talk about the most private aspect of your body are no fun at all.     

You are probably going to hate the title of this book, but it is a complex and insightful work that I always recommend to couples who have unequal levels of desire or need for sex. The Sex-Starved Marriage: A Couple's Guide to Boosting Their Marriage Libido by Michele Weiner-Davis is careful not to take sides, but the author is sex-positive and believes that mutual pleasure and intimacy make a marriage better. For couples who need to create more emotional rapport and perhaps seek alternate routes to gratification, I recommend Urban Tantra: Sacred Sex for the Twenty-First Century, by Barbara Carrelias and Annie Sprinkle. Both books are still in print and can be ordered at a bookstore or on-line.

There are also some good Internet resources. Here are some of the things I found. At www.womenshealthmatters.ca/centre/pelvic_health/vulvodynia/treatment/index, there is a good description of current treatment options. This information is also available in French. Go to the Home page to be taken to that associated site. An article in a little more technical language, but still comprehensible to the lay person, by Tori Hudson, ND, is entitled "Vulvodynia: Diagnosis and Treatment." I found a copy at www.tidp.com/issue/166/166/vulvo.htm. The National Vulvodynia Association is also worth contacting. Their website page on treatment is at www.nva.org/treatment/html. They can be reached by phone at (301) 949-5114.

I may be harping on the gender inequality issue a little too often this month. But I would like to ask, Gentle Reader, what do you think would happen if a significant number of men experienced blinding pain every time they tried to have intercourse? Would science and medicine hurry to their aid? Would legislative committees grump about finding the tax dollars for research? Uh huh. Just sayin'.