Ouch, that sucks. One thing I'm wondering about is if her periods are especially painful, is there a specific reason not to suppress them with birth control?

@1 That's a good point. If the combination birth control pill is safe for her, it might be a good option. Unfortunately, it does have a lot of risk factors and contraindications, so there are a lot of people who can't safely use it due either to increased risks or bad side effects. Safer methods that sometimes suppress periods also don't necessarily suppress periods for everyone who uses them. But it does seem worth checking for a person in this position. Given it's been 7 years and the woman has been to various doctors, it's highly likely that it isn't a feasible option for her or it would have come up (I would hope). But for other people reading this, if it applies to them, it may be a good option.

"Doctor, Doctor! It hurts when I do this!"

"Don't do that."

Anxiety over pain can be as bad as the pain itself. I hope this couple can find a work-around that works for them. There's all sorts of sex. FIguring out what works should be a fun exercise in itself, especially if approached with humor.

BTW, after you've been with someone a LOT of years, sex is a lot of good things, but "mind-blowing" is hard to achieve on a regular basis. Frequency = familiarity. With familiarity, it's hard to be unexpectedly awesome. Even expectedly-awesome can't be mind-blowing, since you're expecting it. It can be very, very nice, though.

You could do worse than settling for regular and pleasant intimacy with someone you love.

LW specifically mentions sphincter spasms preventing elimination (urinary or fecal or both?).

Could be proctalgia fugax, generally of unclear origin but quite possibly a consequence in this case of the earlier pelvic-floor injury.

Nerve damage can cause malfunctioning of the rectum, preventing it from emptying completely during a bowel movement (premature spasms or reverse peristalsis), and the residual stool can trigger proctalgia fugax contractions during sleep.

As painful as it is, and assuming other problems have been ruled out, there are specific possible pharmaceutical remedies. Reassurance, hot-tub soaks before bed, and gentle anal massage during an episode all can help, along with the meds listed in the Wikipedia article and NSAIDs such as Tylenol and Aleve. If Dr. Brotto's specific resources don't help, consulting a proctologist might be a further suggestion.

This is partially in response to @1 and @4's suggestions re: hormonal birth control.

I had vulvodynia for about 8 years, and in my case the situation didn't resolve until I got completely _off_ of hormonal birth control. (Switching types of birth control was not sufficient. I had to get completely off of it.) I don't know that our situations are exactly comparable though, as (1) my trigger was not pelvic injury, and (2) my clue as to the problem was that period sex was the least painful. I guess my takeaways as someone who's been through something similar is (a) if BOB's wife has been on regular medications for many years, it might be worth examining whether any of them might be blocking healing, and (b) pay attention to not just what feels good but when it feels good, as that can be useful data.

In the end, I can't really know if the birth control caused my pain or just blocked my ability to recover from the insult, but it's worth keeping in mind.

Another piece of advice, now that I think about it, I was resistant to therapy at the time because, well it's hard to remember what I was thinking, but I just didn't want to talk about it, especially with a relative stranger (ie therapist). That was a mistake. Especially after 8 years of this, both me and my husband had a lot of things that were weighing on us. We sorted it out eventually, but therapy earlier would have been helpful.

Good luck!

Well if this don't make a lotta ladies cross their legs, nothin will.

And a lotta men really appreciate the risks their women go thru to bear them children.

Oof...well, I learned something I hope I never wind up needing to know. I feel bad for the both of them.

It's nice to see such an apt illustration of "horses for courses".

@9 Some people really want children and are willing to undergo massive risks to have them. As to those who don't want children, this is just one of many reasons good birth control options and easily available abortions are vital. Nobody should have to take the risks of pregnancy and labor unless they choose them. But many people do want to have children genetically (or can't easily adopt... it really isn't as simple and easy an option as people tend to pretend it is) that they will knowingly accept such risks. I don't know if this woman knew it was a possibility before having kids, but I think it's rude to use a serious medical problem as a reason to be sex-negative and procreation-negative to a couple of parents.

Wow Dan! Thanks for bringing in this Lady Parts expert! I feel like I just got a graduate course in one letter!

@13, I think you're reading wayyyyyyyyyy too much into @9's response. I didn't get any sex-negative or procreation-negative vibe from their response at all. I think s/he was just trying to say that a lot of ladies will read this and, thinking of how painful it would be to have such an injury, literally cross their legs at the thought. I know I did.

@15 That's possible. There's a lot of sex-shaming, so it may not have been meant as implying that they should do that, just that they might wince and do that. If so, my apologies for not having thought of that interpretation.

I just want to add from experience that pelvic floor physio can be very useful for vulvodynia. Focusing on the ability to unclench may be the key.


Also, in a situation where the pain is kind of coming back under control, massaging the clitoris to 'redirect' the nerves at the start of penetration has been effective for me. Not sure what an expert would say about this, YMMV, etc.


Other advice you get for vulvodynia says don't use any products that could irritate the vulva, like soap, perfumed cream, etc., or even clothing softener on underwear. Aqueous cream is a good non-irritant alternative to soap/shower gel.

Thought of something else. I take a mild anti-muscle spasm prescription for the overall problems I have with pain and muscle spasms. Sex is noticeably easier shortly after I've taken it. I don't know if such drugs are used for vulvodynia/vaginismus, but it might be worth discussing with a specialist.

@5 masochistic sex can be mind-blowing, even over decades with the same partner. You don't ever really become used to the pain, and there are so many creative ways to deliver pain. That doesn't help the non-kinky, I suppose, but maybe learning something about BDSM techniques might give them some other fun tools in their toolbox. (I'm thinking of how you can distract yourself from one kind of pain by applying a different kind.) On the other hand, I could totally see her not wanting to experiment with any kind of extra pain, given how much she has had to endure already.

@20 fwiw, I didn't find that my experiences with BDSM were able to assist with the vulvodynia style of pain. It's just too distracting. Rough vaginal sex when my vag is healthy? That's legitimately fun for me. When I was experiencing vulvodynia, though - any kind of contact was more akin to the sensation of rubbing up against burned or severely bruised skin. It was just too sensitive and uncomfortable. I couldn't work with it. That's just me, of course. Try to imagine taking a flogging if your back was already suffering from a burn or something like that. It's a bit much. I'm not saying noone could get their kicks from it, but that's on the extreme end of the scale.

@Luluisme, thanks for writing with actual experience to counterbalance my imagination.

But if I may ask you for more details -- what if the pain were somewhere completely different? Would it be possible for nipple torture or needle-play to distract you (with endorphins) from the vulvodynia kind of pain?

@EricaP, no, unfortunately. At least not in my experience as a submissive with vulvodynia (now mostly under control). When you are in pain all day, all week, all month, adding pain for fun just feels like noise at best and overwhelms at worst. And one of the worst things for vulvodynia was being aroused, because it woke up the nerve endings which made them more sensitive to the pain. Ugh.

What about Acupuncture? Visualization and Meditation? Swimming in the Ocean?
Might sound glib suggestions. Just my standbys for physical and emotional pain. Have not had any of these conditions, however.
LW, so sorry your wife has such a hard time. You and your child too.

@15, That was exactly my reaction: "Another reason not to have kids!" I don't think sex-shaming was intended in @9's leg-crossing comment.

And my second thought was that this is a perfect example of why men shouldn't have any say in abortion ... women alone bear the physical risks, they alone get to make the choice.

Regular reader but never usually post. I had severe pelvic floor pain for about 6 months last year following a D&C with complications after a miscarriage. Similar to LW's wife, pain would sometimes keep me up all night and made sex very difficult. At one point it was difficult to leave the house.



At that time a friend was doing a clear out and was getting rid of a vibroplate machine (you stand on them and they vibrate - they are supposed to be good for muscle tone) which she donated to me. Unexpectedly after about 3-4 days using the machine I was completely pain-free. I'm imagining that the vibrations helped to "unknot" whatever tension was causing my pain. Whatever it was I'm very relieved!



While I don't know if this would help the LW's wife as her issue has been going on for quite some time, it worked for me, and might be useful to someone googling desperately for a solution in the middle of the night as I often was!

@EricaP, well it doesn't hurt to try things, and personally I definitely had better days and worse days vaginally, so experimenting is key. And also, your point about the pain being someplace completely different - I don't agree with @24 that this could never work. Any kind of play that is not focused on the vagina IMO is a great idea for someone with vulvodynia. (Although, I didn't find that arousal made things worse. YMMV.) That being said, it's definitely a different ballgame to incorporate pain play when starting from a context of already feeling injured. It's challenging not to feel anxious, which makes things worse. On some level, the Drs advice above about "when sex hurts, you should stop" is really spot on. It's easy to pressure yourself into doing things your body's not ready to do, because you remember that time when it was.

True @26. It is Women's Business.
Birthing, should be Women's Business, as well.
Watching any TV show, women giving birth, invariably the woman is lying down. Worst position to give birth. Walking round during labour, groaning into the contractions, not yelling in pain.. And squatting to give birth. Being vertical, not horizontal.

From years of lurking around women's health boards, I would say the most important thing is finding a good specialist.



I will also put in a plug for high-dose fish oil, helps with pain management.

I learned more about my vagina today! How cool is that?

Has anyone mentioned proctalgia fugax? I didn't read the comments, but I didn't see it in the official response. You might want to look it up, BOB.



The sphincter pain in particular made me think of that. I'm a writer, and I did research on it awhile back. Much of the doctor's response sounds familiar--controlling the pain requires learning how to relax those areas (muscles) when you feel it coming on. Overall stress reduction helps, and practice in isolating those muscles and learning how to relax them when you feel the pain coming on is key. Knowing the type of trigger--knowing when your body is tightening up from stress--helps too, and it's an alert to slow down and relax.



This may or may not apply, but it sounds like it, maybe along with everything else the doctor said. It can't hurt to look it up if you haven't already. Good luck.

Dr. Brotto suggests that the problem may have progressed to a condition where the experience of pain has been pushed down and down to a very low threshold, so light sensations are perceived as pain. That makes sense to me - if you can push limits up, far beyond where they started, you can push them down, too. What the two of you need is to start moving those limits the other way.

From many years experience as a bottom in intense sexual stuff, I know that few men who are exclusively tops really understand what "slow" means, and few exclusive tops really understand what a slow buildup is. This is not their fault, and it's easy to teach the willing, but it's a very common problem.

That may be a part of what's going on when having sex in this situation.

When anyone, for any reason, has been brought to a physically and mentally highly charged super-sensitive state, just about anything can go over their limit. Then, you need to slow wayyyyy down and get very subtle. Hot breath on a nipple can be extremely intense. A tongue just resting on a sensitive area, not moving, can be extremely intense. Moving that tongue might be too intense when someone is in a particularly sensitized state, so going from not moving to moving should be done very, very gradually (much more gradually than you think should be needed), to allow the person who's nipple it is (this of course applies to other body parts) to handle the increased sensation without it tipping over into unbearable sensation.

My recommendation if you two choose to try sex together again would be for you, the guy, to forget about your dick for awhile, and forget about orgasms for awhile. Go for hot breath on the sensitive parts of her, maybe the lightest of touches, and movement AT LEAST five times slower than you think is too slow. Really. Slow. Go for small sensations that are completely within her comfort zone and then very. very. very. gradually. increase them, enough to keep her interested, but sometimes more gradually than she wants. You want her to ask you for more, which means that you stay well within what's comfortable for her at first. If it takes an hour until first tongue contact, that's just fine. If you don't get to first tongue contact at first, that's fine too. And when she asks you for more, increase any sensations very gradually, watch her non-verbal responses, and trust them - her non verbal responses will tell you when you should back off some (even if she's saying more) or when you can gradually get less slow - you've got her mind and body both giving you signals, and you need to follow the most conservative of the two at first.

If all this going very very slowly stuff is new to you (we don't know those intimate details), you'll have to calibrate your behavior by paying close attention - eventually you will get the speed right.

If you are attentive, and you can go really slowly, and you can go really lightly, and you can increase those sensations very gradually (that's the real clincher, increasing only as fast as your partner can handle it, which is usually much more gradually than you are inclined to go) then a partner's sensation limits can be pushed higher and higher over time, until he or she will be able to get pleasure from amazing degrees of intensity. But close attention is needed, because you want to push oh so slowly against those limits, and nudge them higher than they are now, but never go over them. When you go over the limit and strong sensation is felt as pain, you lose a lot of ground and have to start back at a much lower level of sensation again.

This is the kind of situation where going much more slowly will get both of you where you want to go more quickly.

Good luck!

@36, I never understood that process before, thank you for spelling it out here.