Recent Savage Love Letter of the Day: A letter writer's fiancé doggedly pursues a highly problematic kink, two women on the verge of a nervous dickdown, a letter with a lot going on in it, and a letter writer immediately cheated on the woman he recently committed to—should he tell all or shut up? And, as always, last week's column and Savage Lovecast.

For TIA:

Thank you for answering “Floored.” This is a very important topic for anyone who gives vaginal birth. Seeing a PT is a good start, but limited. There’s so much more to the postpartum aversion to intercourse, and it can be about trauma response from birth, and how the psychological connection to the pelvic floor. To say the birth trauma is understated is the most polite version of cultural understanding I have to offer. I’m glad you touched in how the OBGYN brushed TIA off. That’s fucked up. I think your response should include a broader range of modalities to address this, and to include how many women this effects. So many of your columns are about topics that effect so few, Dan, and this one really touches so many. I feel like your response was simplistic and downplayed and I can’t help but think you would respond differently if your PV had been ripped apart twice by a small human skull and you couldn’t fuck your husband. On the other hand, at least you printed her letter.

Well, as I like to say, a column is usually the start of a conversation about any given topic, not the end of the conversation...

I read the letter from "Thanks in Advance" (and your reply) with interest, as I had just been to a pelvic floor specialist the previous day. I have a similar issue and wanted to share some of the outcomes of the appointment in case they are of use. I don’t present myself as a medical expert, just as another person navigating an altered body and complex/slow medical system post-birth. It took me four months to realize I had a problem, four months to get my first appointment with a specialist and then another two for the follow-up, so I empathize with the letter writer’s frustration and wish to get things going. Scar tissue from the birth might be the issue, but there are other things to ask about too.

Firstly, breast feeding can drastically impact the moisture in the vagina. The specialist that I went to described the vagina during breastfeeding as (sometimes) presenting menopausal symptoms—low estrogen which causes vaginal dryness and thin lining that can tear easily. I am not sure if the letter writer is breastfeeding, but if she is, she might discuss an estrogen cream with her doctor. Also, I found out that I have a raging UTI and probably have had it since the birth. This post-birth UTI feels completely different to my pre-birth UTIs. I would never have guessed that I had an infection, but it is apparently the cause of a tearing pain in the urethra area during PIV intercourse. I was initially given the dilators that Dr. Gelman talked about, but this pain would not go away even with the smallest size. This is something to ask about, particularly if your doctor doesn’t see any obvious scar tissue. Finally, my specialist encouraged me to get my thyroid tested again, as imbalances cause changes in estrogen and progesterone levels.

And:

I wanted to share some info following your “post-baby vaginal dryness” response. I have a 16-month-old son, and also experienced extreme discomfort that closely resembled shards of glass, and dryness during intercourse postpartum while breastfeeding. Something widely unknown, I learnt eight months into our nursing journey, was that breastfeeding hormones can cause pain during intercourse (mother nature’s way of natural birth control!! Haha!) A pelvic floor therapist cannot help with this and didn’t help me. If this is the writers issue she just needs to ride it out, as soon as my supply dried sex immediately became just as fun again! Breast feeding = low estrogen levels = vaginal dryness, inflammation of the vagina, thinned vaginal walls. (“physicians fail to warn women of lactational atrophic vaginitis”) Please spread the word! I tell every mom I know, this needs to be more widely known. The fact that birth has occurred for thousands of years and there are STILL unknown, not commonly shared symptoms/experiences/issues infuriates me. If men had babies I’m pretty sure every single possible details would be on billboards.

Thanks for keeping it real, Dan.

And...

Thanks to you and (especially) your readers in devoting some attention to the issue of pelvic floor problems after birth. Like others, I had no idea the the toll that childbirth can take, and how many aspects of your body are affected. I was lucky enough to have a pelvic floor PT specialist in my little corner of Massachusetts. She provided both education and treatment, which was extremely eye-opening. She was hugely helpful and I encourage everyone to seek out this kind of support. However, I know her specialty is not always available or easily accessible. I was delighted when she developed a fantastic online resource that provides both the educational component and also access to exercise regimens (complete with video) to help address and strengthen pelvic floor problems. I've been recommending it to friends/family and it's extremely helpful, plus affordable. Whether someone has pelvic floor problems due to pregnancy or for another reason, this is a great resource and I highly recommend it: mycorefloor.com. Thanks for all you do, Dan, hope you'll spread the word.

On that woman whose boyfriend doesn't enjoy period sex:

Just read the letter from the woman whose boyfriend won't have sex with her during her time of the month, and it brought back all these awful memories of the days when I used to get periods (and I, like her BF, also used to hate having sex during that time.) Three or four years ago I talked to my gynecologist about getting rid of my periods altogether, and he put me on a special birth control pill that did exactly that. Would you mind spreading the word about this? It doesn't seem to be common knowledge, at least where I live—I don't know a single other woman who uses the pill in this way. When I've brought it up to people I usually get a confused reaction, or the question, "But is that even safe?" (There seems to be this idea that you can get "backed up", like a sewer.) But it is safe, according to my doctor, and it seems like real a shame that more woman don't know this is even possible. Periods can really, really suck.
Obviously everyone's personal medical issues are a factor, but I would love it if more women knew they could ask their doctors about this. Although my "special" pills (Lo Lestrin) are pricey, my gyno told me you can get the same effect with regular ol' cheap birth control pills by skipping the sugar pill days. The first few months weren't great, but now I can't imagine living any other way. No cramps, no PMS, no stained underwear, no bloating, no feeling like I got kicked in the crotch by a steel-toed boot twelve goddamn times a year, no scheduling my life around this thing. Best decision I ever made.

If you look up the history of "The Pill," I believe you will learn that the only reason it stops for a period is because Catholicism intervened; it wouldn't have been legalized otherwise. I got this tidbit out of a book of essays called What the Dog Saw. Also consider that evolutionarily, it is NOT normal for a woman to have a period nearly every month for 30-40 years. People who as if it's heathy forget that as far as evolution is concerned, a woman should usually be pregnant or nursing.

Anyone out there who's curious about the how "The Pill" came to be—and why those sugar pills (and the period) were included—should read Jonathan Eig's fascinating social history The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution. I can't recommend it highly enough!

And finally: someone who sought and got and took my advice—see the third letter in this column from "Needs Advice, Want Threesomes"—sent in an update:

You gave me tremendously helpful advice when you responded to my letter in Savage Love. I eventually broke up with my girlfriend. We're not friends, but we're not enemies either. I'm tremendously happier now and two months ago I met the love of my life. My new girlfriend is everything I've ever wanted in a partner and more—sex positive, foodie, fit, sexy and funny—and if this works out, Dan, and I think it will, we're naming our first born Dan or maybe Savage. (Savage would be such a radical name!) Keep on doing what you do. I'm forever grateful. Now you can sign me...
Advice Taken, Now Having Threesomes

Two months in is a little soon to be calling someone "the love of [your] life," ATNHT. Feeling like someone could be the love of your life at two months? Sure, yes, of course! But it'll take time to determine if that's actually the case—as you seem to be aware, ATNHT, seeing as you qualified your feelings in the very next sentence ("if this works out"). Here's hoping it does work out and thanks for sending in an update!

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