Tag Archives: vaginismus

Love Wins.

The church my man and I attend has real people in it – people who have excelled and fallen short in their efforts at relationships, being Christians, and life in general. In an environment like that, I shared my story out loud for the first time last Wednesday night. An unexpected thing happened: as difficult as it was to admit some of my more embarrassing mistakes, I became so proud of Jesus. So proud that my God is the kind of God who pursues diamonds in the rough. So proud that my God accepts me as I am – and you as you are – because he revels in the journey we’re on. So proud that my God is in control of the whole thing.

It’s like this. Addiction was a fourteen-year way of life for me – from 1996 to 2010 – and it sometimes nips at my heels even now. I didn’t reason my way out of it or will it to stop; you can’t treat addiction that way. Instead, I went to the office of a counselor hand-picked for me by God. For some, that sounds extreme I’m sure: couldn’t it just be a happy coincidence? But here’s the truth. I ended up finally making my decision to get help on a Wednesday that Dr. Morgan happened to be sharing the walk-in intakes, something he doesn’t always do. I arrived at the Health Clinic during his office hours, which are fewer than everyone else’s due to his research activities. He happened to be the one to take me back, even though several other counselors were available. His approach to counseling proved almost exclusively cognitive, in the sense that we looked around my brain and applied logic where I wasn’t. Given that I live my whole life in my brain, the method felt tailored for me. It’s all these reasons, and a few others, that assure me God oversaw my healing process, even when I wasn’t consulting him. He put me in the right setting to recognize what I was doing, why, and how to stop it. Then, he gave me the strength to change. If you’d ever seen me binge, you’d know: only Jesus can do that.

When I got married in June 2007, sexual dysfunction ignited my addiction, causing whatever shards of self-esteem I had left to dissolve in the heart-wrenching pain of loneliness and anger. My body was too wrong, too large, and sentenced me to a sexless marriage. Every failed “treatment” plunged me into further despair, and I looked to food with renewed zeal each time. I reached a low after my third miscarriage; not only was my body oversized, not only did it reject my then-husband, but it also made a farce of my dreams of motherhood. My destructive behavior had no limits: I binged, entered an inappropriate relationship, wallowed in self-pity and hatred, and ignored God’s invitations to surrender. I couldn’t see a way out of the dark and depression; for a while, I didn’t even want one. And even still, when I’d had enough, when I shrugged and said, “Fine, You win,” there was Jesus. Even when I’d turned Him down. Even after my divorce. Even when the old patterns lured me back. And now I can’t even see a shadow of the wife I was for so long. I have eyes only for my man, and I thoroughly enjoy him – loving him, living alongside him, sharing an intimacy with him that is exclusively ours. I have been made entirely new. Only Jesus can do that.

I shouldn’t be here, in this place of lightness and joy, after the places I’ve been. I spent years destroying my body, being unable and unwilling to stop abusing food. I’ve been through the loss associated with infidelity. I’ve felt the pain of my babies fading. I’ve walked through the disappointment and rage of (supposed) infertility. I’ve tried to soothe myself, to protect myself when I felt assaulted by the storm, only to wake up drowning in further waves of pain. But I’m here – joyful, peaceful, and free. Only Jesus can do that. I am married to the sexiest, strongest, kindest man God ever created. I am mother-by-marriage of two beautiful children that look just like my favorite man. I am mother-by-blood of a 34-week-old pregnancy miracle who is about to forever change my world for the better. I am blessed to live in a lovely home with a wonderful family that makes my life a joy beyond words, beyond anything I could’ve made for myself. But even if I lost everything tomorrow, I have been shown that my God is greater than the gifts he gives and the pain I endure. Whatever I live through tomorrow, He has the answers. He meets my needs. He loves me and speaks tenderly to me and remains faithfully beside me no matter where we go. No matter what happens, there’s Jesus.

That’s all I ever needed to know, really. I’m loved, I’m of priceless worth, and there’s always Jesus.

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Dragon-Slaying

My official diagnosis was vaginismus, or severe tightening of the vagina that makes sex incredibly painful or even impossible. For me it was a chicken-and-egg question: there was no way to know whether it was already happening before my surgery or whether the surgery indirectly caused it. Dr. C believed the latter, saying the surgery likely gave me a subconscious fear of sex; my physical therapist said it was a moot point. Women with vaginismus often go years without getting treatment because so few doctors know how to remedy it. Many in the medical community feel that vaginismus is strictly emotional and write it off with a “prescription” for sex therapy. I was lucky enough to have a doctor who believed in a holistic approach: Dr. C made me an appointment with a physical therapist who works exclusively with women’s health, listed home remedies and simple exercises that are proven to help, and suggested I see a university psychologist. She encouraged me to think realistically but hopefully: “Physical therapy will take longer than a pill,” she cautioned. “But if we can train your muscles, we can completely eradicate the problem.”

The idea of physical therapy was odd to me. What was the therapist going to do, massage my lady parts into submission? Mini nightmares (cue Jaws theme music) edged into my mind at random times of yet another medical professional getting involved with my uncooperative body. But in October 2010 I entered the physical therapist’s office half an hour before my appointment and filled out the obligatory paperwork. When Penny came out to greet me, I knew I’d made the right decision. She was a leftover hippie, sporting chunky jewelry and au naturel brown and gray hair. Penny is originally from San Francisco but had found a home in our own Virginian hippie oasis. She took me back to her therapy room, closed the door, and said, “What am I going to help you with?” And with that, she stole my heart. She was so confident, so compassionate, and so ready to help.

I told my story…again…rather dispassionately by now. My optimism had waned over the years, and I was starting to believe that, as Dr. B had warned me in the counseling room, “Some women just don’t care for sex, and it’s possible you are one of them.” Penny listened patiently, nodded, and said, “I can help. We’re going to get your insurance to cover this, and we’re going to train your muscles to relax. When you relax, the pain will subside. You might have some vestibular vulvodynia, especially since you still have scar tissue, but if the muscles stay calm, you probably won’t notice it.” So once more, I crawled up into the stirrups. Penny explained every move she made, locating tense and less tense areas, making a sort of map for treatment. The next appointment, she hooked me up to a biofeedback machine that used color-coded graphs to show us exactly which muscles succumbed to spasms, when, and how intense. Because of the information the machine provided, I began to differentiate my pelvic floor muscles, feel when they tensed, and learn how to release them. Tensing had become such a habit that I realized I was holding them tight even when it didn’t make sense—while studying, for example, or while driving.

Penny also taught me generalized relaxation techniques. As you might imagine, going through a master’s program away from my family-and-friends support system while dealing with sexual dysfunction and increasing marital difficulties was pretty stressful. We found that as I employed Penny’s global relaxation techniques, I was better able to manage the tensing of my pelvic floor due to stress. Over the next few months I spent hours and hours in Penny’s therapy room, practicing deep breathing, intentional muscle relaxing, and pelvic floor strengthening exercises. For her own part, Penny used the biofeedback machine, manual manipulation—the weirdest-feeling pelvic exam you can imagine, and strain-counterstrain techniques on my lower back (which is connected to pelvic floor muscles). Strain-counterstrain was my favorite. It’s a muscle-relaxing method in which you find a tender and/or ticklish muscle—in either case, it’s tensed—and apply pressure for 60-90 seconds until the muscle melts like butter. Although I had never had back pain, I felt so good after strain-counterstrain sessions.

I saw small successes every step of the way. After just a few sessions with Penny, I started noticing when the spasms happened, and I was able, gradually, to mitigate them and then stop them altogether. Next, I was able to start using tampons, which had never been possible. Then, I made it through an entire exam with Dr. C with absolutely no pain whatsoever. Finally, when Penny had to use certain instruments during manual manipulation, I stopped having spasms. Granted, I had to be present in the moment, focusing on my pelvic floor muscles and their movements…but for the first time, I wasn’t having any spasms at all. That was the first moment of my life that I felt true confidence in my body. Maybe—maybe—there would come a day when it didn’t feel broken. Maybe there would come a day that sex would be enjoyable. Maybe I would one day feel womanly and feminine and even…did I dare say it?…alluring. For the first time, all of this seemed possible. At this point, no sex of any kind had been a part of my life for several months, but with the possibilities there, I started feeling a sense of pride in my body and decided it was time to lose weight. And that is exactly what I did.

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The Dreaded 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. Naturally, while sex 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, quite frankly, 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. Like, 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. Women, are you crossing your legs yet? 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 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.

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Killer Ovaries

In August 2009 we moved out of state for me to go to school. Part of my scholarship was 100% coverage for any services provided by the health clinic, so within a month of our arrival, I made an appointment with the university gynecologist. I wanted answers and figured that starting all over with a new doctor might occasion them.

Words cannot express how grateful I am for the incredible health insurance the university provided me and the amazing doctors who helped me. Dr. A was my first doctor at the university, and he listened patiently to my story. He promised me we’d find an answer. When I’d finished giving him all the pertinent details, he began asking me some questions—how much energy did I have, what were my eating habits, what was my typical menstruation cycle. Answer by answer, we elucidated the constellation of symptoms and their probable cause: polycystic ovarian syndrome (PCOS). It explained so many of my body’s abnormalities. In order to verify the diagnosis, we checked my thyroid, blood sugar, and hormone levels. Just as Dr. A suspected, the culprit was PCOS. He referred me to Dr. C, a specialist at the university in female reproductive disorders.

Dr. C gave me tons of information on PCOS. She explained that the catalyst for my sugar cravings and low energy was insulin resistance, which often accompanies PCOS. Additionally, my hormones were imbalanced, causing irregular periods and other embarrassing problems. Gone untreated, Dr. C told me that PCOS would likely lead to diabetes and perhaps eventual death from it. Despite the enormity of my frustration with my body and the severity of the issue, I still struggled with the decision to start Metformin. For one, a family member of mine had experienced serious problems as a result of taking it. But also, I didn’t like the thought of being on a medication for the rest of my life, especially at the age of 24. After a few weeks of serious thought and prayer, I filled the prescription.

The first six weeks I was on the drug weren’t my favorite days. Metformin causes nausea, painful cramps, and trapped gas, to name a few. I started on the lowest dosage possible and still felt awful. Every time I had to increase the dosage, the symptoms redoubled. But after I’d paid my dues—about ten weeks in—I started seeing a genuine difference in the way I felt. I dropped 10 pounds almost instantly and found it much easier to lose weight even after that, having regulated my insulin imbalance. I had more energy. My menstruation cycle regulated. I felt better than ever, truly. I felt well, healthy. It seemed, honestly, like everything had improved. Except my sex life.

Oddly, the one thing I’d gone in for answers about went unaided. It wasn’t Dr. A’s fault or Dr. C’s fault. It was simply that hormones and insulin and cysts were apparently not causing my dysfunction. When I mentioned this to Dr. C, she said, “It’s so odd…Normally, women with PCOS have a higher sex drive and lower occurrence of dysfunction, due to elevated testosterone levels. We’ll figure it out, Amie. I promise.”

She meant it.

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Exposed!

As time went on, sex became somewhat easier: the shock of the pain ebbed because I knew what I was in for each time. But I wasn’t satisfied with that—I had more in mind for my sexuality—so I began reading voraciously. I read The Gift of Sex by Clifford and Joyce Penner, a book Dr. B called “a good starting place.” And it certainly would’ve been, had I been normal. I read Sheet Music by Kevin Leman, a recommendation from a friend that turned out to be really interesting, if not especially helpful in my then-current state. I read Cosmo articles. I read excerpts of The Celebration of Sex by Douglas Rosenau. I read The Act of Marriage by Tim and Beverly LaHaye (skip it). I read excerpts of Intended for Pleasure by Ed Wheat. I read articles from several websites. I even read a book about kissing. The problem with all that material was that nowhere did it describe anyone like me. Advice for avoiding awkward wedding nights, rekindling the passion for older couples, adjusting to babies in the house, and breaking sexual inhibitions abounded…but there was nothing for me. When I used indices to reread portions that supposedly addressed lack of sex drive and/or painful sex, the most I found was “Try some relaxation techniques,” or “See a doctor.” Once more I felt alone in my struggle and frustrated that I couldn’t seem to help myself. These books were designed for people whose biggest problem was ignorance or a stressful schedule. Mine was all-out dysfunction.

I seemed to be hitting the same wall with Dr. B by that point. I’d tried all the sexy music, sensual massage, glasses of wine, and non-intercourse intimacy I could handle. I’d lit candles, I’d watched romantic movies, I’d read and written some erotica. And don’t get me wrong: Dr. B’s influence was absolutely crucial in my battle for healthy sexuality, and with his help I made some very important strides. But my sometimes-impatient self was irked when the speed of my progress cooled. Even though there were occasional days and nights on which I truly wanted to have sex, it still wasn’t “making love.” It was fulfilling an uncomfortable, frustrating duty. I was nearing the end of my rapidly fraying rope, and unfortunately, that is where the story pauses for the next year and a half of my marriage. Sex was possible but excruciating, and my enthusiasm for satisfying sex was evaporating by the minute. I threw up my hands in frustration with God for not erasing the problem.

The night I ran completely out of patience, two years into marriage, is still as vivid a memory as the chili I ate tonight. My husband and I had another couple over for dinner, and after dessert we decided to play a game (as often happens if you are my dinner guest—fair warning). Although we knew we were at a disadvantage—they’d weathered several more years of marriage than we had—we were up for the challenge of the Newlywed Game. One question the two husbands were asked was, “When was your hottest night of lovemaking in the past year?” They both recorded answers with seemingly little difficulty. However, when my husband revealed his response, his friend said, “For us, pretty much every time is awesome. You must not have had a lot of sex if you can remember a specific night.” Usually I have a great poker face, but that night I sat there stunned, staring at my husband’s friend, with whom it didn’t seem to register that he’d said something deeply insulting. All the feelings of being exposed, of fighting an embarrassing battle of inadequacy, washed over me. Burning, crimson shame appeared on my face. Everybody knows, the sickening voice in my head whispered. Everybody knows.

For me, the problem with all this sexual strife is that it’s the one thing we’re supposed to figure out entirely on our own. All any person or book ever said was, “It hurts in the beginning,” and “Figuring it all out with your partner is so much fun!” Well…what about those of us for whom it was still painful after two years? What about those of us who couldn’t figure anything out, even with a manual like Sheet Music, because it was impossible to make even the “easy” stuff work? Who are we supposed to turn to? Try to talk about sex in your Bible study, and you’ll likely make the room fidget and drop eye contact faster than you can say “scented massage oil” unless you have an unusually open group. I found that very few people, even my closest friends, were able to give me real, honest information, their words being veiled by a sense of propriety. (Not that there’s anything wrong with propriety; it’s just frustrating to hear about it over and over when you truly need answers.)

After my husband’s friend made his comment, it was literally weeks before I was able to face my bedroom frustration again. Everything had simply begun to feel insurmountable.

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Sex-Free Honeymoon

The more I talked to Dr. B about sex, the more layers of ugliness we peeled back. We spent the first few sessions primarily on my anger and disappointment over the way things had turned out and how my brain linked those negative emotions with sexuality. And then we spent hours and hours working through all of the religious, churchy oppression I’d been subjected to. You can imagine, then, that “shame” wasn’t a foreign word in our meetings. But gradually, shame over having sex dissipated and left something unexpected in its place: shame over not having sex.

My husband and I got married on a gorgeous June day in Colorado in 2007. Our ceremony was a perfect, a family-only celebration at his parents’ house. The honeymoon, however, wasn’t scheduled until October—we wanted to give ourselves plenty of time to settle into married life before going on vacation. But as I sat in Dr. B’s office less than 48 hours prior to leaving for the Canary Islands, I was stressed and frustrated that after months of trying, sex still wasn’t possible. And we were getting ready to leave for our honeymoon. “I always imagined my honeymoon as a week of walking on the beach, making love, and drinking champagne!” I exclaimed. “All I’m thinking right now is how angry I am that this once-in-a-lifetime experience is going to be nothing like what I pictured. I won’t have a honeymoon like everyone else’s.” Every attempt at sex had ended in disappointment, shame, and sadness for me, and the thought of an entire week of nothing but that was too much to bear.

“Amie, you have to decide right now that you will not have sex on your honeymoon. It simply will not happen. Your honeymoon will not involve sex. Will you admit that for me?” Dr. B was sterner that I’d seen him. My eyes welled, and I nodded. That moment was a breaking point for me. Certainly I’d felt sexually angry and helpless before, but sitting in a strange man’s office declaring that my much-anticipated honeymoon would be sexless just seemed so unfair. My marriage had not begun at all like I’d expected. Everyone, including the minister who performed our ceremony, told us how steamy the first year would be, given that we were in our twenties without having been sexually active. We’d be fighting a lot and having lots of makeup sex, we’d be missing each other terribly while at work, and we’d have the novelty of romance still intact. Married couple after married couple prepared us for that. Not experiencing anything like it, I felt shortchanged in so many ways.

Dr. B let my tears roll in silence for a few moments before pressing on. “Sex is not the only way to enjoy each other, you know,” he suggested. I returned his eye contact but inwardly rolled my eyes. “Try not to focus on what isn’t yet possible. Instead, explore each other’s bodies in ways that are.” He explained that he believes many couples lose their sense of wonder over their partners’ bodies because they stop doing this. “Take some time to really look at each other, take in the delicious physical gifts you have to offer. Just because you can’t have sex doesn’t mean you aren’t sexual, and it certainly doesn’t mean you can’t enjoy sexual pleasure. If on your honeymoon the intent is to be close and exult in the physical gifts you can give each other, you’ll have a very satisfying week. Sex is an expression, not just an act.” I wasn’t convinced, but I did leave encouraged.

I was still mentally working through all of this when the alarm went off Saturday morning. While my husband and I are both seasoned travelers and light packers, we are notorious for arriving late to the airport. That October morning was no exception, and we fairly flew around the house, trying to get last-minute issues resolved and decisions made. The whole time, my mind was also working with the sex-free-honeymoon situation I was facing and the utter frustration of it. The longer I turned the thoughts over in my head, the more I became embroiled in a maelstrom of negativity. Looking back, I realize that this was entirely my fault for not taking control of my thoughts, and every time we “expressed ourselves” over the course of the week I felt a backlash of anger and hopelessness. By the time we returned home, I felt an intensely deep shame over not being able to perform wifely responsibilities. It was time for another discussion with Dr. B. Even though I had been going every two weeks, I called and scheduled an additional appointment when we got back in town.

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Talking About My Feelings

One of the first questions Dr. B asked me was, “What are your feelings about sex?” You’d think after months of obsessing over it, this would be a no-brainer. But after a knee-jerk response of, “Anger,” I had little else to say at first. What were my feelings about sex? As I thought about it, the proverbial dam broke, and I found myself emptying my head of quite a lot of thoughts.

“I’m angry—angry that my body doesn’t work, angry that God won’t answer my prayers, angry that my mind is apparently causing problems, too. I’m angry because I imagine everyone else in their lovely homes gets to have lots of wonderful sex with their partners. I’m angry because it feels like there’s a huge aspect of life that I don’t get to be a part of. I get angry when I hear my coworkers talk about sex…it seems like no one else struggles with the stuff I’m struggling with. And I’m angry that no one listened to me for so long, so I’m in this frustrating place now where I simply can’t make sex work for me. Of course, even if that first nurse practitioner had mentioned the scar tissue, I’d still probably be sitting here. But it would’ve been one less obstacle to deal with after the wedding.

“And I’m really, really disappointed. Sex is built up to be this great thing that makes you feel good, makes you feel close to your partner. I haven’t had a moment of that. It hasn’t made me feel good, and it hasn’t made me feel close to my husband. If anything, it’s been the complete opposite on both accounts. I can’t believe how stressful sex has made my life. I wish God hadn’t created it to being with, honestly. All it’s done for me is made me feel estranged from my spouse and hate my body even more than I already did. I mean, the honeymoon period is supposed to be all sex and rose-colored glasses…we haven’t had sixty seconds of that. This marriage and sexuality business has been nothing but heartbreak, stress, and frustration since the very first days after our wedding.

“I’m scared. I read a sentence in a book by a Christian marriage counselor that terrified me: ‘If you don’t have a passionate love affair with your husband, someone will.’ I can’t! I can’t have a passionate love affair with my husband! To be completely honest, I wouldn’t blame him at all for finding someone else. I mean, he’s waited for 26 years to have a sexual relationship with someone, and I can’t do that for him. It’s not fair for him to kiss it goodbye forever. And who knows? Maybe I’ll never be able to have sex. Some women never can—I read that somewhere. It would certainly hurt me if he cheated, but in the end…I’d understand. I can’t give him what he needs. And it just seems wrong to think after four months of marriage, ‘I wouldn’t blame my husband for cheating on me.’ That’s not normal.

“But I mostly feel hopeless. I’m still determined to make this work—I really am—but my hope is waning by the minute. It seems like we’ve already explored so many options—counseling, surgery, now this—and nothing is helping. Granted, you and I have only just started talking, so I have some hope there. But I have a hard time believing that it’s this hard for other couples. It seems like talking to someone in the beginning should’ve been enough. Surely surgery should’ve been enough. It’s gotten to the point where it’s embarrassing. I feel like I missed a day in school or something, and I’m being punished royally for it. The students I teach at the high school know more about sex than I do. I feel like an idiot, like an inadequate idiot. And I feel like everyone can see it.”

After I’d finished my monologue, Dr. B nodded. “We need to talk about your past.”

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