Posts tagged ‘Pelvic pain’

Period. Ow. 

I’m less tight and painful this time than I have been last time, which was better than the time before. But still, it’s tighter than normal and placing myself on a chair often hurts. My right side of my pelvic floor twinges when I walked for the past couple mornings. I get mild spasms when I have to poop because it pulls on those muscles. 

I know it’s way better, but it’s still so discouraging. 

Ow. 

I am heading home from what was supposed to be a movie date with BF1 because my muscles are spasmy, tight, and painful. I hate it when they get like this, and I can feel the pain and tightness when I walk. The dilator didn’t glide right in this morning either. 

We’re heading home where BF1 will cuddle me, we’ll watch a movie, and I’ll have some Scotch and use my myofascial ball. But damn. 

A sexual trauma

Four years ago:

We’d been in some sort of nebulous sexual relationship for a few months, with a prior six-week period before that. The sex was good; we had chemistry. He was not amazing at checking in or adjusting when I had muscular issues, and had always been a little pushy sexually.

I was at his place for the weekend. We were having sex; he was on top/behind me, I was on my belly. Things were going well until he was close to coming, at which point, he pushed in, all the way, hard. It HURT (and continued to do so for at least twenty minutes as my muscles seized up). I said, “Ow, ow, ow, please pull out now.” And he waited a minute before he did.

When he pulled out, I went fetal, withdrawn, and semi-catatonic, feeling very sad (I later learned this is a very typical trauma reaction). He was a bit concerned, and said, “Hey, I don’t like you like this.” He cuddled me, and once I came out of my withdrawn state enough to talk, after several minutes, I told him that I used to allow someone to fuck me a lot before I found my vulvodynia treatment and when it hurt every time; and that that wasn’t something I would allow, ever again. That when sex hurt and I said I needed him to pull out, he needed to pull out. He didn’t really respond to any of that, and I think I went out to the couch shortly after.

He never did apologize.

Improvement and relief

I have real improvement.

There’s been improvement along the way: no longer having intensely sharp cramping, seizing pelvic floor muscles when I have to poop; the easing of residual muscle tension post-dilator; the easing of post-sex soreness. Today I discovered that the psoas-related deep pelvic pain has lessened immensely.

At the risk of being too graphic, I haven’t been able to take a full-on, no-holding-back pounding for years, a lot of them, without at least some muscular discomfort. And today I did. There are several things that I did today that would have caused me discomfort before and didn’t today.

It’s not totally better, of course. I still have some of the deep pelvic pain. But this is the first real improved comfort during sex that I’ve seen. I love it. I love it so much.

And labial pulling is totally helping the fascia over my urethra, which didn’t get irritated with either partner today.

I’m so relieved. So, so relieved. I cannot wait to keep getting even better, and having better, more worry-free sex, and feeling healthier, and sharing more things with my fantastic partners without the preoccupation with how my muscles will respond.

ETA: And the dilator, it slipped all the way in, without a single bit of discomfort or resistance or pain, for the first time ever. Ever. So much relief and gratitude.

My new assignment

I have new homework! Yay?

I’ve had a bundle of sensitive tissue at 12 o’clock, right under my urethra, at the vaginal opening. This is one of the newer developments over the years. It’s pressure sensitive instead of being raw like the other pain where I use the capsaicin.

L said there’s fascia there. I’ve been assigned the homework of labial stretching, which is exactly what it sounds like: I take hold of my labia on either side and pull gently to stretch them, and the fascia underneath. Five minute hold on a couple spots, on both the inner and outer labia, for another twenty minutes of homework.

On the plus side, after she did this and then went to work on it internally, I couldn’t feel it. So it may have released so well when she did that that it became non problematic. I’m hoping so. I’d asked her because J had released it with gentle direct pressure before, and I’m only occasionally successful in doing so myself. So perhaps this is a missing piece to that.

We did more abdominal myofascial work today, and didn’t hit any directly emotional spots. Last time, I felt fine when I left and then cried off and on for the next several days, so we’ll see what happens this time.

I asked L how to handle not being able to fit all the things in every day, and she said just to rotate them each day if I can’t do them all. I’d mostly been doing that, with a concentration on the dilator, so I’m glad I know how to proceed with that.

She didn’t feel my muscular tightness much at the opening when she went in, which was super encouraging.

So. Good progress, and labial pulling.

Capsaicin and tissue health

When my vulvodynia first appeared, it felt like a tiny paper cut (at 6 o’clock facing my vagina). I became aware of it a few times during sex; the irritation was very minor, but it was there over a period of months. That irritation began to become much worse over the proceeding months.

It got to the point where the burning would become very intense during penetrative sex, and I would have active burning sensations for about 48 hours afterwards. I was to that point when I was diagnosed, though I’d made my (correct) self-diagnosis by then.

Things I tried:
-Emu oil (topical)
-Sea buckthorn oil (internal; this actually cleared the surface irritation for about two weeks, and with the burning temporarily gone, I became aware for the first time of the underlying muscular dysfunction in my pelvic floor).
-Vitamin E oil
-Neem seed oil
-Estrogen cream (not only unhelpful but, containing propylene glycol, burned on application)
-Lidocaine cream (I’m pretty sure I was at 5% but it might have been 2%)
-Probably a whole host of other various oils and such I’ve since forgotten

So by the time I tried capsaicin, I’d done all the other things I knew to do.

The first time I used capsaicin–0.025% compounded in an acid mantle base–I couldn’t believe how incredibly painful the burning was. Capcaisin is the compound that causes cayenne and other pepper to be spicy, and it’s the real deal.

I moved up to 0.05% capsaicin after a while, and to an olive oil base once the acid mantle began itself to burn. Seven years after that change, I still use 0.05% capcaisin in an olive oil base. About three years after I started the capsaicin I had adapted to it sufficiently that it’s been years since I’ve sat on an ice pack upon its application. I put it on and go about my day with that regular burning sensation in my vulvar vestibule.

So the issue with all this is that the capsaicin is a band-aid. It depletes Substance P, which is what starts the pain cascade, but it doesn’t actually fix anything but my pain perception. The tissue to which I apply it is still red and irritated; I’ve been looking at it more closely lately, and it looks almost ulcerated in a couple places. Even with the capsaicin, there is typically some discomfort by the end of sex, especially with my larger partner. That are does not like friction.

My specialist has offered up a couple alternatives to control the pain; he wonders whether the capsaicin is furthering the irritation. His theory is that my hypertonic pelvic floor is the underlying cause of all of this, and that the tightness of those muscles is strangling the blood supply; and perhaps once we can fix that part, the tissue can heal. I worry that this is too simplistic, especially given that women with vulvodynia have up to 30X the nerve endings in the affected area. How do you make the overproliferation of nerves clear up? We’ll see.

In the meantime, I’m going to try applying slippery elm and aloe to the tissue to see if I can heal those mucous membranes a little bit.

So the other options I was given: a ganglion block from a pain specialist. It’s not as bad as I’d initially assumed, but I’m going to leave nerve blocks for further down the line if other options fail. The other alternative is trigger point injections, typically done with lidocaine, with which I am considerably more comfortable. Once we get everything in my abdomen moving better through more myofascial release, the plan will be to get me shot up with lidocaine trigger point injections, then send me off to the PT who will work at crazy deep levels requiring pain management for the next couple days, but possibly allowing much deeper release than I can currently get in a session.

Meanwhile: Both partners (yes, I have two; they know all about each other and everyone is on board with this and happy) are totally willing to forego penetration if I want to come off the capsaicin for a while and see what happens with the surface vulvar tissue when I do. I am worried not only about not being able to have the sex I want, but also that I won’t tolerate some of my other treatments (dilator, Therawand, intravaginal massage) very well if the surface pain is so raw and hard to take.

Here’s hoping I can find a way to increase the tissue health without having to come off the capsaicin, and that healing the muscles will help the surface to heal like my specialist thinks it will.

The intensity of things I didn’t expect to find.

Having looked into some of the biomechanics and alignment information, I had started to get comfortable with the idea that maybe there wasn’t any real trauma involved in my pelvic floor dysfunction. That maybe I’ve just used my body in unfriendly ways, like we all do in American culture: the wrong shoes, wrong movements, frozen feet used to encapsulation in shoes and a complete lack of surface variation, sitting all day and sitting on my sacrum when I do sit instead of my sitz bones, etc. I felt like I could start to let go of the idea that there had to be trauma connected to all of this.

Two sessions ago, I saw J, the main PT I’ve been seeing. J does primarily intravaginal work on me, relaxing the too-tight muscles. She does some connective tissue work as well, mostly rolling on my abdomen. My last session with her two weeks ago, she did a lot of that; I’d developed quite a few sensitive spots, which ended up sore as she worked on them and after.

The next day, I woke up with abdominal pain and bloating. I wasn’t gassy, and it didn’t really feel like it was necessarily digestion related. I remembered how a week earlier, doing some alignment exercises with a friend, including psoas release, I’d woke up in the middle of the night with similar sensations that I’d assumed were digestive. After this experience, I realized they probably had more to do with the lymphatic tissue.

I saw my specialist the next day. He agreed that I would probably do well with additional myofascial release to get my abdominal area moving, and also suggested lymphatic drainage massage.

The week after, I saw L instead of J at the pelvic PT clinic. L is trained in myofascial release, which is where we focused. I’d seen her once before, when I was having deep pelvic pain after using my dilators and she’d released part of my psoas to resolve it (which worked; still some discomfort while using my dilator, but no real lingering pain afterwards since).

She hit one area on my right side, over my psoas, and I felt instantly teary. I wasn’t able to let go and cry, but the immediacy of the emotion as she hit that spot was striking to me.

I’ve been a mess this week: depressed, overwhelmed. Work and family issues have been at the forefront as well. Today, I’ve cried a bit off and on with my partner. I’ve been thinking about traumas I underwent at age fourteen and in college, how they connect to my family, how all of those things are being triggered now.

And here’s what I think I’m realizing: That this means it’s working. That perhaps L hit something that is releasing now, even if that release wasn’t immediate. Partner wants me to consider antidepressants, but I don’t want to medicate the emotions away. I feel like feeling them and processing through them will lead to more health in the long run, even if it makes it harder now, and I feel like medicating was part of how this happened in the first place.

I’m no longer convinced of the lack of trauma involved in my pelvic pain development, though.