Sex is something we may all partake in when in a relationship (or not!) but, for many women, it can actually hurt too much to do “it”. Why is that? Well, the condition is called vestibulodynia, and we spoke with sex therapist Ashley Lemieux to get the low-down on vulvo-vaginal pain and how you can get the help you need to enjoy sex again!
What is vestibulodynia?
Vestibulodynia, says Lemieux, “is pain that is localized at the entry of the vagina [known as the vestibule], characterized like a burning or cutting pain.”
There are two main types of vulvar pain: unprovoked vulvodynia and provoked vestibulodynia. The latter is most common and the most researched; there is pain when pressure is exerted on the vestibule, be it with penetration of the penis, a finger, a gynecological exam, or even riding your bike. “The pain stops when there is no pressure, but after sex there can be a slight discomfort,” says Lemieux.
The onset of the condition varies. “There is the primary subtype, which begins with one’s first sexual experience and has persisted, and secondary, which randomly begins later in life, often after aggravating circumstances.” There are two types of diagnosis subcategories, which causes for much debate in thefield: dyspareunia, which is vulvo-vaginal pain, and vaginismus, which isn’t necessarily pain, but tension of the lower muscles at the entry of the vagina that makes penetration impossible. “Some women can be in so much pain, they can tense up prior to sex due to the anticipation of pain, making penetration impossible” says Lemieux.Who is affected by it?
“Vulvo-vaginal pain occurs in 21% of women under 30, and 10 to 15% of women over 30,” says Lemieux. There are certain risk factors, such as genetic predisposition (if a close family member such as a mother or sister has had it), taking the birth control pill at an early age, starting one’s period early (i.e. before the age of 12), and having repeated yeast or urinary tract infections. “There is a correlation with these risk factors, but not causality,” advises Lemieux. This means that if you’ve had a yeast infection, it doesn’t mean that you will get vestibulodynia. However, just because you’ve never had a yeast infection doesn’t mean there isn’t a chance you’ll get vestibulodynia, either.
How can it be treated?
There are various treatment methods, with the below three being the most common:
-There is physiotherapy, which includes “strengthening and rehabilitating the pelvic muscles to make penetration easier and less painful”. The physiotherapist will often give you homework, such as gradually inserting different-sized dildos into the vagina, to help slowly diminish the pain.
-Another prescribed treatment is nightly lidocaine application, which is a topical anesthetic. “The more pain you have in one area, the more active the pain signal to your brain,” explains Lemieux. “The lidocaine numbs the region to reverse it.”
-A doctor can prescribe anti-depressants. They help to limit the pain signals sent to the brain but, warns Lemieux, there can be side effects.
How can vestibulodynia affect your couple?
A woman affected with vestibulodynia may avoid sex if she feels she is less able to satisfy her partner (or has even lost partners in the past), is depressed, has low self-esteem and suffers from high anxiety.
As for a couple, “a partner may feel as if he’s the one causing the pain,” says Lemieux. “He may feel powerless and guilty.” Sex therapy for a couple can work on removing any negative feelings related to sex and offer pain management techniques, such as breathing exercises to help relax the muscles. A sex therapist may also help a couple widen their sexual repertoire, allowing them to have fulfilling sex without penetration, since that can be painful on the female half of the couple. Sex therapy combined with physiotherapy has approximately a 40% success rate when treating vestibulodynia.
However, some women may feel obligated to have sex: “In a lab study, 86% of participants said that they still had sex for motives other than their own personal desire,” says Lemieux.
As a last resort, a woman can have a vestibulectomy, a minor surgery in which a small portion of the vestibule is removed. While there is a two-to-three week recovery period and penetrative sex should be avoided for three months, Lemieux says that there is a 70% success rate following surgery.
Is vestibulodynia under-reported?
“It is under-reported due to embarrassment, but the saddest part is that women who do report it can’t be referred to a specialist because some doctors don’t know about it,” admits Lemieux. On average, a woman sees six to seven doctors before getting diagnosed; that could mean up to seven years of suffering before getting treatment!
There is good news, though: there is starting to be more dialogue on the subject and research both in the field and in laboratories are being done. Conferences are taking place with medical doctors in attendance, ensuring that vestibulodynia gets talked about and becomes more known within the medical community, more so than in the past.