Savage Love: Vulvodynia, or pain in the vulva, is very common, and it sucks, but there are treatments and providers that could help

And your gynecologist should have already referred you to a pelvic floor specialist.

SAVAGE LOVE
Savage Love
I am a 29-year-old woman and I have a problem when I have sex or masturbate. I always feel an annoying pain, a stinging sensation in my vulva, at the entrance of the vagina, that does not allow me to enjoy it, as the pain is too overwhelming. Unfortunately, this situation has led me to avoid having sex or masturbating in order not to feel that pain. I have consulted several gynecologists, but no anomaly or infection of any kind has been found. With the last doctor we also talked about a possible psychological component but, apparently, even on this level everything seems normal. Do you or an expert have advice for someone with a problem like mine?—Lost And Baffled Inside America

“Vulvodynia, or pain in the vulva, is unfortunately very common, and it sucks,” said Dr. Rachel Gelman, a clinician, pelvic floor specialist, and author based in San Francisco. “But there are a variety of treatment options and providers that could help LABIA out.”

Dr. Gelman says it’s good that you’ve already had infection ruled out as a possible cause. But there are lots of other things that could be going on—nerve irritation, inflammation, hormonal imbalance, something genetic—and she urges you not to give up until you find an answer. And while Dr. Gelman is too polite to say it, I’m an asshole, so I’m just gonna blurt it out: it’s shocking that not one of the gynecologists you consulted referred you to a pelvic floor specialist.

“The muscles inside the pelvis, aka the ‘pelvic floor,’ and the surrounding musculature can contribute to or cause the pain LABIA is describing,” said Dr. Gelman. “Just like tight muscles in the neck can cause pain in the shoulder, arm, or jaw, a tight muscle inside the pelvic floor can cause pain at the opening of the vagina. A pelvic floor physical therapist, like myself, would be able to assess and treat this kind of muscle dysfunction, which would decrease LABIA’s symptoms and get her back to enjoying sex again.”
Contact [email protected], follow @FakeDanSavage on Twitter and get Dan’s columns, podcasts, books, merch and more at savage.love.

But don’t stop at just getting a referral to a pelvic floor specialist. “Due to the fact that so many systems live inside the pelvis which impact the vulva, several specialists may be needed to investigate and treat the potential causes of LABIA’s pain,” said Dr. Gelman.

So, in addition to seeing a pelvic floor specialist, Dr. Gelman recommends you consult with a vulvar specialist. (You can find a list of vulvar specialists at the website of the National Vulvodynia Association: go to nva.org, and click on the link to its “health care provider list.”)

“A vulvar specialist would be able to perform appropriate tests to tease out what is going on beyond what a general gynecologist may look at,” said Dr. Gelman. “And it’s important to note that the tissue around the vaginal opening is highly dependent on hormones to stay happy and healthy. Certain medications or medical conditions can impact hormone levels, which can in turn impact vulvar tissues and lead to pain. There are also underlying inflammatory conditions that could also be causing this pain.”

And even if you don’t have an underlying mental health or psychological condition, LABIA, the pain you’ve suffered—along with the resulting sexual deprivation—sounds like a lot, and talking about it with someone could help you reconnect more quickly with your ability to take pleasure in this part of your body again. “The brain is powerful and having vulvar pain or any kind of sexual dysfunction can be mentally draining which can further exacerbate pain,” said Dr. Gelman. “So, a good sex therapist may also be a helpful ally here. Bottom line, vulvar pain is common and typically requires a team of providers—but help is out there.”

Find Dr. Rachel Gelman online at pelvicwellpt.com and via @PelvicHealthSF on Instagram.

I’m a young gay man who needs to break up with his boyfriend. I know it, my friends all agree, I even think it’s what he wants. I’ll spare you the messy details. I just need a push. Maybe if you tell me to, Dan, I’ll do it.—Just Another Word

Marry him.

I’m a man in his 30s in Boston. I just got ghosted and want some advice on how to handle it. I matched with a woman online, also in her 30s, and the conversation seemed good and we agreed to meet for a drink. On the day of our planned date, I get a text saying, "Hey, I'm having a really bad day and I don’t want that to be your first impression of me, can we reschedule?” That seemed reasonable, so I agreed. Later in the week I asked what she is up to on the weekend. I didn’t get a response until late Sunday: “I thought I replied, I'm so sorry!” I took her at her word that it was a mistake, and we rescheduled drinks. The afternoon before our rescheduled date for drinks, I texted to confirm where and when we were meeting. We agreed to meet at 7 p.m.. At 6:40 p.m., I got a text from her number: “This is Boston EMS. Gertrude wanted us to let you know she won't make it to the date.” I responded promptly, asking the paramedic what happened and if Gertrude (not her real name) was alright, and the paramedic replied that she was fine and actually more worried about me than herself. In the evening I get a text from Gertrude saying, "OMG! I'm so embarrassed! I'm so sorry!" She explained she had a seizure. I texted her the following day to ask how she's feeling, but received no answer.

Here is my conundrum. I have no way of knowing for sure if both situations were out of her control (her bad day, her seizure) and she's too embarrassed to answer my texts right now or if she stood me up twice in really shitty ways and used a health crisis as an excuse the second time. I would love to hear your feedback. I have enclosed screenshots of our text messages for your review.—Blatant Lies Or Constant Kerfuffles

Hm.

The text messages Gertrude sent you were far less interesting—and far less revealing—than the tiny photo of Gertrude at the top of them. The woman in the photo is conventionally attractive (extremely so: thin, toothy, blond, skinny), and she looks more like a teenage girl than a woman in her 30s. (Indeed, a Google image search on the picture didn’t find a match, but all the “very similar images” that came up were of teenage girls.) So, I’m gonna climb out on a very short and very sturdy limb here, BLOCK, and tell you that the person in the photo isn’t the person you’ve been messaging with. That’s why Gertrude keeps making excuses to call off your dates—increasingly ludicrous excuses.

I mean, take this paramedic nonsense. Dude. If Gertrude was able to hand her phone to a paramedic and ask that paramedic to find one particular guy in her contacts and then send that one particular guy a message canceling a date… then Gertrude was well enough to send you that message herself. And even if sending text messages and canceling dates were services paramedics provided—and they’re not—asking a paramedic to let a date know you’re having a seizure isn’t something a person having a seizure can do because that person is having a seizure.

So, yeah. The problem here is not that Gertrude is too embarrassed to respond to your text messages about finally getting together for that drink, BLOCK, it’s that Gertrude is too non-existent to ever show up for that drink. You most likely won’t hear from her again, but if you do, it’ll be a request for money. I shouldn’t have to say, “Don’t’ send her money,” but I’m going to say it just in case you’re really as gullible as your letter makes you seem: don’t send her money.
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