Q: The Video Series Healing the Pain 'Down There' references a slender vibrator for improving scar tissue mobility, where can that be purchased?
A: You can find the vibrator we currently recommend HERE. Always clear the use of any dilator or vibrator with your qualified health care provider. Use code PainDownThere to get $10 Off!
A: You can find the vibrator we currently recommend HERE. Always clear the use of any dilator or vibrator with your qualified health care provider. Use code PainDownThere to get $10 Off!
Q: Is it true that a decrease in estrogen can cause painful sex?
A: With low estrogen there is thinning of the vaginal tissue as well as dryness that can certainly contribute to pain with sex. However, just because someone is menopausal (meaning low estrogen) the care provider shouldn't jump to the conclusion that the reason for painful sex is just because of low estrogen. Certainly use a vaginal lubricant, such as astroglide or slippery stuff. Check out our blog on this topic for further information
A: With low estrogen there is thinning of the vaginal tissue as well as dryness that can certainly contribute to pain with sex. However, just because someone is menopausal (meaning low estrogen) the care provider shouldn't jump to the conclusion that the reason for painful sex is just because of low estrogen. Certainly use a vaginal lubricant, such as astroglide or slippery stuff. Check out our blog on this topic for further information
Q: I now have “pain down there” for no apparent reason. The first time I had sex it was slightly painful but the pain faded away and felt good. On a few other occasions following that time, the same thing would occur: a little bit of pain but then fading away. But lately if we switch positions or he falls out he cannot insert again. If he does it’s excruciating pain for me. He can’t put it in again, it feels “too tight”. I experience burning pain during sex and afterwards it hurts to urinate (only right after we have sex though). I’d go to a doctor but I have no insurance so I’m unable to afford it. What’s going on?
A: First of all, let us assure you that you are not alone in experiencing these symptoms. There are countless individuals going through very similar situations right now, many of whom also are not getting helpful answers from the medical community. We often see "UTIs" and "yeast infections" overly diagnosed in cases like yours. Of course you need to rule these out. But this can easily be done by going to a nurse practitioner at a Planned Parenthood clinic (fees are usually reasonable even without insurance). If the tests are negative or the treatments don’t help you, don’t continue to accept antibiotics or creams that aren’t proving to be affective in treating your pain. Please also consider:
1. Be sure to always use a good vaginal lubricant, such as Astroglide Gel (not the liquid), another product actually named "Slippery Stuff" which you can find on-line, or even simple coconut oil. These products are generally tolerated by most women even if they have minor inflammation at the vaginal opening (Vestibule). Make sure to put these lubricants on yourself and your partner to eliminate any friction which can help to minimize the pain
2. You could also be experiencing muscular restriction at the vaginal opening (Pelvic Floor Dysfunction - a clenching response to increased sensitivity to touch or friction at the Vestibule). With initial penetration - these muscles (pubovaginalis) are stretched, which may be creating your initial burning pain which then subsides as sex continues. Any time re-entry needs to happen (switching positions or him falling out), your brain perceives this as a "dangerous" situation and your pubovaginalis "clenches" to protect the area of pain. There are certainly exercises that can be done to help to 1) stretch the vaginal opening and 2) retrain the brain that your vaginal opening is not a "danger zone" so that the red flags gradually fade and your gripping reflex is no longer present allowing your partner to enter with low to no pain.
3. Since you say you have "excruciating pain" with penetration, the simple suggestions above may not be helpful enough. If you have already tried these simpler solutions and they are not helpful and you continue with pain, you may have the early signs of vulvar vestibulitis as well as interstitial cystitis / painful bladder syndrome (IC) contributing to penetration pain. Early signs of both of these conditions are quite common in young women. (Usually deeper penetration pain is associated with IC as the tip of the penis "hits" the irritated bladder. Initial penetration pain can be associated with vulvar vestibulitis as the sensitive tissue of the irritated vestibule are stretched) Consider drinking more water and de-acidifying the body by lowering acids in the diet to lower the inflammation that can occur in the bladder, urethra and vestibule. To download our Vaginal Health Guide click here.
4. Our video series Healing the Pain 'Down There’ can help educate you on why this all might be happening and will give you strategies to help make it better yourself and also to help find professionals who may know more about these issues.
A: First of all, let us assure you that you are not alone in experiencing these symptoms. There are countless individuals going through very similar situations right now, many of whom also are not getting helpful answers from the medical community. We often see "UTIs" and "yeast infections" overly diagnosed in cases like yours. Of course you need to rule these out. But this can easily be done by going to a nurse practitioner at a Planned Parenthood clinic (fees are usually reasonable even without insurance). If the tests are negative or the treatments don’t help you, don’t continue to accept antibiotics or creams that aren’t proving to be affective in treating your pain. Please also consider:
1. Be sure to always use a good vaginal lubricant, such as Astroglide Gel (not the liquid), another product actually named "Slippery Stuff" which you can find on-line, or even simple coconut oil. These products are generally tolerated by most women even if they have minor inflammation at the vaginal opening (Vestibule). Make sure to put these lubricants on yourself and your partner to eliminate any friction which can help to minimize the pain
2. You could also be experiencing muscular restriction at the vaginal opening (Pelvic Floor Dysfunction - a clenching response to increased sensitivity to touch or friction at the Vestibule). With initial penetration - these muscles (pubovaginalis) are stretched, which may be creating your initial burning pain which then subsides as sex continues. Any time re-entry needs to happen (switching positions or him falling out), your brain perceives this as a "dangerous" situation and your pubovaginalis "clenches" to protect the area of pain. There are certainly exercises that can be done to help to 1) stretch the vaginal opening and 2) retrain the brain that your vaginal opening is not a "danger zone" so that the red flags gradually fade and your gripping reflex is no longer present allowing your partner to enter with low to no pain.
3. Since you say you have "excruciating pain" with penetration, the simple suggestions above may not be helpful enough. If you have already tried these simpler solutions and they are not helpful and you continue with pain, you may have the early signs of vulvar vestibulitis as well as interstitial cystitis / painful bladder syndrome (IC) contributing to penetration pain. Early signs of both of these conditions are quite common in young women. (Usually deeper penetration pain is associated with IC as the tip of the penis "hits" the irritated bladder. Initial penetration pain can be associated with vulvar vestibulitis as the sensitive tissue of the irritated vestibule are stretched) Consider drinking more water and de-acidifying the body by lowering acids in the diet to lower the inflammation that can occur in the bladder, urethra and vestibule. To download our Vaginal Health Guide click here.
4. Our video series Healing the Pain 'Down There’ can help educate you on why this all might be happening and will give you strategies to help make it better yourself and also to help find professionals who may know more about these issues.
Q: Are there harmful effects of medical devices used in women such as NovaSure, Essure, or Pelvic Mesh?
A: Some medical devises used in women and men's pelvic health can be legally controversial. Our website is here to help all people with chronic pelvic and sexual pain, regardless of what triggered the pain in the first place. Procedures, births and accidents of all types as well as many other dysfunctions in the body work together to produce chronic pain syndromes. We are not here to comment on causal "blame" for any types of trauma but we are here to help sufferers of pain in understanding what is still generating their pain and to help find resources to get help. Our Guide to Healing the Pain 'Down There' will be helpful regardless of the origination of the issues surrounding the onset of the pelvic, genital and sexual pain.
A: Some medical devises used in women and men's pelvic health can be legally controversial. Our website is here to help all people with chronic pelvic and sexual pain, regardless of what triggered the pain in the first place. Procedures, births and accidents of all types as well as many other dysfunctions in the body work together to produce chronic pain syndromes. We are not here to comment on causal "blame" for any types of trauma but we are here to help sufferers of pain in understanding what is still generating their pain and to help find resources to get help. Our Guide to Healing the Pain 'Down There' will be helpful regardless of the origination of the issues surrounding the onset of the pelvic, genital and sexual pain.
Q: I've heard vaginal dilators can be extremely traumatizing and harmful to women with endometriosis, especially if she has not had full excision and even after she has, is that true?
A: There is no scientific or anatomic reason that the presence of endometriosis in any particular woman increases any risk to the proper use of vaginal dilators. Any insertion of any foreign object into the body can cause a disruption to one's energy or "biofield" (as recognized by the NIH) if it is not "welcomed" and allowed by the person's consciousness and belief system. Disruption can cause trauma. The physical body will respond accordingly. The mind/body/energy must be in alignment. Tons of research support this in multiple fields of study, including psychology, psychiatry, surgical medicine, pharmacology, quantum physics, biology, psychoneuroimmunology, neurobiology, and more. Any object put into any body cavity can be reckless and potentially harmful if not done with the right intentions - including the vagina.
When vaginal dilators are used as directed by appropriately trained women's health specialists, there is no evidence that there is any danger or harm that can be done to any mature female. Using these properly designed instruments, if done with the intention of improving sexual health and to decrease various aspects of genital pain, is not only safe but is recommended by most pelvic health specialists.
A: There is no scientific or anatomic reason that the presence of endometriosis in any particular woman increases any risk to the proper use of vaginal dilators. Any insertion of any foreign object into the body can cause a disruption to one's energy or "biofield" (as recognized by the NIH) if it is not "welcomed" and allowed by the person's consciousness and belief system. Disruption can cause trauma. The physical body will respond accordingly. The mind/body/energy must be in alignment. Tons of research support this in multiple fields of study, including psychology, psychiatry, surgical medicine, pharmacology, quantum physics, biology, psychoneuroimmunology, neurobiology, and more. Any object put into any body cavity can be reckless and potentially harmful if not done with the right intentions - including the vagina.
When vaginal dilators are used as directed by appropriately trained women's health specialists, there is no evidence that there is any danger or harm that can be done to any mature female. Using these properly designed instruments, if done with the intention of improving sexual health and to decrease various aspects of genital pain, is not only safe but is recommended by most pelvic health specialists.
Q: I’ve had ulcerative colitis for 5 years nows. Been on numerous medications. And this recent November I started having frequent urination and trouble emptying my bladder. For this I’m seeing a urologist, gynecologist, and physical therapist… In physical therapy I do pelvic floor exercises … my symptoms are pretty bad. I feel like I have to go like all the time. It’s been tough. Do you know what this might be? I have an autoimmune disease (Ulcerative colitis) .. is my immune system attacking my bladder too? Can’t stand having ulcerative colitis and this urinary issue too.
Ulcerative colitis and urinary issues are definitely related. As you have had inflammation of your bowels for 5 years with your ulcerative colitis, the structures "in the neighborhood" (bladder, pelvic floor muscles etc) have also been impacted. It is not uncommon for there to be an increase in pelvic floor muscle tension as a protective mechanism against the pain you have been experiencing from the ulcerative colitis. With the increased tension, the bladder can be effected allowing for increased sense of urgency. Once you start taking yourself to the bathroom frequently, then the bladder doesn't get a chance to fill and stretch (think of filling a water balloon) . . . if the bladder doesn't stretch and expand, then it does not have a strong contraction to empty the bladder leading to difficulty with emptying the bladder. As long as you don't have pain in your bladder with delaying urination, I would suggest talking to your Women's Health Physical Therapist about urge suppression techniques allowing the bladder to fill more which will allow it to empty more efficiently. Over time, once you begin the delaying process, the urgency will subside as well. I would also check with your PT about how tight your pelvic floor muscles are. She can teach you strategies for being aware of the tension they hold and then how to relax the tension which will also help with the bladder and the pain.
Ulcerative colitis and urinary issues are definitely related. As you have had inflammation of your bowels for 5 years with your ulcerative colitis, the structures "in the neighborhood" (bladder, pelvic floor muscles etc) have also been impacted. It is not uncommon for there to be an increase in pelvic floor muscle tension as a protective mechanism against the pain you have been experiencing from the ulcerative colitis. With the increased tension, the bladder can be effected allowing for increased sense of urgency. Once you start taking yourself to the bathroom frequently, then the bladder doesn't get a chance to fill and stretch (think of filling a water balloon) . . . if the bladder doesn't stretch and expand, then it does not have a strong contraction to empty the bladder leading to difficulty with emptying the bladder. As long as you don't have pain in your bladder with delaying urination, I would suggest talking to your Women's Health Physical Therapist about urge suppression techniques allowing the bladder to fill more which will allow it to empty more efficiently. Over time, once you begin the delaying process, the urgency will subside as well. I would also check with your PT about how tight your pelvic floor muscles are. She can teach you strategies for being aware of the tension they hold and then how to relax the tension which will also help with the bladder and the pain.
Q: It seems like a lot of your information is on mindfulness and cognitive approaches to chronic pelvic pain. Isn't this taking away from finding the real cause of the underlying issue or issues?
The approach that we discuss is not solely a cognitive approach, rather it is BIO-PSYCHO-SOCIAL meaning that there are many contributing factors to pain . . . From the Biology (meaning the tissue, the muscles, the nerves, the fascia and the hormones etc), the Psychology (meaning the emotional state you are in when you experience pain as there has been a lot of research showing the experience of pain heightening or lowering based on fear or depression or anxiety or happiness or contentment) and the Social (meaning many different things including the support you have around you.)
We are absolutely NOT saying that pelvic pain should only be addressed from the Cognitive standpoint. However, for so long it has been looked at through the lens of Biology and Structure only. For example if healthcare providers didn't visually see anything wrong on MRI or US of the uterus and ovaries and bladder/bowel and did not visually see redness or irritation - then women would be wrongly be dismissed as "all looks good - nothing is wrong" without taking into consideration the other contributors of pain i.e cyclical tissue irritation, muscular tension, nerve irritation etc. On top of the other biological considerations of pain we can not treat that in a bubble without taking into consideration the "psycho-social " side as was described above. We want to address ALL aspects of the pain experience.
Both Dr E and Karen when they see their patient take into consideration muscular tension, nerve and tissue irritation, myofascial tension etc. And these of course would need to be assessed on an individual basis for you - and we are happy to give you names of healthcare providers in your area. Just CONTACT US. Or VISIT OUR RESOURCE PAGE.
The approach that we discuss is not solely a cognitive approach, rather it is BIO-PSYCHO-SOCIAL meaning that there are many contributing factors to pain . . . From the Biology (meaning the tissue, the muscles, the nerves, the fascia and the hormones etc), the Psychology (meaning the emotional state you are in when you experience pain as there has been a lot of research showing the experience of pain heightening or lowering based on fear or depression or anxiety or happiness or contentment) and the Social (meaning many different things including the support you have around you.)
We are absolutely NOT saying that pelvic pain should only be addressed from the Cognitive standpoint. However, for so long it has been looked at through the lens of Biology and Structure only. For example if healthcare providers didn't visually see anything wrong on MRI or US of the uterus and ovaries and bladder/bowel and did not visually see redness or irritation - then women would be wrongly be dismissed as "all looks good - nothing is wrong" without taking into consideration the other contributors of pain i.e cyclical tissue irritation, muscular tension, nerve irritation etc. On top of the other biological considerations of pain we can not treat that in a bubble without taking into consideration the "psycho-social " side as was described above. We want to address ALL aspects of the pain experience.
Both Dr E and Karen when they see their patient take into consideration muscular tension, nerve and tissue irritation, myofascial tension etc. And these of course would need to be assessed on an individual basis for you - and we are happy to give you names of healthcare providers in your area. Just CONTACT US. Or VISIT OUR RESOURCE PAGE.
Q: I get these "paper cuts" that form between the opening of the vagina and anus. It comes and goes through-out my life, but even more now after menopause. Is there anything I can do to stop the formation of these cuts? I've read that it could be related to heavy metals, enzyme factors and their effect on hormone function. Local anesthetic salves manage the pain temporarily but it doesn't stop the cuts.
You appear to be describing these life-long "paper cuts" on the perineum; The area between the anus and vulva. Paper cut like lesions are not uncommon in younger women and usually are related to chronic dermatologic inflammation which can result from Lichen Sclerosis, Lichen Planus, and even other less common dermatologic manifestations of Crohn's , Ulcerative Colitis, and other forms of chronic dermatitis. If Lichen Sclerosis begins to "fuse" the intralabial folds, then we commonly hear about paper cuts during and following intercourse - all of which can be extremely painful.
Also important to know is that menopausal changes would be very unlikely to be related to thinning out of the perineal skin, as that tissue is not estrogen dependent. However, if vaginal dryness and atrophy increases after menopause, it is likely to enhance all of your previous experiences of sensitivity at the vaginal opening and perineum. In addition, any long term scarring from vagina birth lacerations and repairs or any earlier surgeries such as rectocele or perineal repairs. And even any long term use of potent corticosteroids applied to that area through the years if you were misdiagnosed as having yeast, fungal, or bacterial infections.
The chances of heavy metals and other enzyme and hormonal pathologies are very slim. Because many women don't receive proper care by their traditional practitioners, they seek out other sources of information, like chat rooms and groups, where there is often misleading, misinformed, and even conspiratorial ideas floating around that can be frightening and cause more pain and suffering. But the greatest threat to patients is the lack of appropriate and accurate diagnoses. Ask the vast amount of women how much time is ever spent by any practitioner actually looking closely at the vulva during routine exams or even asking about the lower genital tract.
You appear to be describing these life-long "paper cuts" on the perineum; The area between the anus and vulva. Paper cut like lesions are not uncommon in younger women and usually are related to chronic dermatologic inflammation which can result from Lichen Sclerosis, Lichen Planus, and even other less common dermatologic manifestations of Crohn's , Ulcerative Colitis, and other forms of chronic dermatitis. If Lichen Sclerosis begins to "fuse" the intralabial folds, then we commonly hear about paper cuts during and following intercourse - all of which can be extremely painful.
Also important to know is that menopausal changes would be very unlikely to be related to thinning out of the perineal skin, as that tissue is not estrogen dependent. However, if vaginal dryness and atrophy increases after menopause, it is likely to enhance all of your previous experiences of sensitivity at the vaginal opening and perineum. In addition, any long term scarring from vagina birth lacerations and repairs or any earlier surgeries such as rectocele or perineal repairs. And even any long term use of potent corticosteroids applied to that area through the years if you were misdiagnosed as having yeast, fungal, or bacterial infections.
The chances of heavy metals and other enzyme and hormonal pathologies are very slim. Because many women don't receive proper care by their traditional practitioners, they seek out other sources of information, like chat rooms and groups, where there is often misleading, misinformed, and even conspiratorial ideas floating around that can be frightening and cause more pain and suffering. But the greatest threat to patients is the lack of appropriate and accurate diagnoses. Ask the vast amount of women how much time is ever spent by any practitioner actually looking closely at the vulva during routine exams or even asking about the lower genital tract.
