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| Dr. Andrea explaining a metaphor in The Bell Jar |
Welcome to the second installment of Ask Dr. Andrea, our new IBWMW
Doctor-at-Large. Dr. Andrea is an open-minded, completely cool
doctor with specialties in women's/sexual health, sustainable medicine,
Ayurveda, nutrition, yoga and such. She'll be answering your questions, eh, about every month or so, so if you have a burning issue--perhaps literally like our suffering friend below--email it to jillhamilton001@gmail.com.
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I have three questions:
1.
I have a very itchy part of the entrance to my vagina that usually
lasts a few days each month. I don't think it is a yeast infection, as
there is no discharge or smell, and I was prescribed Diflucan which did
nothing to ease the itching. The natural lubricant from my vagina seems
to make the itching worse after masturbating, or after
sex. My doctor did not seem very worried about it, and prescribed
Clobetasol Propionate, which I use liberally every time I get itchy and
it solves the problem. However, do you have other patients that have
this? The spot is located right on
the entrance to the vagina at the back part of the "rim" and the spot
is approximately the size of a nickel. Oh, and scratching at it with
toilet paper makes it itch even worse.
2.
Perhaps this is related to the first question. I have pain every time I
have intercourse. It is not bad, maybe a 3 on a scale of 1 - 10. The
pain is during the first penetration, even if I'm lubricated and have
already orgasmed. After that, I can be penetrated several times with no
pain. Is my vagina just highly sensitive?
3.
This question is just purely out of curiosity. In the book "The Bell
Jar", the main character starts to bleed uncontrollably the first time
she has sex. She goes to the emergency room and the doctor says
something like "this happens to one in a thousand girls", or something
like that. What is it that happened to her? Or did the author just make this up? I have always wondered...
Dr. Andrea: Ok, so, all the info and things you've tried narrowed the answer down a bit, so thanks!
There are several things that could be going on, so
it's difficult to figure out without at least an exam, and sometimes
even a biopsy is required for definitive diagnosis. The first question
sounds to be a version of "vulvar vestibulitis syndrome" (assuming yeast
is truly ruled out by symptom type as well as ineffectiveness of the
usual treatment, and that steroid cream helped). Various dermatological
issues in that area that seem likely are as follows: lichen planus or
sclerosis, lichen simplex chronicus, HPV related irritation, HSV
(atypical presentation), psoriasis or seborrheic dermatitis, tinia
(ringworm), pemphigus, or erythema multiforme. Hormone cycles can affect
all of the above, as well as diet and contact with fabrics and
soaps/lotions (and of course yeast or bacterial infection would make
symptoms worse). So, I would suggest a couple things right off to see if
they help: make sure your diet is low in processed flours and sugar,
wear natural fabrics like cotton for underwear to wick away sweat and
allow airflow, and use soaps and detergents without dyes or perfumes
(preferably natural instead of petroleum sources).
As for the second question, yes, it definitely could
be related, and yes, it sounds like your vagina is sensitive! That can
be a good thing- but it requires a bit of patience and care to work
with. It sounds most like something called vulvodynia (or dyspareunia,
although that usually refers to the entire sex act being painful). In
your case this might be due to a muscle spasm that won't relax until
it's rather forced to. There are several ways to approach this. The
first is giving yourself more time and having your partner both take it
easy during first penetration, as well as massaging the vulvar area
(from the entrance in/up about 2 inches) well beforehand. Fear of it can
make it worse, so taking time away from sex to do your own massage will
help too. One way to do this is by doing a daily massage before your
shower with warmed sesame or almond oil (put the oil in a flip-top and
warm it with a few changes of hot tap water in a larger container),
liberally massaging everywhere. And yes, inside! Not necessarily with
sexual intent... think self-love, rather than self-loooove. The good
thing about the self-massage (other than that you'll never need lotion
again) is that the oil is antibacterial and antifungal as well as
lubricating and moisturizing, so it can kill several birds with one
stone. Not that I advocate killing birds. You get the idea. There are
also physical therapists that help with vaginal
