Tuesday, October 23, 2012

Dr. Andrea will Not be fazed. Questions about itchy privates and Sylvia Plath references? No problem, sister.

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.

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
muscle spasms, but they are difficult to find and clearly you'd have to find a good one you trust. I'd try it on your own first, and if you run into point tenderness you can't massage through, or any other symptom arises, definitely ask your gynecologist.

Loved the third question- and yes, that can happen. I don't know about the statistic, and that was written a while back obviously, but I'm thinking it could have been related to an artery/vein malformation in an unfortunate location, or just a larger than usual tear in the hymen or vaginal wall. She could have had a mild bleeding disorder also- I haven't read that in ages so I can't remember more details that might make more sense. Then again it might just have been a metaphor :)

For more info on the massage (also called Abhyanga in Ayurveda/Indian medicine), send me an email and I'll send a handout with more detailed instructions. Enjoy!
Remember, if  you have a question for the good doctor, email it to jillhamilton001@gmail.com. For more info on Dr. Andrea, check out her web site.

(Note: This is not a substitute for individual medical advice or care. Check with your doctor before starting or replacing any current treatment plan. Submitted questions may be edited for clarity.)


Anonymous said...

I used to have pain with intercourse, too! Every time, regardless of lubrication, and it would also let up after a few minutes. And I thought well, okay, my vagina is a sensitive flower and my muscles are always tense in general--massage therapists have scolded me for it--so why shouldn't my vagina be, too?

Then I switched birth control to one with a slightly higher dose of hormones, and the problem went away entirely. WOOHOO, CAVERNOUS VAGINA! PUT ANYTHING IN IT, IT'LL TAKE IT ALL! It is rad. So if that could be a factor for you, maybe look into it?

in bed with married women said...

Okay, that is one of my favorite comments ever. Now I am kind of in love w you and want to toss random objects into your cavernous vag, kind of like a carnival game.