Intimate Issues

The true feeling of sex is that of a deep intimacy, but above all of a deep complicity.
                                                     - - - James Dickey

 Sex is a complex issue for all couples.  Having a chronic pelvic pain condition intensifies the complexity, and often limits the pleasurable aspect.  Face it;  much of our identity is wrapped up in sex.  Who we are as women (or men), who we are as a couple, or as an individual, all of these have our sexuality as part of the question.

I have posted about the importance of communication, and I strongly recommend seeing a certified sex therapist to help with the process.  And, before you start with "my partner is very understanding, we really don't have sex, but we are OK with that as a couple."  REALLY think about that.  Are you OK with it because you have accepted that this is the way it is - and you love each other, so you'll "get through?"  Do you ignore it so it is a "non issue?"  Just because you don't address a problem, doesn't mean it isn't there.  Just think about the possibility of improving intimacy.  This certainly doesn't require a sex therapist, but if it is an uncomfortable subject for you and your partner, think of the therapist as a guide.

Read the post "Sex, Lies, and Dyspar . . . who?" post for some tips and guidelines for what to do pre and post coitus to limit pain, and improve function.  

For a lot of people this information is not enough.  If vaginal intercourse is extremely painful, there are options.  Rectal intercourse is a little much for some people to get their heads around.  If it is not too "out there" for you, discuss it with your partner - they may not be as oppossed as you fear.   As a warning thought, if your pain is from the pelvic floor muscles, especially tightness or spasm, this option is not going to be less painful.  Be very careful when experimenting with new sexual concepts, both of your physical well being, and of your psychological limits.  Change takes time. 

If you are way outside of your box, allow for awkwardness (and fear),  and be very gentle with both yourself and your partner.   Allow a lot of emotional space.  Set up guidelines early.  Always, always, always have a way out.  You and your partner both need to be very comfortable with saying "no" or "stop."  No questions asked.  It doesn't matter if the block is physical, emotional or psychological, in an intimate situation, all limits must be honored.  Again - a certified sex therapist will help with working through the psycholgical and emotional blocks that come up.

There are also ways to mimic intercourse.  Well lubricated inner thighs can be a sexually satisfying alternative to vaginal intercourse.  And, before you do the "what's in it for the woman?" question, realize that sexual pleasure is more global for women than it is for men.  We really are wired for sex, personally I think more so than men.  Genital stimulation is not the biggest part of sexual arousal, or even orgasm, for most women.  Intimacy, closeness, passion, all the sounds and sensations surrounding sex.  For us it is a"whole body" process, and eliminating the worry and pain of trying for "penetration" can be surprisingly satisfying for both partners.

Oral sex is an option for some.  Many vestibulitis and vulvodynia sufferers cannot stand the stimulation of oral sex.  Again, proceed with caution.  Fellatio (oral intercourse with the male recipient) can be a problem for the woman because of positioning issues.  Most of the positioning options add a lot of abdominal pressure, which can increase bladder pain.  Play with positions, and until you are very comfortable, don't make orgasm a goal.  I also treat people with jaw, neck and headache issues, so if you are prone to these conditions, be VERY careful with oral intercourse.

Please add comments if you have postioning advice, or pre-post coitus tips. 

Brief Discussion

"What are you eating under there?"
               "Under where?"
           - 1st grade potty humor


The under wear question is huge with the vulvodynia/vestibulitis/urethritis population.  Everyone has an opinion, and, as usual, the answer is a very individual choice.

We were all told by our mothers (well, maybe just me) that white cotton, loose fitting, full coverage underwear is the best for our "girl parts."  Granny underwear.  And all of us, as soon as we had any choice in the matter, began exercising our individuality in panties.  Victoria Secret is a modern girl's best friend.  But wait - there is deep, good truth in the advice given to us about white cotton. 

Dyes can be very irritating to the external genitalia.  Unnatural fibres, and some natural ones (silk and wool) can irritate skin and mucous membranes.  Cotton seems to really be the best option for most people.  Even the cotton panel - the underwear industry's feeble attempt to combine beauty with health - doesn't quite cut it, unless the whole garment is made from some breathable cloth.  I have talked  to a few (OK, one) people (person?) that feels most comfortable with spandex - I do not suffer from any of these conditions, and spandex underwear will absolutely irritate the tissues around my vagina.  It is a very individual choice, but cotton really is best for MOST people.

What about style?  The industry has truly changed over the years, bikini briefs, french cut, thong (oh - I will get back to these), classic "granny,"  I'm sure they have a real name - but I've never met anyone that calls it any different.  My new favorite is the boy-cut.  These have the comfort of a brief, but without the elastic at the legs.  Tight fitting elastic around the legs can disrupt blood, nerve and lymph supply to the region - not enough to cause permanent damage, but if the area is already sensitive and irritated, there is no point in pushing it.

It is much easier these days to find pretty, sexy underwear with less irritating qualities.  The severity of your symptoms may dictate your choices from day to day, so if symptoms fluctuate, or if you are not that severe, you may have more options.  Lacy pretty fabrics are still OK, as long as they are breathable fabrics, and are combined with a white cotton panel.  Look for styles that are not binding around the legs, and if you are prone to bladder pain, look for styles with the waist cut either below, or well above the bladder.

Now it is time for me to get on my soap box and rant about thong underwear.  This style was virtually unheard of until the late '80's, except with male strippers.  When they first hit the scene, it was an instant "no panty line" success.  Everyone I knew that tried them hated it, but wore them anyway, because fashion is such a callous dictator.  Remember, this was the era of spandex leggings, wide belts and BIG hair.  Today they are so common that many of my patients and younger relatives can't even imagine wearing anything different.  Convincing people to give up thong underwear often feels like a culture war (I'm showing my age - it may even be a generation gap).  But, it is a HEALTH issue.  

Our rectum and vagina are seperate openings for very good reasons.  The bacteria that lives in our large bowell is essential for breaking down waste at the end of digestion.  There are also yeast in the bowell, and they live in a delicate balance with the bacterias.  None of these things belong in the vagina.  The vagina is a particularly friendly environment for yeast to grow and flourish.  Anyone that suffers chronic vulvar pain knows how bad yeast infections can be, how they can make things worse, or even be the precipitating factor in a flare.  Thong underwear can create a miniature superhighway for migrating yeast.  Direct route from the rectum to the vagina.  Not a good thing, and completely avoidable.

Remember, you always have choices, and the more educated you are about potential consequences, the better your choices can be.  If you are getting ready for prom or some other special occasion, and want to wear a super tight, sexy skirt, or some flowing clingy material - by all means, where the thong.  Be sensible, wear it for the evening, and go back to cotton whities for a few days after.

Share your stories (and opinions).