Misdiagnosis

I am SO THRILLED right now.

I am super thrilled. You know why I'm thrilled? Because everything that has been happening to me is all due to a MISDIAGNOSIS.

I don't have vaginismus. 


I have vestibulodynia (which is a symptom, not a diagnosis- we'll get to the diagnosis later on).

I found this out today when I met with the esteemed and renowned Dr. Andrew Goldstein of the Center for Vulvovaginal Disorders in Washington, DC.

Someone called 'Missing Out' emailed me about Dr. Goldstein all the way back on December 28, 2011 but I just bypassed it back then. Then someone else posted a clip of ABC news talking about Dr. Goldstein and his knowledge of vulvovaginal disorders. All things considered, I finally decided to check him out. I should have gone to him a lot sooner than this- in fact, I should have gone to him before going anywhere else (and this will be my new recommendation to everybody).

Here's how his office works: You fill out a seven-page questionnaire about your pain and everything you are experiencing. You bring this with you to your first appointment. At the first appointment they take a urine sample (to check if you have yeast infections or anything else), blood (to check if you have hormonal imbalances or anything else), speak with you for a long time and also do a thorough medical/ internal exam.

I started out simply talking to Dr. Goldstein about everything I had tried thus far and how I had been told to use the dilators, had tried pelvic floor therapy and I still always had pain. Just looking at my descriptions of pain on the sheet before even examining me, he told me he was skeptical that I had vaginismus. Nevertheless, he would wait till the internal exam to determine that for sure. After talking everything through, we went to the exam room.

I got up on the chair (it was a regular chair like you might have in a gynecologists office, except the place to rest your feet were lined with fur so they were comfortable). The really cool thing is that he hooks you up to a camera so that you can see everything he is doing or touching on a large screen while he does it, so that I could follow along with him. Before he even started looking at my vulva and vagina, though, he tapped on my stomach and asked me if I felt any pain or just pressure. I said pressure and that it was ticklish. Then he took a Q-tip and touched my bellybutton and asked if it was sensitive. I said it was. That's when he moved on to the vulva.

With his Q-tip, he swabbed the mons pubis, clitoris, labia minora, labia majora, perineum etc and asked me if I felt any pain at all. I said no. Then we got to this dividing line inside of the small lips/ labia minora which is called Hart's Line. When he was outside of the line just touching the labia minora. As soon as he was inside of it with the Q-tip I was tensing up and in a lot of pain- and that was just with a Q-tip!

We soon discovered that this entire area was causing me pain. This area is called the vestibule. However, when he would insert his finger through the hymen to the vagina and thrust it in and out, everything was great. There were no problems whatsoever- I felt no pain. It was only when he was touching the vestibule that I felt the pain.

He then had to spray the entire vaginal area with vinegar because that would turn problematic areas white, but nothing turned white so I don't have those sorts of diseases, which is good.

Then he took me back to his office (after I had gotten dressed) and walked me through the following explanation. He showed me this picture:

Please click it to zoom in. The purple part is the part where I have pain- called the vestibule. What I have is therefore called vestibulodynia. The thing is, that is only a symptom, not a diagnosis. It's like if someone were to have chest pain. That could mean any number of things- not just a heart attack.

He also explained the origins of the word. Odyne is the Greek goddess of pain. Dynia thus means abnormal pain response. And vestibule is the part that is having the abnormal pain response.

There are a dozen different causes of pain in the vestibule (he goes into depth about them here if you scroll down, but I am going to go down the list he gave me in terms of my personal pain).

1. Atrophy- Thinning due to decreased estrogen and testosterone because of taking oral contraceptives. The one I am on, Yasmin, is the worst for causing this.

2. Tight pelvic floor, also called vaginismus- I do not have this. This is because if I DID have this, I would only be having pain in the lower part of my vestibule, but in fact I have pain in the entire vestibule.

3. Congenital Neuroproliferate Vestibulodynia- You are born with too many nerve endings in this area. Some women have up to 30x (3000%) the normal number of nerve endings. The types of pain that I was describing- burning, cutting feeling like a 'hot knife' is associated with this diagnosis. Hypersensitivity of the belly button is also linked to this, because the same tissue that comprises the vestibule is the tissue left over in the belly button.

4-9. Dermatologic conditions - I don't have these which he can tell because he did the vulvoscopy with the vinegar today.

10-12. Vaginitis- some kind of inflammation or infection- I don't have this either.

The thought is that either I have #1- the atrophy and thinning because of the birth control pills that I am on- or #3 - the congenital neuroproliferate vestibulodynia where I have too many nerve endings there because I was born this way.

The Treatment


I need to stop taking birth control pills and need to apply a special estrogen/ testosterone cream that he prescribed to me twice daily over the entire vestibule, digging deep into all the nooks and crannies (so it is going to hurt). Then, in three months, he will reevaluate me to see how much pain remains. If we are lucky, it will all be gone and I will just need to find a new contraceptive method.

If the pain is NOT gone (and he suspects it will not be due to my description of it, the fact that I haven't been married or on birth control pills for very long and because my belly button is sensitive), then we will have to consider a surgery called a vestibulectomy that will have to remove some of the nerve endings from that area. Of course, ideally we are hoping that just taking me off the birth control pills will make all the difference.

I talked to the doctor about women in the Orthodox community in general. A prominent Hasidic Rebbe actually sends all women who are experiencing painful sex directly to Dr. Goldstein, and apparently Dr. Goldstein has also worked alongside Talli Rosenbaum and he has given speeches and lectures in Israel on this topic to very Charedi crowds. He says that most times when Orthodox women think they have vaginismus, they really don't and it is a misdiagnosis. In contrast, he has seen a prevalence of Indian women presenting with real vaginismus.

He also said that if I can get together qualified people in New York who would like to learn from him about different types of sexual pain, disorders and potential treatments, he would be happy to speak about it (which is awesome).

He also gave me a free copy of his book, which is AWESOME (and really helpful at explaining everything). It is called 'When Sex Hurts: A Woman's Guide to Banishing Sexual Pain.' If you are in the same boat as me, you MUST MUST MUST read it and own it. It is so helpful.

I also learned from the doctor that there is an International Society for the Study of Women's Sexual Health, which he is part of. Who knew?

I am just SO HAPPY because he stressed to me that my anxiety is not what caused this or brought this on, this is not a psychological issue, this is not in my head and this does not reflect the fact that I don't care about my husband or anything like that. It is purely a medical issue. And it is treatable.

I'm so happy!

Clinical and Torah Perspectives on Intimacy & Fertility

It seems the Orthodox Union and the Puah Institute are going to be addressing fertility and intimacy issues (link). I am pleased to see that they will be discussing dyspareunia (painful intercourse). Anyone who is Jewish and who either has these issues or wants to learn more about them should attend. It is taking place Sunday, April 29th.

I'm not sure if they've done this conference in the past or if this is the first time. Does anyone know?

You can see the flyer and information and pre-register/ sign up here.

Fifty Shades of Grey

You may have heard about Fifty Shades of Grey by E. L. James. It's making the rounds in America right about now. It's been labelled 'Mommy Porn' and is considered to be erotica that leans more to the kinky side (as it involves BDSM). It was originally published on the Internet as fanfiction starring Edward Cullen and Bella Swann, then was changed to a book about Anastasia Steele and Christian Grey.

The book itself is poorly written, bizarre and the characters (especially Anastasia) are often bland and boring. It does, however, have very steamy sex scenes. It's not the sex scenes in and of themselves that have me thinking, though- it's the semi-brutality and focus on pain and punishment that's expressed in the book. The backdrop to this is that Christian Grey is screwed up because he grew up in an abusive family, and somehow this predilection is a means of therapy for him.

Like a typical Beauty & the Beast story, Anastasia is going to be able to save Christian (we don't see it in this book but there are two more books in the trilogy). What bothered me in the book was how much of the sex was about sheer animality rather than love. I was really moved by the parts where Christian did forfeit control/ go outside of his comfort zone in order to try to give love to Anastasia and help give her the 'more' she was asking for. I like Christian better than Anastasia, but I don't like how domineering and controlling he is. I think he is just on the side of abusive personality himself.

I was trying to figure out why so many people like the book. I know the reason that I (semi) liked it had to do with the character of Christian. I am a sucker for people who are in difficult places undergoing difficult things and who are trying to go outside of their comfort zone in order to be better (in this case, for him to love Anastasia in a way that doesn't mean he also hurts her). Some of the sex scenes were hot but some of them just were too brutal/ animalistic for me. I see sex as an outlet for love, not an outlet for animality. The book as a whole actually made me reflect on what Jewish values of sex are vs. secular values. And I think that there *could* be Jews who would do the stuff that Christian and Anastasia did in a loving way, but it was clear that he was doing it in a punishing/ domineering/ controlling/ possessive/ scary way.

I like the idea of a passionate person who can be controlling or possessive, but not in the way that the characters of Edward Cullen or Christian Grey are. I really like the love story between Chuck Bass and Blair Waldorf on 'Gossip Girl.' I think they are good examples of this kind of relationship. Chuck learns from his mistakes, is aware of when he goes too far and in the end wants the best thing for Blair (which is why he pays for her dowry). His focus is on what is good for her which is why he even lets her leave him for a relationship with Dan Humphrey. And I think that shows real love more than the whole Christian consistently making Anastasia come back to him does.

Melancholy

Pesach was beautiful. We had some friends and family over at our seder. It was wonderful.

I sit here now and listen as the sound of piano music wafts up the stairs. My husband is playing. It's very beautiful and melancholy.

Every time I deny my husband sexual relations his eyes look at me and they look so sad and hurt. If I had feelings left that I could feel, I would probably be pained. But for some reasons, they've drifted so far away from me. I've gone into protective mode and this is also a selfish mode.

I need to figure out a way to get who I really am back.

Fight

So we had sex recently. I had to prep for it by using the smallest dilator, then the middle one, then the largest, then the dildo. It sucked. I hate using the dilators. I cried when I shoved the large size and the dildo in.

It did prepare me for my husband, though. He went in pretty easily. He was all happy and excited about getting to have sex where it wasn't a struggle to fit him inside. I was detached, spending most of my time watching the ceiling and waiting for it to be over. I was also upset because he was being all tender (sweet chaste-like kisses) and I want him to be passionate and excited and exciting, not all tender. Tender doesn't turn me on. Anyway, he was looking forward to my continuing to use the dilators on a nightly basis and thus alleviate pain. I didn't say anything the night we had sex because I didn't want to burst his bubble.

But then I was extremely sore and in pain the whole day after we had sex. And I decided that I don't want to do the dilators, even if he says that long term they are somehow going to help. You try shoving big painful pieces of plastic inside of yourself and see how you feel.

I was upset at him for pushing me away and always putting distance between us. I said that wasn't helping us on an emotional level. So then he said: "You can't feel loved by your wife if she can't have sex, even if it's not her fault." This hurt my feelings. What about this couple?  Why can't my husband be like the husband in that story? Can't love go beyond the physical?

I know that if I don't want to do the dilators, I have to see some kind of doctor or therapist to figure out if there are any other solutions. Maybe I can try Botox. And I don't think this one fight means everything is over between my husband and me. But I do think it means that this is messing up my marriage and that he is being mean. It's mean to say that just because I don't want to be in pain that means I don't love him, even though I get that he is hurting and in pain, too. I guess we're just both being mean to each other.