Friday, May 10, 2013

History, Diagnosis and Treatment

No matter how I try to avoid the subject, rephrase the issue, or forget about the problem all together, there is really no way around it. For a long time now I haven’t been able to have sex without experiencing pain, but more on that later. I suppose I should start at the beginning.

I have always had vaginal issues. From a young age, I suffered with recurrent urinary tract infections for no apparent reason. Later on, I was diagnosed with and treated for endometriosis, although no official tests were ever performed. This treatment consisted of medically induced menopause at age 16 which lasted for 9 months. With the lingering endometriosis and irregular periods, my OBGYN prescribed oral birth control. I continued to use birth control to regulate my periods for 9 more years. 

It was in college that I met my best friend. We lived in the same dorm only one floor apart. After a year of hanging out it became apparent that we went meant for something more, and we began dating the following summer. The two of us were inseparable, depending upon each other for everything. What can I say - we were young and in love! A few years passed; we both graduated and finally married in October of 2009. Believe it or not, we had abstained from sex until we got married. I had the Mirena IUD placed about a month prior, but it didn’t really start to kick in until a bit later. That’s when the real problems began.

I started to feel burning during intercourse. At first, we thought this had everything to do with the type of lubricant we were using or was related to my endo, but as time went on, it got worse no matter what we tried to do differently. We took our “real” honeymoon in March of 2010, and by then the pain (burning) was so bad we could not have intercourse again. As a last ditch effort I had the Mirena removed after reading various reports that it could be the cause, but the pain persisted. I also noticed a severely diminished sex drive. I saw a couple of physicians and a physical therapist who diagnosed me with vaginismis and recommended various exercises, but none of them helped. Thankfully my pain was only related to intercourse. I could still wear whatever I wanted, ride my bike, and maintain an active lifestyle.

In late 2010, I started working as a travel nurse in labor and delivery, and we moved from the Midwest to California. It was one of the nurses from my home hospital in St. Louis who saw Dr. Andrew Goldstein on TV and told me I should look him up. Upon searching I found the book “When Sex Hurts.” I read the book and realized that the second author, Dr. Irwin Goldstein, at San Diego Sexual Medicine was just a few hours from my current travel assignment. I set up a courtesy call, and he recommended I find a new physical therapist in the area through the APTA website She prescribed various exercises and dilation which did help to strengthen my pelvic floor and relieve the pain, but it was still there. I also tried using 1% topical Lidocane as recommended in the book, but it only made the pain worse.

I first saw Dr. Goldstein on November 1, 2011. He reviewed my lab results, checked my pudenal nerve, and completed a Q-tip test. My testosterone was really low so he placed a pellet implant and had me apply Estrace cream to my vagina twice a day. Slowly, my sexual drive increased, and my husband and I were able to have pain free sex for the first time in quite a while. After a few more times we started to feel hopeful, but unfortunately, once the pellet dissolved the pain returned. Dr G. recommended using Testim too as a source for testosterone because I couldn’t make it to San Diego for another pellet placement, but the Testim did nothing but cause my body hair to grow and acne to flair up. I went back to see Dr. Goldstein in April of 2012 and had two pellets placed. Again we managed to have a few weeks of enjoyable, pain free sex, but once again it dissolved quickly and the pain resumed. In September, 2012, two more pellets were placed and I was given Axiron to use as well. This proved to be too much testosterone at once, causing hypersensitivity without really reducing the pain at all. Since this was no longer a hormonal issue, my diagnosis was changed to provoked vestibulodynia.

In December of 2012, my husband and I made another trip to San Diego for the VAT test which would numb my vestibule area – the cause of my pain – so we could attempt intercourse. Unfortunately, I didn’t stay numb for long from the VAT, but it did indicate that a Vestibulectomy – surgery to remove my vestibule – was the next step since we had exhausted all other options. We tried to delay the surgery to save money because it would not be covered by my insurance. We were also trying to figure out the timing for the recovery to coincide with work and time between assignments. However, after much thought, prayer and advice from our parents we decided it was best not to wait. My surgery was scheduled for May 8, 2013, and we headed back to San Diego a few days early to prepare.

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