Painful Sex - Danielle's Story

I’ve wanted to be a pelvic health physio since I was a physio student.

New Graduate Physio 2013

I’d always thought that women’s health physio was all about pregnancy, post-partum recovery and prolapses. Little did I realise how important pelvic health physio would become in my own life. This is quite a long post, it’s my story of painful sex and the long road it took to finally find the right help.

It all started with a tampon when I was 15 years old. I was meant to go swimming, but I got my period. Nearly 45 minutes later I was sitting on the bathroom floor in pain and in tears because I couldn’t get the stupid thing to go in. Subsequent attempts over the years were just as successful until my early 20’s. Periods were already a nasty business for me, but I’d been assured that it was just because I was a teenager. At 16 I was put on the pill to regulate my periods, and no one ever told me to stop taking it. I ignored my painful periods for years after as I thought they were normal (But more on that in a future post).

Newlywed - age 20

5 years later I was newly married. I had a run of 3 UTIs in the months before my wedding (including an awful one on my wedding day). Our first sexual experience I felt a knife-like pain and had some bleeding. Then every time after that hurt too. I'd always been told the first time hurts but no one told me it would keep hurting like this. It was time to see the doctor. The next 6 months I got STI tested 3 times and I got 2 pap smears which were all normal. I took 5 courses of antibiotics, and 4 or 5 rounds of thrush treatment with no effect. My poor GP was running out of ideas, so she sent me for an ultrasound scan which I didn't know would be an internal one. The sonographer was lovely and after seeing how nervous I was let me put the ultrasound probe in myself, it still hurt but at least I controlled the hurt. The scan said I was “normal” but I didn’t feel normal.

I so desperately want to be intimate with my spouse, but I was afraid to be sexual because of the pain. A part of me wondered if God was punishing me for not waiting until marriage to have sex. I became depressed. My GP all but gave up after 7 months of tests and failed treatments, told me it was probably pelvic inflammatory disease and referred me to a gynaecologist. I never heard back from that gynaecologist about an appointment. I googled pelvic inflammatory disease and it didn't seem to fit my symptoms. I called my mum in tears. My mum suggests a second opinion. Because I had IBS symptoms I was sent for a colonoscopy in case the pain was actually coming from my rectum, but again it was normal.

A year later I still hurt, to the point that I was stopping sex after not even a minute because I was in too much pain to continue. After sex my vulva felt like it was on fire for an hour, and I would lie there with an ice pack on my crotch, desperate to make the pain go away. A new doctor gave me combination antibiotic, antifungal and anti-inflammatory cream to knock out literally anything that could possibly be affecting my vulva/vagina. It did nothing. Had I tried relaxing before sex? How do you relax when you know it's going to hurt? Maybe I was allergic to condoms? Getting rid of condoms did nothing. Maybe the pill was causing vaginal dryness? Stopping the pill didn’t help me either, and just made me anxious of getting pregnant.

I saw another GP, a sweet grandmotherly woman. She asked me if I was a christian and I said yes. She sat me down told me that because I was married, sex wasn’t sinful or shameful in God’s eyes so I could relax and enjoy sex. I think she was genuinely surprised when I returned still in pain, so she sent me for an ultrasound. This time the ultrasound was not normal, it showed adenomyosis and polycystic ovaries. Although the ultrasound didn’t show this, the GP also diagnosed me with endometriosis. She told me that because I’m already on the pill, there is not much else I can do treat these issues, but to come back to see her for help when I want to have a baby because it’s going to be difficult. I asked for a referral to a gynaecologist and then left her office in tears. Never in a million years did I expect this. Not only was my vagina broken, but now I won’t be able to have a baby? I was devastated.

The gynaecologist was a quiet middle aged man. When he examined me he was able to push on what hurt, but said that everything looked healthy. He told me I don't have polycystic ovaries or adenomyosis and my pain doesn't fit with endometriosis. He sent me for another scan just to be sure about the endometriosis, it’s an internal scan and I had to have an enema before it. Based on the scan my gynaecologist said I don’t have endometriosis and there's nothing he can do for me. (Spoiler alert: I would be diagnosed with endometriosis in 2020) I left the office in tears, and I'm beginning to think that pain is just my life now. I was given a referral to a sexual medicine specialist, and I wait 13 months to see her. Her name was Vicki. She made me feel heard and understood. She diagnosed me with vaginismus (a spasm of the pelvic floor). I feel relieved but I also feel like an idiot. As a physio I should have guessed that this came down to muscles, but it hadn’t occurred to me because I’d thought that vaginismus meant penetration was impossible, while for me it was possible but horribly painful.

I saw the sexual medicine doctor for a year and also saw a pelvic health physio. The doctor gave me an anti-inflammatory cream and then amitriptyline (an antidepressant) in cream form for my vagina. I made many jokes about how my vagina was depressed and needed antidepressants. We had many sessions where she talked about shame, self-esteem, self-care, and self-compassion. I never realised how much the way I thought about myself impacted my pain. My physio diagnosed me with provoked vestibulodynia (meaning pain and sensitivity to touch on the entrance to the vagina). By that point I also had some bladder urgency as well. We worked through breathing exercises, stretches, dilators, trigger point therapy to my pelvic floor, and how to desensitise myself to penetration again. She reframed the pain science I already knew about other body parts to my pelvis, vulva and vagina. With both my doctor and my physio I learned how to slowly build up to sexual activities with a partner while keeping myself calm and relaxed, focusing on enjoyment not on whether the sex was “successful”. I cried happy tears and my physio did a little happy dance the day I told her I had sex and it barely hurt. I’m tearing up a little now just writing this.

The pain didn’t go away 100%, but I am now able to enjoy sex, mostly without pain. I know now how to communicate with my partner so that we can do things that don't hurt me. Pain is not scary or depressing anymore. I have found patterns to my pain, so I know why it hurts and I know what to do about it. The pain might be triggered just before my period, while I’m ovulating, if I’m stressed, or if I forget to use lube, or if I skip foreplay. For each situation there are things that help.

Please know that if you're reading this and sex hurts for you, there is help and things can get better. It doesn't matter your gender or how long you've had your pain for, things can definitely get better.