Collapsed V

Your gynecologist can show you how to use your dilators correctly, but it is up to you to control the frequency of use and the speed in which you advance to larger-sized dilators. Relaxation exercises and physical therapy can also play an important part in dilator therapy, helping to make the process a success.

Up until now, dilators were designed for use only while lying down. Unfortunately, that did not bear well for the multi-tasking women of today who need to do the dishes or read bedtime stories to their kids while doing dilator therapy. With that in mind, I designed wearable dilators to be used while standing and multi-tasking. (No, I haven’t thought of everything, but I’m trying.)

Since the biggest problem with effective dilator treatment has always been poor compliance, I’m hoping women will turn to this new and improved model to help themselves.

PT (Physical Therapy) for the Vagina

As easy as it is to relate to PT for back or knee pain, PT for the vagina and bladder may sound a bit foreign to most women, but it turns out that PT for pelvic issues is growing in acceptance and popularity as a last resort in resolving issues related to painful sex and bladder dysfunction.

In fact, there are physical therapists trained in exactly this field. These qualified therapists will meet with you in order to get a clear understanding of the nature of your symptoms and then follow up with a pelvic exam in order to identify areas of weakness in and around the vagina. The therapy itself usually involves weekly sessions of stretching and massaging the outer and inner vagina in order to treat the areas of discomfort.

As with any other health professionals, you may get a referral for a vaginal physical therapist from a trusted health care provider or from your gynecologist. You may even find that your gynecologist is trained in just this sort of therapy. You won’t know until you ask.

Hormone Replacement Therapy (HRT)

There has been a decided rush to judgment in recent years as to whether or not HRT is helpful or hurtful in the long run. In fact, the landmark Women’s Health Initiative Study (WHI) in 2002, which examined hormone replacement therapy (HRT) and its impact on breast cancer, heart disease, and osteoporosis has been the biggest deterrent to women considering estrogen replacement therapy. The study’s conclusions caused enough panic among women so that HRT became a dirty word. Truth is that the findings were inconclusive in many ways, as results varied depending upon the health of individual women. Subsequently, it was concluded, “Hormone therapy affects many organ systems in the body and changes the risks of many diseases—some in good ways, others in bad ways. Depending on hysterectomy status, age, and other individual factors, the consequences can vary dramatically.”

What is now understood is that HRT is safe for many women to use within the ten-year period of time from the onset of menopause. The bottom line is that menopausal women need personalized care in their treatment, not information from generalized studies. Their vaginas depend on it!

Vibrators: Still a Girl’s Best Friend

In addition to the varied treatments for a dry vagina (or out of commission clitoris), I always suggest trying a vibrator. Especially in the case of acquired orgasmic dysfunction (AOD), which I talked about earlier, a vibrator can be an easy solution in helping to achieve orgasm when the aging process seems like it’s arm wrestling you in the bedroom.

I would love to normalize the conversation about the usefulness of vibrators in treating orgasmic dysfunction, since not only do orgasms ease the stress of every day living, orgasms work out the pelvic floor—which helps with incontinence. In addition, they are good for the heart, the mind, and the soul.

Do yourself a favor and give yourself the gift of my favorite vibrator, the Inspire Vibrating Ultimate Wand by Caloxotics. (Amazon Prime can get it to your nightstand by tomorrow morning!)

The unfortunate fact is that many women will suffer from painful sex for years before broaching the subject with a health-care provider. It’s been reported that “30 percent of women experience pain with vaginal sex and most don’t tell their partners when sex hurts.” Don’t wait, please. Aside from the common issues I’ve mentioned, there are many other diagnosable and treatable causes of a vagina that feels like it’s collapsing under pain! Those causes include:

Vaginal Infection. The signs and symptoms of a vaginal infection may include vaginal discharge, odor, or itching, which may be the cause of your vaginal pain and swelling with sex. A trip to your health-care provider will keep you educated.
Pelvic Inflammatory Disease (PID). Sexually transmitted infections (STIs) such as Chlamydia and Gonorrhea are the typical culprits of PID, a serious pelvic infection that can lead to infertility and pelvic pain. Getting STI checkups is especially important when you change sexual partners.
Penis Size. “Bigger is better” is not the case for a vagina that can’t tolerate a long, thick penis. The average penis is 5.7 inches in length and 4.8inches in diameter (girth). When flaccid (not erect) the average penis measures between three and five inches. When erect, the average penis measures between five and seven inches. The vagina may stretch to accommodate a larger sized penis, but it may take time, patience,strategic sexual positions, vaginal dilators, and open communication.
Vaginal Tears and Lacerations. Tears and lacerations can result from many things—sex without proper lubricant, a larger-than-average penis, use of a particular sex toy, or trauma from childbirth. Vaginal lubricants can help avoid some of these problems.
Latex Allergy. The majority of condoms are made out of latex, which propose little problem to most women, except those with latex allergies. An allergic reaction to latex may involve vaginal swelling, itching, and pain during and up to thirty-six hours after sex. If you have a latex allergy, you can use a polyurethane condom as an alternative for your safe sex measures.
Ruptured Ovarian Cyst. If you are having sex during ovulation or mid-cycle, chances are there is an expected large ovarian cyst waiting to ovulate and release the egg. Aggressive sex can cause this cyst to rupture, releasing its fluid contents along with the egg and causing pain. A pelvic ultrasound combined with your menstrual history can help with a proper diagnosis.
Endometriosis and Uterine Fibroids. Both of these female problems can cause pain with sex, especially with deep penetration. A detailed health history, pelvic ultrasound and a discussion with your health-care provider of other related symptoms are necessary in order to detect these conditions.
Positional Sex. Certain sexual positions are known to be anatomically hard on the vagina and female organs, including the uterus and ovaries. The missionary position tends to be anatomically easier for women, whereas Doggie Style or “from behind,” which allows for deeper penetration for the male, may bring more discomfort and pain for many women.
Virginal. If you have never had vaginal penetration with a penis, your first experience with sex will probably be painful. It may take time and regular sex before you start to experience anything like pleasure. Prepping the hymenal ring with a vaginal dilator a month before penetration would be a novel and effective plan. Also, a good lubricant or numbing gel (lidocaine) at the entrance of the vagina can also help relieve pain.In any case, patience and good communication with your partner is the right recipe for success.
Emotional Problems. Depression, anxiety, relationship problems, and fear of intimacy all play a role in painful sex. Psychotherapy and the ability to communicate your feelings to your partner can help overcome some of the emotional problems that may inhibit a healthy, enjoyable sex life.
History of Sexual Abuse. Any history of sexual abuse and trauma (emotional or physical) can contribute to an aversion or general dislike of sex. A devastating experience that leads to “post-traumatic stress disorder” may only enable you to feel pain with sex. As in dealing with emotional problems, therapy and open communication with your partner is key to helping resolve issues linked to abuse and trauma.

When it comes to dealing with the cause, effect, and treatment of a Collapsed V, women simply want the same responsiveness from the medical community as men have had with their sexual issues.

Think about this: A man walks into his doctor’s office with a complaint about his inability to have or maintain an erection, and then he walks out with a little blue pill. Boom. A woman walks into the same doctor’s office with a complaint of period pain and pain with sex. If the underlying cause of that pain is endometriosis, it will take, on average, 9.2 years for that woman to be correctly diagnosed, as reported in Lili Loofbourow’s illuminating 2018 essay, “The female price of male pleasure.”

In that same essay, Loofbourow noted that PubMed (the database for the National Center for Biotechnology Information) has 393 clinical trials studying female dyspareunia—the severe physical pain experienced during sex—10 clinical trials studying vaginismus, 43 studying vulvodynia, and 1,954 devoted to the study of erectile dysfunction. Here’s the math: There are five times as many clinical trials on male sexual pleasure as on female sexual pain. Women are the ones who forego the conversation on their own sexual health and experiences, since society seems to be telling them that the ultimate goal of the sexual experience is a man’s orgasm. That is not an ultimate goal. The goal needs to be an equally shared and equally satisfying experience, one that is pain-free.

It is time for women not to feel shame or embarrassment about issues of their own sexual dysfunction. In fact, the FDA is finally showing support for the challenges faced in female sexual health by researching and approving viable new treatment options. There are health providers out there who are willing to listen and act, and there are treatment options available—even if they don’t come in the form of aneasy-to-swallow, little blue pill. As women, our needs are a bit more complicated than that—to which I say, “Amen.”

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