you know what really grinds my gears? how as children we were constantly told “you will understand when you’re older”. will i?? will i mom?? my realization was just when im googling something about my private genital area and im literally here asking myself “what exactly is my clitoral hood?” don’t get my wrong, i know where my clit is but what exact region is my hood? i’m looking at all these google images and i see some paintings that resemble vaginas and it dawns on me. i literally grew up with a vagina on my wall. it’s a painting of a flower but i did research and this artist is inspired by VAGINAS. so i have this memory of the adults in my family coming to the realization of what they are looking at and little kid me is asking what’s going on?? what is the painting?? all i see is a flower? so i’m just brushed off and told i will understand once im older. i grew up always looking at this painting, trying to see what the adults are seeing. well, here i am, 27 years old and i am googling what parts of my vagina are. when my mother could have sat me down and explained what it was. what i had on my own body. to go to the bathroom and take a look because i never had the idea of even actually looking at my genitals until my early 20s.
don’t get me wrong, there are probably some things you could tell a kid they will understand when they’re older or maybe wait a little longer to explain some things when they are older but something like that? kids need to explore their bodies and also know their bodies. but that’s just something that grins my gears. educate your children, please

Clitoris and Clitoral Adhesion
I was shocked to learn women have prepuces and that you should retract it to clean it to avoid clitoral adhesion, clitoral phimosis, etc.
I’m 42 and it has always been somewhat uncomfortable touching my clitoris (either by myself or my partner). Over the years it was full of ups and downs and I always attributed this to level of arousal, but I think I’m wrong it was all clitoral adhesion.
So I decided to look for myself and I can’t retract my hood completely. It hurts a lot and really similar to uncomfortable sensation I’ve sometimes had when having sex but way more because it’s like I found the source of it.
I’ve compared it to images in this site https://www.rachelrubinmd.com/post/new-research-on-clitoral-adhesions And it’s quite similar to mild to medium adhesion.
My doctor is not familiar with this and can’t help. She was going to look for resources…

• anyone was able to solve this at home?
• is there a doctor like the one from the link in Ontario, Canada?

Thanks everyone

TLDR: I’ve got PN twice, once due to a sports injury (1.5 years of leg pain and 7 months of clitoris pain), and the 2nd time due to an electric shock (pretty much all the symptoms you’ve ever seen associated with PN). Both times I healed by administrating 90% of the treatment myself, with the remaining 10% performed by physical therapists. No surgical procedures or dry needling.
If you wanna go down the road of doing self-treatment, this is the literature that was the most helpful to me:

• Breaking Through Chronic Pelvic Pain: A Holistic Approach for Relief Jerome M. Weiss
• The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (3rd edition) Clair Davies and Amber Davies

You will find pretty much all the information I used to develop my treatment in these 2 books. Each person is different, and their PN is provoked by different factors - therefore reading the books yourself is much better than just replicating exercises/massages I did.
I am not a medical professional, therefore things I share should not be taken as medical advice.
__________________________________________________________________________ __________________________________________________________________________
I cannot believe that I am finally making this post! For the ones that are here for the full roller coaster, here we go:

Part 1: “It WiLl PaSs On ItS oWn”

In September 2022, I was stretching after a long day of work and a pole dancing session. I was a bit tired and distracted, which made me slide on my yoga mat and weirdly rotate my leg (this will be important later in the story). I felt instant pain down my whole leg, assumed it might just be a pulled/overstretched muscle, and tried to continue my life as normal.
Not only that the pain did not go away with time, but it kept getting worse, to the point that I had to work remotely 80% of the time and drop pole dancing altogether. I saw 5 different doctors (of which 3 were sports injury specialists) in a span of one year, and I received nothing useful. I was told it would pass on its own, that I was weak, and even that I was too old (28 at the time). Done 2 different MRIs, nothing.
I accepted that perhaps I was stuck with this pain forever. With some stretches/exercises and shoe soles I managed to bring pain to acceptable levels, and even tho I could not do any demanding physical activities or walk for a long time, I made peace with it.

Part 2: The Curse of PN

Fast forward to September 2023, after a couple of days of increased activity and walking, I woke up with clitoris pain. Initially, it was not that bad, even tho it was constant. Sex was painful but still manageable. I was misdiagnosed with fungus infection 2 times, treatment changed absolutely nothing.
It was slowly getting worse and culminated in late Novembeearly December.
Let me tell you, I am no stranger to pain. For most of my life, I lived in the Balkans, and our mantra over there is to just “suck it up”. I was subjected to intense unnecessary pain on many occasions (including complex dental procedures without anesthesia).
Nothing could compare to that insane clitoral pain at all times, for days and days in a row. I felt I was going insane. I do not have a history of any mental health problems, that was the first time ever that something pushed me over the edge of considering ending it all. One night I really could not take it anymore - however my husband talked me out of doing anything bad to myself, and the next day I got a prescription for xylocaine. Since my clitoral pain was very local, it helped a bit. Was not perfect, but was enough to survive.
In January, I started seeing pelvic PT, and while the pain reduced a bit, it never really stopped, not since September. I was mentally and physically tired and just wanted the pain to stop at least for a moment. You can see here my 1st post on this subreddit and how I felt at the time.
I also started seeing a bunch of different specialists in hopes of getting an answer, with little success.

Part 3: The final straw

So after 2 months of waiting, I finally got an appointment with a well-known gynecologist in the area, who was apparently a specialist in complex female issues. Not only that he spent 80% of our appointment typing with 2 fingers my information (that I had already provided beforehand), but he also told me that he could not help me AFTER I finished his little “interview”. He was also insisting on putting me on birth control, even tho I already mentioned that I cannot have sex at all for multiple months.
The final straw was when I mentioned that lower back massage sometimes helps me feel less pain, and he told me it's all in my head because these 2 things are not connected in any way.
EXCUSE ME? At that time, I had zero knowledge of how nerves work. But, while lying down and receiving treatment from PT, I was staring at the image of the pudendal nerve on the wall. With no medical background whatsoever, I could tell, based on the vague memory of that image, that it starts in the lower back, and eventually one of the branches ends in the clitoris.
Needless to say, I was furious.

Part 4: “Fine, I’ll do it myself”

That very same night I thought to myself “How can this guy be a doctor? I would do a better job than that”, and that’s how it all started.
I started learning about the human body from scratch. I wanted to be sure that nothing was left unchecked. Literally going through what are cells, different types of cells, what are their roles, etc., all the way up to the bigger picture. I dropped all the other activities in my life, I was only reading all day. Learning about anatomy and neuroplasticity was really helpful - I was less scared when I finally understood what was (and especially what wasn’t) at stake in my case.
Eventually, I stumbled upon the information that damaged muscles can pressure the nerve and cause all sorts of problems. Damaged muscles are known to be contracted, with painful points inside of them. I decided to put this knowledge to the test and see if that was perhaps where the answer lies.

Part 5: Symptom-free in only 2 weeks (Trigger point release)

I quickly found that one of the muscles in my thigh was kind of stiff. Massaging it (or putting TENS machine on it) would significantly reduce the symptoms (up to 90%) for a while. However, they would return. I knew I was close to a breakthrough.
I started to explore nearby muscles because I learned that damaged muscles sometimes lead to dysfunction of the surrounding ones. I came across obturator internus. Now this muscle is particularly interesting, because not only does it wrap around the clitoral branch of the pudendal nerve (image: https://imgur.com/a/xwEG0XT) , but it also can affect the sciatic nerve (responsible for leg pain). And, surprise, surprise, this is the muscle engaged when we ROTATE THE LEG (remember - thats how my problem started in the first place, I rotated the leg weirdly).
I was both furious and excited - how could so many doctors miss such crucial connection, especially because I would always mention leg pain and clitoral pain, just in case it was related? No one ever told me it could be.
Anyway, I started treating this muscle, together with piriformis which also seemed to have painful points. I used the combination of stretching and strengthening exercises focused on obturator internus/piriformis I found on YT, together with the myofascial trigger points release massage method I was learning about at the time.
I shared with my PT what I found, and she also started treating me using the same technique on those same muscles.
In 2 weeks, I was symptom-free. I cannot begin to explain to you guys how happy I was! I was working on my success post, but then, a disaster happened.

Part 6: The Downfall

Even tho my symptoms were pretty much gone, some work was left to be done. My muscles still had a "habit" of contracting themselves (google the effects of chronic pain on the central nervous system), therefore continuing PT was beneficial (it’s fully covered by insurance in my case, so why not). Little did I know that would become my greatest regret.
My therapist had some personal issues, so another girl was replacing her. She suggested we do electrostimulation of muscles, to which I agreed, because I used it successfully at home too.
I have exactly the same machine, same brand, at home (I purchased it inspired by my PT). Thats how I know I am extremely sensitive to electricity, and I use it on the lowest settings. I repeated that to the girl twice and she said okay. I even told her exactly which mode and level to put.
The next thing I feel is AGONIZING BURNING in the whole left side of the body. I screamed and jumped from the therapy bed, she turned off the thing the same second. But the damage was already done. That girl eventually admitted that she put more than double what I asked for because “she was distracted”. The symptoms I developed literally in one second due to that “treatment” were (I will probably miss some):

• Inner tight burning
• Vagina and vulva burning
• Clitoral pain
• Back pain
• Anus pain and burning
• Pain when peeing
• Pain when sitting
• Literally unable to walk properly

I was not back to square one, I was at square minus one hundred. More than 90% of the symptoms I had were completely new and they were scary.
I still do not know how I found the strength to accept my new situation and start the healing journey from the beginning. But I did it and here we are.

Part 7: Final success

With a bit more research I realized that what happened due to this shock was SI joint inflammation, so I treated that first, with back massages, TENS machine, stretches, and anti-inflammatory creams. I was also treating trigger points. After some time of pretty much all-day self-therapy and research, symptoms significantly reduced.
The only symptoms that were left were thigh-burning, pain when sitting, and clitoral pain. The remaining contracted muscles did not respond to my massage anymore, they were too traumatized.
I visited a therapist who specialized in McKenzie technique, and while this method is not focused on pelvic problems, it is:

• Used in sports injuries, therefore there must be something to help traumatized muscles in there
• Is fully focused on exercising at home, which again, was what I wanted

(As far as I know, this method is not proven to have long-lasting effects, without being combined with other methods, be mindful of this)
He gave me a couple of exercises to try and perform every day, which I added to my usual treatment. Combined with myofascial trigger points massage, in which I became even better with time, the remaining symptoms eventually vanished.
Today I woke up symptom-free.
This is clearly not the complete end, because neither muscles nor nerves can heal overnight. But I am pain-free, and very motivated to continue treating myself with the same level of eagerness and diligence, so the symptoms do not come back again. ___________________________________________________________________

Conclusion

I encourage everyone in this subreddit to seek knowledge.
I am not talking about googling the symptoms and reading random internet pages/watching tiktoks that cite no credible source for their claims. I am telling you to truly dive into this. It will take time, effort and discipline, but you can help yourself. All of these doctors got their knowledge from somewhere, and we can do it too.
There are SO many reasons for PN to occur, and you know yourself and your life the best. Armed with knowledge, not only you can perform a variety of PT techniques yourself, you can also be more confident when visiting doctors. I cannot explain how differently I am treated now, when I can speak “their language”.
The effect on mental health is also incredible. The more you understand what is happening within your body, the less anxiety you feel over your future.
I would like to end this post with a quote that inspired me throughout my journey (which is the opening line of the first book I shared here):

We only see what we look for, and we only look for what we know.
-William Boyd

​

I quit 10mg of Prozac on July 26th after taking it for six weeks. Cold turkey because it gave me mania, I was on it for OCD. On August 28th, my genitals went completely numb, my whole groin felt anesthetized, and I had no access to my emotions. I had complete anhedonia and severe panic attacks. I couldn't empathize with others and I felt completely disconnected from friends and family, even my adorable two year old niece. I had DP/DR really bad and the numbness extended to other parts of my body, mostly my thighs and toes. My clit would not get hard at all and it had a weird texture. It was very pale and retracted. I was drier than the Atacama desert. I never had complete anorgasmia, but my orgasms were next to nothing, I couldn't feel them at all and I could only have one with a vibrator in one position. No libido, just the urge to keep "fap checking" as you say. Weed wasn't fun anymore, but I could still feel high. My brain felt like a block of wood and my memory was shot. It was almost like I had amnesia. Aphantasia.
The OCD was gone, but at what cost?
I never had sexual dysfunction, anhedonia, or emotional blunting in my life. I was a horny little pleasure machine who didn't like to kill stuff in video games because it made me feel bad.
I had an incredible, yet brief window in September from smoking weed while drinking a full up of coffee. Ever since I did that, I got windows. (DO NOT DO THIS, THIS HAS CRASHED PEOPLE SEVERELY) This has kept me going. I get windows that are two weeks long after I menstruate that were mostly about sensation and emotion. I was waiting for such a window to write this.
I had ups and downs, a couple crashes from things like taking too much vitamin D, drinking caffeine for a few days in a row, and deciding to smoke weed again. I caught covid and had a massive crash from that, but I completely recovered from it.
My depersonalization/derealization was the first symptom to go, it was 90% gone by January. (although I have DP/DR from physical and verbal abuse as a child, but I never experienced months of disassociation like this) Right around that time, I started getting icy, zappy sensations in my forehead and left cheek. I got the same sensations on my thighs and in my vagina later. When the persistent DP/DR lifted, a lot of my mental and emotional symptoms improved.
Next, my anhedonia started to lift as well. I had horrible musical anhedonia, which was really sad to me because I loved music so much and it brought me so much pleasure. I started to notice frission (music chills) while I was watching TV and there was a good song in the show. I was getting into the stuff I was watching and I was finally able to absorb it. I started playing my favorite game again. I can't feel music with the same intensity as before yet, but it is increasing all the time.
I still have some emotional blunting, but it's definitely less. I feel connected to the people I love again and I cry if I think about killing myself. But it's like I have the Diet Sprite of emotions when I used to have a full cup of Dr. Pepper. I don't know who I am without emotions, without empathy. My empathy could definitely use more work. I hate being like this, I don't feel like myself yet.
Orgasm gradually improved, but hit a bump when I got covid. I had anorgasmia for a week and then it slowly came back, that was really scary and depressing because it's the only symptom I didn't have. I'd rate them at 6/10 on average now. The feel good brain chemicals are released, there is contraction of my pelvic muscles, but there is something wrong with my sensory nerves and I just can't feel it right.
My clitoris and vagina have regained some sensation and I have a tiny amount of erogenous sensation at baseline, windows go up to 50%. My groin no longer feels anesthetized, but I still have a severe loss of sensation.
In the beginning, my clit and vagina were in really bad shape. My clit was retracted and pale and just felt disgusting to touch. It has since consistently been perky and poking out like it used to, but it's still not as firm as it should be and my clitoral hood also feels loose. I always had a little dent on one side because my labia is asymmetrical and that dent has become super prominent. My vagina on the other hand has gone from being slack and dry to almost completely normal. I'm still missing a little grip strength and wetness, but I wouldn't call it weak, loose, or dry.
Aphantasia is still a problem, but it's decreasing by itself. My brain makes weak flashes of images and I can form a shitty mental picture. I used to be an artist, this was once a strong skill of mine. I hope I can be an artist again, I went into student debt to learn how to draw as well as I do.
I still have almost no libido, but sometimes it shows up. I very much had one yesterday, I masturbated three times and actually felt horny for the first time since September. I would get these brief flashes of arousal when I thought of my friend-with-benefits, but I could never maintain anything. I hope I'm turning a corner with that symptom. Spontaneous arousal still doesn't really happen. But just this week, my FWB opened up about their kinks and we talked about how I could indulge them within my boundaries and that made me horny for the first time in months.
The numbness in my clitoris was so bad I couldn't feel the tip of a sewing needle on it. Now I very obviously can, it's painful again. I'm still missing some pain perception though. I can put my fingertip under my clitoral hood when that used to be too painful. (my clitoral hood also used to be tighter and the tip of my clit was larger)
My clitoral erections are softer than they should be and my clit feels thinner than it should be, but I get clitoral erections more often with my vibrator. I can get wet enough to have penetrative sex, it just wouldn't feel good so I don't bother.
I have been doing a few things to help myself. From the beginning, I was taking walks every day because I read that exercise helps nerve regeneration, and my nerves felt injured. Unfortunately I stopped walking when it started to snow, but I'm back to walking for half an hour every day if the weather permits.
I masturbated at least once every day since like week 3 of this bullshit.
I use a TENS device on my posterior tibial nerve, which increases blood flow to the pelvic area. I'm focusing on things that don't alter me neurochemically, but support blood flow and nerve health. I eat a mostly healthy omnivorous diet. I've been eating beets, which have a ton of nitric oxide and folic acid this week and I have a significant improvement in bloodflow to my clitoris, so I'm looking into beet juice and nitric oxide supplements. I started taking vitamin C for bloodflow, ACE2 upregulation (covid fucks up these cellular receptors) and demethylation as well. I'm also trying to find the right dose of vitamin D that won't crash me so I can treat my deficiency.
I also quit smoking weed, but I did try a little recently and I could feel it more! It was just crumbs from my grinder but I was acceptably high for two hours. It does give me temporary crashes, so I do not smoke and I will not smoke until I am completely healed. I also don't drink because of health issues I have, and I was never a big drinker.
I might add more to this post if I think of something I missed. I think my odds of beating PSSD are good. I'm going to continue with no herbal supplements or anything and just wait. I think I'm still way off from being recovered, I'd consider myself "almost there" if I could orgasm through rubbing my clitoris again. I feel like I'm halfway there, or at least out of the pit.
Update: For all of April 2024 I have felt sudden and massive improvements in anhedonia and emotional blunting and both of those are almost gone! I feel like myself, just a little washed out. A pastel version of me. Diet Coke instead of full sugar Dr. Pepper.

Wether a woman is a virgin, or very sexually unrestricted, even she has sexual needs, theres this misconception that if a woman isnt having casual sex or likes to take her time in relationships or wants to wait until marriage she is asexual, this couldnt be further from the truth, and neglecting your future wifes sexual needs will lead to a really unhappy marriage.
So how do you satisfy your woman?
There is both an abstract and physical component to this, but physical cant be succesful if the abstract isnt there.
First, you must get rid of harmful ideas that get spread about sex due to pornography, ignorance, etc, ideas like:
-Sex is a man's need that his wife must be willing to satisfy, nothing will destroy the sexual polarity between you and your wife/girlfriend faster that turning sex into some sort of resource your woman is obliged to give you.
-If a woman doesnt wants sex with you she is not into you and she doesnt thinks you re worthy, it is true that if a woman doesnt finds you attractive the though of having sex with you wont be arousing to her, but this doesnt means that if a woman is into you she will turn into a pornstar (porn is harmfuly unrealistic, dont base your ideas on it), there are many situations where a loving couple might experience a crash in libido, things like pregnancy, stress.
Rather than looking at sex like some sort of resource or need, look at it more like the cherry on the cake of an already amazing relationship, a natural consequence between a healthy loving couple, things will naturally happen and you shouldnt worry about it, look at it more as a way of showing love to your woman, by making her bloom in pleasure, a loving activity where she should be the priority first and foremost, that way you ll ensure the experience is amazing for her and you, specially for her , and she will want more and more, you should enjoy being around your woman even if the possibility of sex isnt there, thats ironically a thing that will increase the chemistry between you two significantly, it is paradoxical but the more you feel like you need sex from your woman, the more you ll destroy the chemistry between you and her, specially if it is a woman who follows this sexual compass, as these women tend to have really strong boundaries and their creep detector is quite sensitive.
-Dont treat sex as a performance, treating it as some sort of performance for either party will harm the chemistry severely, for her, because if you see it as a performance for her, this will turn it into a chore, and the last thing you want in a succesful relatiomship is for your woman to see sex with you as a chore. And for you, because your woman will feel like you re not into it, you re not enjoying sharing the moment with her, but rather you re so focused on performing that will lose the connection with her.
-Dont treat sex as a reward you get from your woman, that means, dont try to do things to convince her or get your woman to sleep with you, dont flirt with her, or gift her flowers, or do chores to get her in the mood, no, if you gonna do all those things do so because you re genuine about it, you do find her hot, you do appreciate her, you do care, thats the only reason why you should do all of the aforementioned.

• You should feel like she is the woman of your life, contrary to popular belief, is not just women the ones who wait until they are ready for it, you should also wait until you re ready for it too, meaning that you do feel and find her like the woman of your life, a woman you would fight for, a woman you would climb mountains for, a woman you would break your back working on the field for her, and if you feel like that, she will definetly notice it in the way you look at her, the way you kiss her, the way you speak to her, the way you intimate with her. This wont be difficult to do if you dont treat sex as some sort of proof of your manhood and worthiness.

-Dont treat sex as some sort of proof of your manhood or worthiness, theres nothing more unnattractive than a man who values himself based on how much sex he can get from women, a woman choosing to sleep with you doesnt makes you more worthy or manlier, theres men with a bodycount on the 30s who are complete losers, meanwhile theres men who built empires when they were virgin, men who have won wars and dont have more than one partner count, be confident in yourself and things will happen naturally.
Now it is time for the physical:
-Looks matter, specially for her, if you make your woman feel like you dont find her physically attractive, this will destroy the chemistry between you two, she wants to feel like you find her attractive and desire her, but also she wants to feel like she is special to you, that means she wants to feel like you do desire her because of who she is, not because you re horny and want to fuck, and how do you achieve this? Easy, like i said, look for the things you like about her, see if she is someone you would actually take that step for.
Now, your looks do matter too, ensure that you re fit, healthy and well presented, groomed and practice proper hygiene.
-Sex is not just penetration, inserting your thingy your woman's privates specially when she is not properly aroused will either cause pain or feel bland, foreplay is a must, and frankly, when you dont have silly idead about sex, foreplay becomes natural on every encounter you have, when you get intimate, enjoy caressing her body, enjoy kissing her, kiss her whole body, enjoy touching and kissing her boobs and nipples (BE GENTLE AS THEY ARE SENSITIVE), her waist, just touch gently and see how she reacts, if you dont enjoy foreplay or you want to jump straight to the point, you might have been damaged by pornography or you have any of the harmful ideas about sex mentioned before. Your tongue, your fingers and your pelvic bone can do way more for your womans pleasure than your thingy, ensure that you stimulate her clit, as this the organ that will make her bloom. How to find the clit? You can look up the internet to see where it is located as an image is worth more than a thousand words.... but is located just at the end of the pelvic bone where the superior labia begins , and after knowing where it is, as long as you followed this guide properly, you need to know that a woman's privates also get erect, yes, a woman's privates get swollen, lubricated and her clit gets larger and exposed, not to the same degree a man's thingy does, but it goes through the same process, you ll know this because when you touch her pelvic bone, just at the end before superior labia begins, you ll notice that theres a little thin bump that extends until her superior labia where the clit's tip is, thats an aroused clit.
VERY IMPORTANT.
Treat the clit gently, it is a really sensitive organ, a bad movement will cause pain or discomfort for the woman, dont stimulate it in an overly fast motion, specially when your woman is climaxing, keep the same pace you had, slow and steady wins the race, is the journey, not the destination, and when your woman is climaxing, progressively lower your pace as it will become numb the more it progresses.
-Forget about fingering, that is not pleasureable at all for many women, clitoral stimulation is the be all end all, sure you can gently touch your woman's vaginal cavity as that will feel good, but forget about this insane fingering motion that is overly exagerated in pornography (thats one of the reasons why you must drop porn if you want an awesome lover for her), that will actually cause pain for many.
Another thing, even after your woman has climaxed, her uterus might still feel aroused, so you can continue stimulating here from there, after that you can do an slight trusting motion BUT BE GENTLE and remember to listen to her cues, communication is the key after all.
And remember to kiss her a lot.
You dont need a massive dong to stimulate her, this is actually a myth perpetrated by pornography, massive dongs are more likely to cause pain rather than pleasure.
Myths about the first time:

• Women bleed during the first time, some do, some do not.
  
• The first time is supposed to be painful for the woman, false, if it is painful she either is not properly aroused or she might have vaginismus, which is a condition that surprisingly affects a considerable amount of women, be open to all posibilities.
  
• The first time the woman's privates are always tight, absolutely not, if she is aroused, her privates naturally go looser to facilitate the insertion, dont fall for this harmful myth.
  

With this guide your chances of having succesful life lasting relationship and being the lover her dream will increase exponentially.

Me (33F) and husband (39M) are together for 6 years and married for 4. Going through a DB situation here and trying to explore reasons why. I have "grown up" watching porn from the age of 14-15. It seemed like a natural thing to do as a teenager to me. My sexual experiences include a long distance relationship of 6 years (16-22) with frequent sexting (no images exchanged but really graphic, erotic chats). I had met this ex online, and though we met only twice in real life, we had a really respectful relationship, and that sexting was actually beautiful. It would end in mutual masturbation and I can say I was extremely fulfilled during those years. That relationship ended abruptly when I fell for a long time friend. I feel i ended my sweet LDR mostly because I could have actual physical intimacy with this friend. So with this friend, we knew we did not have a future due to certain reasons, we knew there was an expiry date. So with him, I think I went all out KNOWING that it is not long term. We were together 5 years (22-27 yrs) and had the best sex life. You can say I brought my pornographic fantasies + all the sexting fantasies to life. I had quite the libido and went no holds barred. Really enjoyed that time even though as PEOPLE we didnt gel all that much. But then it wasnt meant to last anyway. Eventually, found my husband. Sweet, nurturing, caring, my friend, yang to my yin, my partner, the best. During the initial parts of our courtship, I was really enthusiastic because i DID have a high libido. But i discovered that with him - he wasnt THAT sexual, he didnt watch porn and it could never be part of our bedroom activities unlike my past 2 experiences, he wasnt a fan of receiving and giving oral sex, wasnt so much into giving me orgasms (i cant climax with PIV, so it is always by clitoral stimulation), he didnt sext. Plus for me, sex always had the element of slight degradation and thrill (referencing my early exposure to porn, the graphic sextings, and the sex with my bf) but for my husband, sex was more like .. lovey dovey, mild, not like "thrilling" or "dirty", sometimes even talk in a "baby tone" referring sex as "sexa" - i dont even know why one would use baby tones for sex. My initial enthuasiasm died down slowly + I was pursuing a hectic degree course in the initial 3 yrs of our marriage (i am a doctor) + gained a lot of weight / developed self esteem issues with the body change of becoming 30lbs heavier and cut to now, we barely have sex. Plus plus plus. We started trying for a baby, and during the course of that, discovered he is infertile. Severe issues for which we underwent one cycle of IVF and got some embryos banked. So even this trying for a baby for 8 months without success, the discovery of infertility, the ivf took its own toll. Result? Sex happens once to twice a month at max. And it is not fun. It is mechanical, awkward, as if I have forgotten to even do it. He lasts really less now, anyway it is really vanilla with bare minimum foreplay, within 2 to 3 mins we are done and there is NEVER talk about MY orgasm. Sometimes he will make a half hearted effort and ask me... i refuse once... and he is ok with that refusal. I have mentioned to him many times, that we dont do it at all, we should do better, he agrees, but then no effort from him. I wish for a naughty text, a racy look, a touch, some gesture in public, something to turn me on. Some thrill. I would love to reciprocate. I am not a leader but once ignited, I can gain my lost libido. And I do have the libido at least 60% of it but now I just watch porn and secretly masturbate. But am i to be blamed?? My possible theories for my issues: 1. The porn history reshaped my brain forever 2. My first two relationships were dysfunctional - one was virtual and the other mostly physical 3. My weight issues would SURELY be contributing - when I was lighter, I would be up for trying few different positions but yes in my current shape I mostly am a slob in bed - lazy and uninspired 4. Even though my husband is the best in all other aspects, sexually we dont match somehow. What is the solution? Should I take the lead and be all sexual for some time till we regain our rhythm?

DOWNLOAD: Katie Morgan – Pornstar Coaching
“How To Give Your Girl The Most Incredible, Heart-Pounding Sexual Experiences Of Her Entire Life!”
You’ve seen those boring “couples” videos made by so-called sex experts who think doggystyle is “kinky” and oral sex is “taboo”… what a joke!
In PornStar Coaching I’ll show you the REAL secrets to giving your girl mind-blowing sex… we hold nothing back!
This explicit program is designed to turn any guy into a GOD in the bedroom – regardless of your previous sexual experience, stamina, and even if you’re below-average in size (it’s not important when you know this stuff!)

What You’ll Learn In Pornstar Coaching

Program One: PornStar Confessions

• A simple tweak to the missionary position that gives her the feeling you are a full 2 inches longer and thicker inside of her (Julia and I pull out one of our favorite toys to show you this secret that you’ll use with every woman you are with from now on to make her eyes roll back with ecstasy)
• A special “sensual massage” to use before sex that primes a woman to have MULTIPLE ORGASMS (Doing this first gets her so incredibly turned on she’ll be begging to have you inside of her)
• 3 “Sexual Initiation Triggers” – Touch these spots BEFORE sex to make her shake with anticipation… then again DURING sex to take her over the edge…
• Secrets of Sexual Addiction: Here’s how to get her so into you that she won’t even look at another man (Warning: this will cause a woman to want to be around you a LOT… so it’s best not to use it unless you are really into her)
• How to keep sex EXCITING long after the initial “thrill” has past (Do just these 3 little things and SHE’LL start initiating sex with you… even if you’ve always been the one to have to get things started before)
• A special place (and a special way) to touch a woman to guarantee mind- altering sex! (This technique is so simple (and so little-known) even 15% of all women don’t know about ít)
• “She’s faking it!” A dead giveaway that proves if a woman is faking her orgasms!
• What do lesbians know about oral sex that men don’t? (Amazingly, this is why more guys today are losing their women to other women!)
• A sensual secret just recently discovered which every man should know about how to … instantly … put his woman “in the mood”! (This works faster than anything else a man could ever do and women desperately want their man to learn this secret)
• A sex act impossible for men to discover on their own that women RAVE about… and… often say, “is more enjoyable than orgasms”
• A little known foreplay secret that gives a man a foolproof method which guarantees his woman has an explosive orgasm every time they fuck!
• An exclusive “pleasure map” containing a “fingertip” guide to the 3 most sizzling “hot spots” on a woman’s body… (includes at least 1 she probably hasn’t discovered herself!)
• A secret “pleasure spot” on a woman’s body (NOT the G-spot) which is so hidden away by nature … not one man in a thousand knows about it … and yet… touching it like this produces awesome, shuddering waves of pleasure!
• The six “tricks” which are a man’s surest path to quickly increase his woman’s “clitoral arousal”
• Why a woman does NOT need longer foreplay… if you use this trick to get her in the mood FAST
• How to guarantee your lover almost never stops thinking about you … and… how to make sure all those thoughts are supercharged with passion and white-hot, smoldering anticipation!
• What 44% of women wish men knew about the easiest way to bring her to an intoxicating climax… every time!
• The two amazingly simple secrets (totally unknown by most men) which will cause “peak sexual excitation” … and… give women dramatically, longer-lasting orgasms
• 5 secrets you need to know… if… you want to be able to kiss like a truly world-class lover! (This is the type of erotic foreplay ALL women demand men know)
• The rare quality a man MUST have if he wants to please one of those SUPER-HOT women who has her choice of men… and … have any chance of success! (These hard-to-please women will overlook everything else except this)
• A technique that helps a woman have her FIRST orgasm from penetration women CAN’T discover by themselves! (She will love you for this)

Program Two: Forbidden Sex Poistions
In this program, you’ll discover the mental and emotional tips and tricks for taking your sex life to the next level… and beyond…
You’ll learn:

• A deadly mistake 77% of men make in bed that causes their woman to imagine themselves with SOMEONE ELSE – even if the guy does everything else right!
• The common sex technique women secretly HATE! (Sadly nearly all men do this anyways because they see it in movies… but in real life it turns your woman OFF and makes it even HARDER for her to have an orgasm)
• Why women HATE a guy who is inexperienced – plus a technique inexperienced guys can use to FOOL a woman into thinking he’s a seasoned stud!
• A smooth, rejection-free way to start talking dirty to your woman that fills her mind with naughty fantasies she’ll want to try out with YOU (and only you)…
• The 7-word sentence that SNAPS her into “the mood”. (Use this “trigger” to get her turned on and hungry for your cock whenever you want)
• How to smoothly and effortlessly move from one position to the next (Use this secret to get her to try any CRAZY position you want with zero resistance)
• A trick to setting up your bedroom that DOUBLES the chances a girl will sleep with you…
• A special trick to spice up “doggy style” that makes her SQUEAL with pleasure – every time! (She’ll instantly know you’re an EXPERT in the bedroom when you do this)
• How to introduce kinky stuff like spanking, handcuffs and even candle wax! (Here’s how to bring it up in a way that gets her EXCITED to try out crazy fantasies)
• The specific ORDER of positions you should use to give her the BEST chance of having MULTIPLE orgasms (Even if you do everything else wrong, she is guaranteed to have at least one orgasm when you use this secret… but most likely she’ll have 8, 9, even 10 body shaking orgasms before you’re done)
• The PLACES to have sex that turn her on the most (Hint: It’s not your bed! If you want to instantly separate yourself from her past lovers, take her to THIS spot in your house that turns her on as soon as you walk in)
• The 3 things you must do BEFORE you get in your bedroom to make sure things go smoothly once you are there…
• The ways women like men to be ROMANTIC in bed. If you’re serious about pleasing the girl you are with, tie in these romantic elements to give her the ULTIMATE sexual experience…
• A very slight change in the way you talk to a woman which can DOUBLE your animal attractiveness to her!
• 10 things a man must know about a woman which guarantees he and she will have GREAT (not just good) sex
• The number one rule which absolutely must be observed for women to have a truly spectacular orgasm!

Program Three: Advanced Sex Positions
Advanced Sex Positions shows you how to get more sex, be a master at oral sex, AND how to dominate and make her love all varieties of the doggy style position.
This one has to be seen to be believed.
It shows me and my lover Julia FORGETTING the cameras are on and having a really sexy encounter.
In this Program, you’ll learn:

• How to give a girl the deepest dicking of her life! (Use this angle to make her feel like she’s with a MONSTER… no matter what your size)
• How to turn an ordinary night watching Netflix with your girl into heart pounding sex with no chance of rejection and making it seem totally spontaneous and natural (Do this ANY time you are watching tv to make HER eager to turn off the tv and tear your clothes off)
• The exact order in which to take her clothes off for maximal orgasmic stimulation (Use the WRONG order and she won’t be “heated up” enough to achieve multiple orgasms)
• Why women don’t want to have sex at times and how to get around that “inconvenient truth” and get her horny when you want to…
• Why to AVOID direct stimulation of her erogenous zones UNTIL this moment… touch this area TOO FAST and she will be instantly turned off!
• Explicit demonstrations of orgasmic oral sex techniques… What to do, when to do it, and my secret “tricks” for making your girl scream!
• When it is finally time to move down to her “kitty” and make her whimper helplessly as you decide WHEN and WHICH technique to use to drive her over the edge
• The first thing you must do with your tongue during oral sex if you want to drive her crazy (Anything you do after this is just icing on the cake)
• Exactly where the clit is and the exact pressure to use (Hint: it’s probably NOT where you think because when she becomes aroused the “hot spot” changes!)
• What to do with your hands while she is going down on you (trust me guys, this will make her want to do it more often!)
• How to show control and dominance that make her want to totally submit to you – and love it!
• How to turn her on with dirty talk without coming across as cheesy or staged (All girls LOVE this when you do it right!)
• A secret to use during doggy style that lets you last twice as long!
• A WILD position men think girls wouldn’t like… but most actually love! (Especially because so many guys are afraid to even try it!)
• How to add variety so that you never have to “plan” or schedule sex like an old couple often does… instead you’ll be speeding to meet each other at lunch for red hot middle of the day sex
• How to make her so sexually addicted to you that you can get away with some EXTREMELY taboo sex acts most guys never get to pull off (If you’ve ever wanted to try out the crazy stuff you see in adult movies, you better know this one!)

Program Four: Secrets of Squirting Orgasms
If you’ve ever wondered about how to give a girl one of those ultra- intense SQUIRTING ORGASMS – or what some women call, “The Ultimate Orgasm”, look no further…
In this sizzling hot video, you’ll witness one of these amazing orgasms first hand as I take my sexy friend Julia to a level of ecstasy many women will never be so lucky to experience!
In it, you’ll learn:

• A live and explicit step-by-step demonstration of exactly how to give a woman a squirting orgasm from start to finish (It took me a little while to learn this amazing technique that makes almost ANY woman not only squirt… but have the most intense orgasm of her entire life! I’m very excited to share it with you!)
• The “big secret” of squirting orgasms… why some women have them all the time… and why with others, you have to use this to have one of these powerful orgasms… now you’ll know how to give it to her!
• The exact spots you must touch on a woman’s body to get her to squirt (I’ll show you the order to go in and the types of ways to touch these spots that make her go absolutely CRAZY)

This is TRULY a sizzling hot technique and I’m very excited to share it with
Program Five: Katie’s Sex Secrets
In this seminar-style Program, you’ll discover the mental and emotional tips and tricks for taking your sex life to the next level… and beyond…
In this Program, you’ll learn:

• How to turn YOUR GIRL into a porn star and have her screaming and orgasming like I do… this works EVEN BETTER if your girl is a little shy or uptight because this will UNLOCK her inner sex vixen
• Inside the mind of “Hottest Girl in Porn” (me and how you can use my female psychology to mentally and emotionally stimulate your girl to the most mind altering multiple orgasms of her life… once you discover the “emotional” side of multiples for women she’ll be moaning your name over and over again in ecstasy
• How to QUIET any distractions that might be going on in your mind during sex that TAKE YOU OUT OF THE MOMENT… do this and you’ll notice you enjoy sex more AND your girl totally loosens up
• The number one mistake guys make both during PORN SEX and in real life that is easily fixed “once you get it”… shockingly enough this has NOTHING to do with penis size or stamina…but rather a simple realization that women get and guys NEVER DO!
• If GETTING more sex is important to you WHY you need to ROCK HER WORLD in a certain way that will UNLOCK THE FLOODGATES of your girls inner pornstar sluttyness…
• The exact amount of time a guy should last in bed and how you can last AT LEAST that long even while hitting the most stimulating positions AND being so turned on that you want to explode all over…
• Why IF you think you might be cumming too fast you DEFINITELY are even if your girl has never complained about your stamina… it’s shocking when you find out how long some girls want you to be inside them for in order for them to BE FULLY PLEASURED
• The 3 reasons foreplay should NEVER STOP UNTIL SHE ORGASMS and the exact techniques to give her foreplay orgasms… you’ll be shocked at how EASY it is to give her full body orgasm once you give her a foreplay orgasm FIRST
• The simple sentence that relaxes her and gets her ready for sex… no matter how much YOU are currently the one trying to get sex and even if she totally isn’t in the mood THAT night
• #1 key that PREVENTS women from powerful orgasms and how to remove it… once you get this your girl will start coming at least 2-3 times more each time AND much LOUDER and WETTER
• How a 3 inch guy that I had to work with once gave me a deep spot orgasm despite his size and the advanced position that he used… you can copy this position exactly and if you are larger than 3 inches it will be 3x more sexually dominating for your girl
• How guys in porn LEARN to be good quickly and why ANYONE who thinks great lovers are BORN is dead wrong…
• How to finger her WITH HER PANTIES still on in a way that unleashes her emotions and makes her overcome with desire… she will pull down her panties IMMEDIATELY after you use this motion…and it only takes one finger!
• A 4 step massage that initiates sex every time even if she is tired, worked too much or in a bad mood… this cuts STRAIGHT to the core of her femininity and inspires her TO SATISFY you
• My favorite sexual position and how you can get your girl to do it… this works best if your girl is self conscious, prude, or worried about seeming slutty
• 5 kissing secrets stolen from French men (the most romantic in the world) that instantly sparks passion and the most romantic sex of her life… if you are not ok with giving your girl the most powerful emotional experience of her life you might want to skip this
• My favorite sexual position and how you can get your girl to do it… this works best if your girl is self conscious, prude, or worried about seeming slutty
• A mindset that every guy who is AMAZING in bed has… you can implement this instantly and it will improve your sex life as much as ANY technique or positions….this is NEXT LEVEL mindset technique…
• The exact grip you need to use to pull her hair while in doggy style to create a bad boy image and drive her over the edge with animalistic primal pleasure… most guys would NEVER think they get away with such “manly” behavior and are amazed WHEN SHE LOVES IT
• How to take an ordinary bedroom accessory that every guy has and turn it into one of the most powerful sex toys imaginable…
• The 3 types of orgasms you can give her before sex, how to decide WHICH ORGASM TO GIVE HER and when it’s time to finally penetrate her…
• Why stamina does NOT matter if you don’t have PROPER TECHNIQUE…
• Why confidence is “biologically proven” to be the biggest turn on for girls and how to have the confidence of a guy who has been with 300 women… your girl will think that you are a different guy

Hi! Hope you are doig fine 💛 Do you know of images that can help me compare normal vs. fused glans clitoris and clitoral hood? I'm not sure what's normal as there's not too many images of vulvas with retracted clitoral hood where I can check the normal glans clitoris.
Edit: after posting, I found what I needed (of course...) So sharing here if you also need some more information: https://www.rachelrubinmd.com/post/new-research-on-clitoral-adhesions
Thank you!

So a week ago I looked up what the little white bumps that honestly look like chicken skin on my vulva was and google images showed they are fordyce spot. Apparently a lot of women have them. Well, then I noticed one specific fordyce spot was itchy and a lil swollen looked like a tiny lil pimple but it wasn’t painful. All the results on Google said they are harmless and don’t cause pain or anything like that.
At that time I was having other vaginal issues like pale yellow discharge that smelled like urine, and some itching/burning on vulva. So I drank my yogurt shake probiotic and that cleared up but my little bump is still here. Except, it looks like an angry bump with a very clear white/yellow center that looks ready to burst. And my god it’s painful and kinda itchy. I’m thinking it’s a boil but it’s on the vulva like at the start of vulva from the mons pubis downward maybe like a 3-4 centimeters above the clitoral hood is the best way I can describe it. Now, I’ve had a boil before under my booty on both thighs and both of them were huge and became infected. The goal is to see my gyno Monday but until then what can I do to make this better? Bc it’s on my vulva I don’t think I can slap a bandaid on it bc of the loose tissue. And I know we’re not supposed to pop it but my god the urge to do so is very tempting. Is there anyway I can clear this up fast so I can be able to have sex next Saturday?
I’m about 99% sure it’s not an STD as I’ve been tested so many times (all negative) because I tend to be a little hypochondriac sometimes. Probably also worth mentioning I do get peeling skin on my area down there pretty much anywhere hair grows, I’m assuming it’s from seborrheic dermatitis that I have elsewhere on my body.

8 Sex Myths That Experts Wish Would Go Away
By Catherine Pearson
Published Oct. 15, 2023
Chalk it up to the variability in sex education, in high schools and even medical schools, or to the fact that many adults find it hard to talk about sex with the person who regularly sees them naked. Whatever the reason, misinformation about sexuality and desire is common.
“There are so many myths out there,” said Laurie Mintz, an emeritus professor of psychology at the University of Florida who focuses on human sexuality. And, she added, they can “cause a lot of damage.”
So the Well section reached out to a group of sex therapists and researchers, and asked them to share a myth they wished would go away.
Here’s what they said.
Myth 1: Everyone else is having more sex than you. “Oddly, this myth persists across the life span,” said Debby Herbenick, director of the Center for Sexual Health Promotion at the Indiana University School of Public Health and author of “Yes, Your Kid: What Parents Need to Know About Today’s Teens and Sex.”
Many teenagers think “everyone is doing it,” she said, leading them to jump into sex that they simply are not ready for. This myth can make older people in long-term relationships feel lousy, too — like they are the only ones in a so-called dry spell, when they may simply be experiencing the natural ebb and flow of desire.
“It’s pretty typical to find that about one in three people have had no partnered sex in the prior year,” Dr. Herbenick said, referencing several nationally representative surveys. She also points to research she has worked on showing that sexual activity has declined in recent years for reasons that aren’t fully understood. (Researchers have hypothesized that the decline has to do with factors like the rise in sexting and online pornography, as well as decreased drinking among young people.)
“It can help to normalize these periods of little to no partnered sex,” Dr. Herbenick said. “That said, for those looking for some longevity in their partnered sex life, it’s important to think about sex in a holistic way.” That means caring for your physical and mental health, she said, and talking through your feelings with your partner to maintain a sense of intimacy and connection.
Myth 2: Sex means penetration.
Sex therapists often lament that people get caught up in certain “sexual scripts,” or the idea that sex should unfold in a particular way — typically, a bit of foreplay that leads to intercourse.
But “we need to move beyond defining sex by a single behavior,” said Ian Kerner, a sex therapist and author of “She Comes First.” He noted that this type of narrow thinking has contributed to the longstanding pleasure gap between men and women in heterosexual encounters. For example, a study found that 75 percent of heterosexual men said they orgasmed every time they had been sexually intimate within the past month, compared with 33 percent of heterosexual women.
One survey found that 18 percent of women orgasmed from penetration alone, while 37 percent said they also needed clitoral stimulation to orgasm during intercourse. Instead of rushing toward intercourse, the focus should be on “outercourse,” Dr. Kerner said, which is an umbrella term for any sexual activity that doesn’t involve penetration.
“If you look at most mainstream movies, the image is women having these fast and fabulous orgasms from penetration, and foreplay is just the lead up to that main event,” Dr. Mintz said. “That is actually, scientifically, really damaging and false.”
In surveying thousands of women for her book “Becoming Cliterate,” Dr. Mintz found the percentage of women who said they orgasmed from penetration alone to be 4 percent or less.
Equating sex with penetration also leaves out people who have sex in other ways. For instance, Joe Kort, a sex therapist, has coined the term “sides” to describe gay men who do not have anal sex. Lexx Brown-James, a sex therapist, said that view also overlooks people with certain disabilities as well as those who simply do not enjoy penetration. Many people find greater sexual satisfaction from things like oral sex or “even just bodily contact,” she said.
Myth 3: Vaginas shouldn’t need extra lubricant.
Postmenopausal women sometimes describe the pain they experience during penetrative sex as feeling like “sandpaper” or “knives.” But while vaginal dryness affects older women at a higher rate, it can happen at any point in life, Dr. Herbenick said, which has implications for women’s sex lives.
An estimated 17 percent of women between 18 and 50 report vaginal dryness during sex, while more than 50 percent experience it after menopause. She noted that it is also more common while women are nursing or during perimenopause, and that certain medications, including some forms of birth control, can decrease lubrication.
“As I often tell my students, vaginas are not rainforests,” Dr. Herbenick said, noting that her research has found that most American women have used a lubricant at some point. “We can feel aroused or in love and still not lubricate the way we want to.”
Myth 4: It is normal for sex to hurt.
Though lubricant can help some women experience more pleasure during sex, it is important to remember that sex should not hurt. An estimated 75 percent of women experience painful sex at some point in their lives, which can have many root causes: gynecologic problems, hormonal changes, cancer treatment, trauma — the list goes on.
Shemeka Thorpe, a sexuality researcher and educator who specializes in Black women’s sexual well-being, said many women believe that pain during or after sex is a sign of good sex.
“We know a lot of the times that people who end up having some sort of sexual pain disorder later in life actually had sexual pain during their first intercourse, and continued to have sexual pain or vulva pain,” Dr. Thorpe said. “They didn’t realize it was an issue.”
Men, too, can experience pain during intercourse. Experts emphasize that it is important for anyone experiencing pain during sex to see a medical provider.
Myth 5: Men always want sex more than women do.
“Desire discrepancy is the No. 1 problem I deal with in my practice, and by no means is the higher-desire partner always male,” Dr. Kerner said. “But because of this myth, men often feel a sense of shame around their lack of desire, and a pressure to always initiate.”
(Dr. Herbenick noted the related myth that women don’t masturbate, which she said holds them back from fully exploring their sexuality.)
But while there is data to suggest that men masturbate more often than women do, it is untrue that women don’t want sex, or that men always do, said Dr. Brown-James. For instance, one recent study found that women’s desire tended to fluctuate more throughout their lifetimes, but that men and women experienced very similar desire fluctuations throughout the week.
Myth 6: Desire should happen instantly.
Sex therapists and researchers generally believe that there are two types of desire: spontaneous, or the feeling of wanting sex out of the blue, and responsive, which arises in response to stimuli, like touch.
*People tend to think that spontaneous desire — which is what many lovers experience early in relationships — is somehow better. * But Lori Brotto, a psychologist and the author of “Better Sex Through Mindfulness,” said a lot of the work she does is to normalize responsive desire, particularly among women and those in long-term relationships.
She helps them understand that it is possible to go into sex without spontaneous desire, as long as there is willingness and consent. Dr. Brotto likens it to going to the gym when you don’t feel like it. “Your endorphins start flowing, you feel really good and you’re grateful you went afterward,” she said.
Myth 7: Planned sex is boring.
Dr. Brotto also disagrees with the idea that “planned sex is bad sex,” because it makes it “clinical and dry and boring.”
That view is “so harmful,” she said. And it results in many people treating sex like an afterthought, doing it only late at night when they’re exhausted or distracted, Dr. Brotto said, if they make time for it at all.
When clients bristle at the practice of scheduling sex, she will ask: Are there many other activities in your life that you love or that are important to you that you never plan for or put on the calendar? The answer, she said, is usually no.
Scheduled sex can also lend itself to responsive desire, Dr. Brotto said, giving “arousal time to heat up.”
Myth 8: Your penis doesn’t stack up.
Men are under a certain amount of pressure when it comes to how their penises look or function, Dr. Kerner said. Younger men, he said, believe they shouldn’t have erectile dysfunction, while older men get the message that premature ejaculation is something they grow out of with age and experience.
The data tells a different story. Though erectile dysfunction — which is defined as a consistent inability to achieve or maintain an erection, not just occasional erection issues — does tend to increase with age, it also affects an estimated 8 percent of men in their 20s and 11 percent of those in their 30s. And 20 percent of men between the ages of 18 and 59 report experiencing premature ejaculation.
“We don’t have a little blue pill to make premature ejaculation go away, so we’re not having the same cultural conversation as we are with erectile dysfunction,” Dr. Kerner said. “We’re just left with the myths that guys with premature ejaculation are bad in bed, or sexually selfish.”
Likewise, studies show that many men — gay and straight — worry that their penises do not measure up, even though many partners say they do not prefer an especially large penis.
“Partnered sex is complex,” Dr. Kerner said. “It involves touching, tuning in, connecting, communicating.”

Hi! Just diagnosed? Think you might have it? Have general questions about vaginismus? Here is a handy guide I have made from my own experiences and research.
TABLE OF CONTENTS (CTRL/CMMD + F to search!)

• WHAT IS IT?
• HOW TO GET DIAGNOSED?
• WHY DID THIS HAPPEN TO ME?
• WHAT ROLE DOES THE HYMEN PLAY IN VAGINISMUS? / IS THIS HAPPENING CAUSE I AM A VIRGIN?
• HOW COMMON IS THIS?
• IS IT POSSIBLE TO CURE VAGINISMUS?
• HOW DO I TREAT THIS?
• HOW LONG DOES IT TAKE TO HEAL FROM VAGINISMUS?
• HOW DO I TALK TO MY PARTNER ABOUT THIS? / WHAT OTHER OPTIONS ARE THERE FOR INTIMACY BESIDES PIV?
• WILL GIVING BIRTH CURE VAGINISMUS? / WILL I BE ABLE TO ONE DAY HAVE CHILDREN IF I HAVE THIS?
• OTHER TERMS RELATED TO VAGINISMUS

WHAT IS IT?

Vaginismus is a pelvic floor dysfunction disorder. Your pelvic floor muscles are tight and unconsciously clenching and closing the opening to your vagina both when attempting penetration and in your daily life. The pelvic floor muscles also connect to all other groups of muscles in your lower body — back, hips, and legs. Vaginismus not only can cause an inability to have penetrative sex, it can also cause urine & fecal incontinence as well as a lack of mobility overtime.
Common symptoms are penetration being outright impossible, or if any penetration is possible, is exceedingly painful in a burning, stabbing, or pinching way. Penetration may feel like "a wall is being hit" in that a partner either can't get inside or can only get a very small way. Penetration may cause tearing or bleeding. Vaginismus can also cause penetrative sensations like the urgency to pee/poop. Many people initially discover an issue before their first sexual encounter when they have difficulty inserting tampons/cups, fingers, or during an internal gynecological exam.
The primary subreddit for advice on this condition is /vaginismus. The primary subreddit for partners and friends of those with vaginismus is /vaginismusfriends.

HOW TO GET DIAGNOSED?

(If you've already been diagnosed you can skip this section)
In order to be diagnosed you need to visit a Gynecologist (also referred to as an OB-GYN), which is a doctor that specializes in female anatomy. You can find a gyno (within the US) here.
I always recommend a physical/internal examination to those who believe they can handle it. There are other issues physically that can present as vaginismus (such as a septate hymen or bacterial vaginosis) that a doctor needs to evaluate in order to rule them out. A gyno, understanding that you are worried you have this condition and hearing your experience, should always go at your pace and explain the process of the exam with you and stop if you ask them to/cry out in pain at any point.
However, if you do not think you can handle a physical exam for one reason or another, you do NOT need to have one in order to get a diagnosis. You can simply describe your symptoms and what you're experiencing and they should be able to diagnose on that alone. I know this because this is how my gyno diagnosed me. Do not let any gyno pressure you into doing an internal exam if you don't believe you are up for it. If they state they can't diagnose without an internal exam, state you will be looking for a second opinion, get up, and leave — and then find that second opinion in a different gyno.
If you do opt for an internal exam, they typically will do a "q-tip" test where they insert a wet q-tip and see how tight you are around that. Depending on your level of discomfort, they then may use their finger as another measure if the q-tip is okay. Some gynos also like to refer for a transvaginal ultrasound to test if you don't have any other condition internally that could be causing the pain. For reference, this is how big a transvaginal ultrasound wand is compared to a size 7 Intimate Rose dilator. If you do not believe you can handle this, please tell your doctor or ultrasound tech immediately so they can cancel or modify the procedure.
If you are scheduled for a pap smear, please note that the guidelines from the American College of Obstetricians and Gynecologists (who set the professional rules for gynos) state that anyone under 21 does not need a pap smear and that anyone above 21 only needs them every 3 years, and over 30 every 5. Either way, if your doctor is pressuring you to get a pap smear and you know you cannot tolerate any level of penetration, again, refuse and find another provider if possible. Your gyno should be understanding to your condition and wait until you can tolerate a pediatric speculum (a small version of the device they insert to open your vagina to get to your cervix to test) to do a pap smear.
Many health plans in the US require an official diagnosis and referral to a pelvic floor physical therapist from a gyno in order to cover treatment. If you doctor dismisses your concerns in any way or refuses to send a referral, please seek out another opinion. Good OB-GYNs do exist! While vaginismus training is standard part of OB-GYN specialization, there are still providers who do not take this condition seriously or misunderstand it. Pelvic Floor PTs are often the most knowledgable and sensitive to vaginismus, so if you feel you'd rather skip seeing a gyno and move straight to a physical therapist, that's also an option — just be sure you will still be covered under your health insurance if you choose to do this.
So, if you found a sensitive, thoughtful, and respectful provider and now have an official diagnosis, they should refer you to a pelvic floor physical therapist (see below: treatment options). Your gyno does not treat the vaginismus themselves (other than prescribing medications that help during treatment).

WHY DID THIS HAPPEN TO ME?

Lots of reasons for vaginismus to develop, or none at all, really. You can develop vaginismus before the first time you attempt penetration (primary) or later on in life after having pain-free penetration previously (secondary). Here are some common reasons:

• Physical trauma to the region or one of the above listed muscle groups (such as scoliosis, MS, significant tearing/scarring, etc)
• IBS/D, Crohn's, or any other chronic digestive issue
• Emotional/mental trauma that causes significant anxiety or other nervousness
• Medical trauma
• Sexual assault
• Childbirth
• Female genital mutilation ("female circumcision")
• Religious trauma/purity culture

This is not an all-encompassing list, and there are definitely other reasons as to why this can happen. It is also possible to just simply develop in a way that causes vaginismus.
It is important to remember that this is not a character flaw or moral failing. This is a medical condition, not something we choose to have. It is certainly, for many people suffering from it, a protective mechanism our bodies develop in order to deal with trauma. No one wants to be in pain or feel like they are different from others and cannot experience something people enjoy.

WHAT ROLE DOES THE HYMEN PLAY IN VAGINISMUS? / IS THIS HAPPENING CAUSE I AM A VIRGIN?

First and foremost, virginity is a social construct. Hymens being “intact” or not to denote someone who is and isn’t a virgin is largely a myth. The only reason your hymen would be giving you trouble is if you had an abnormality with it, such as a microperforate hymen. If you've had a gynecological exam, your doctor would have seen something like this though, because it’s very obvious if it’s abnormal and you would have been referred for surgery. Additionally, if you’ve had a successful period, you likely have no abnormality as well. You can always get a second opinion on that but it is rare, and even people in the vaginismus sub who’ve had their hymen removed, it is a mixed bag —for some it cures the issue, others not so much.
Hymens, in people without abnormalities, have little to no bearing on penetrative ability. Hymens are like a small, thin rubber band that stretches out of the way very easily as long as you’re lubricated and relaxed —even during the first time. When it does come time to lose your virginity, do lots of foreplay and use lots of lube! You likely won’t even be able to really see the hymen if you take a mirror down there and look, because it’s so thin and small. It is another myth that losing your virginity has to hurt. We’re not born with a “freshness seal” like our society wants us all to believe because that would be absurd. Here is a cute little video debunking this and explaining more.
What determines your penetrative ability more than anything is your muscle tone and control, which is why vaginismus is a muscular disorder, not a hymenal one. Even as a virgin, you can work on this condition and train your pelvic floor muscles to become accustomed to the sensation of penetration.

HOW COMMON IS THIS?

Pelvic floor dysfunction disorders of all types, among both sets of sexes, is extremely common. Some statistics for you:

• On vaginismus alone, 1 in 5 women or 20% of the population experience vaginismus. This statistic is also likely lower considering the shame and stigma around reporting this condition, as well as many medical professionals still not being trained on the signs/symptoms/severity of vaginismus.
• 3 in 4 (75%) people with female anatomy experience pain during sex at some point during their lives.
• General PF disorders among people with female anatomy is between 25-35% of the population (slightly above 1 in 5).
• General PF disorders among people with male anatomy 52% experience erectile dysfunction, as well as up to 16% with pelvic floor dysfunction and chronic pelvic pain syndrome. 1 in 5 AMAB have experienced pain during sex, or 20% of the population. These statistics, again, are likely higher than estimated due to stigma of reporting.

IS IT POSSIBLE TO CURE VAGINISMUS?

YES, absolutely! There are countless stories of people overcoming this condition to be able to have pain-free penetration and pelvic floors.

HOW DO I TREAT THIS?

There are a variety of treatment options, many of which are used in conjunction with one another. One thing I want to stress is that trying to "push through the pain" and just keep going when penetrating is not a treatment option and will result in tearing and possible infection, as well as making the vaginismus worse and training your nervous system that penetration = pain. Do not attempt or continue to attempt PIV sex before going through a treatment method, preferably dilation.
Here is a non-exhaustive list of proven treatment methods:
Pelvic floor physical therapy (PFPT) — PFPT, just based on my own experience as well as the experience of others, PT is by far the most effective method for the majority of people in healing this disorder. Since this is a muscular disorder, working with a physical therapist (even for just a few sessions) can help you get a personalized treatment plan to fully understand what specific muscles both internally and externally are giving you the most trouble. Additionally, PTs can help you use the dilators with them to watch your form and get you the most effective treatment techniques. Many people also bring their partners to PT so they can work with their partner during treatment.
PTs should always go at YOUR pace when working together. While eventually a PFPT will need to do an internal exam to assess you, it should only be when you are ready for it. Pelvic floor PTs are specifically trained on the sensitivity of this condition and should never pressure you into doing an internal exam or any exercises you do not want to do. Like with a gynecologist, you are free to refuse any service and see a different provider at ANY time. You can find a PFPT (within the US) here.
For those struggling to afford a PT, here are a few tips: 1) Ask if the office has a sliding scale program to adjust the rate based on income 2) See if your state has expanded Medicaid that can cover the gap in coverage for a reproductive service, which some consider PFPT to be 3) Look at medical schools that have lower rates for people training to be PTs (residents). The treatment will still be overseen by someone with a medical degree (an attending).
There are also online resources from PFPTs, notably The Pelvic Dance Floor on TikTok. She is very responsive to questions and has a wealth of resources.
If you truly cannot get to a PFPT, that is okay! You can treat at home with the rest of the methods here, many of which would be recommended by a PFPT.
Dilator therapy — This is often used directly with PFPT. Dilating is very important so that you can start at the penetrative size level that causes little to no discomfort and work your way up to penis size. You do not want to try to push through the pain of penetration, ever. Dilation works because you slowly retrain your nervous system to understand penetration can be pain-free.
Dilators come in many different sizes, shapes, and materials. Dilators typically start in size from smaller than a pinky finger and go all the way up to average penis size. Typically, there are tapered (in which the top of the dilator starts out small and gradually gets larger) and non-tapered. Starting out with a tapered dilator is easier for some people. The two most common materials for dilators are hard plastic and silicone. YMMV here, though silicone tends to feel more "real" to the experience of a penis than plastic will. For myself, I transitioned from plastic to silicone and silicone was more comfortable inside me.
The Gold Standard for dilators are the Intimate Rose set. This set is by far the most popular because it is formulated by a PFPT, however, it is expensive. There are sets for $50 on Amazon you can also use if you feel Intimate Rose is not affordable for you. If you're working with a PFPT, they may have a discount code they can give you for IR. The most important thing to look for in a dilator is that you feel it is comfortable, maneuverable (as in you can hold it and use it with ease), and has sizing that is gradual enough not to cause a lot of discomfort.
Ideally, a PFPT will tell you how often you should be dilating for the severity of your condition, but for most people, 2-3x a week works fine. You do not want to over-dilate and end up introducing too much stimulation into the region.
Some people choose to dilate when aroused, other people choose not to. There is no better method, and some people do a combination of each. Trying dilation aroused and unaroused will help you figure out what works best for you and your treatment.
During dilation, always think of your vaginal opening as a clock — 12 on top near your urethra, 6 at the bottom near your anus. The tip of the dilator should always be pointed downwards towards 6 o'clock. Pointing the dilator towards 12 will cause you to stimulate your urethra and make you have an urgency to pee. If you're having tightness at the opening, just sit and hold the dilator there and inch it in ever so slightly, using your breathing techniques and downtraining (see below), every time the pain subsides. Once you have the dilator a comfortable inch or two inside, you can slowly move it from 3-9 o'clock in a U shape, finding tender spots and VERY LIGHTLY pressing on them until they release. You can also just make the U-motion back and forth to desensitize yourself to the sensation. Some people, when they become more comfortable, also go in and out at their own comfortable pace like a penis would.
Any time you feel uncomfortable or like you're hitting a wall, try moving your legs and tilting your hips towards yourself as this creates more room in the pelvic floor. You can also buy a wedge pillow to help with this. You do not have to dilate only laying on your back with your feet planted beside you either— some people dilate standing up, crouching, on the floor with their legs resting on a chaicouch, in the doggy position (though doggy is always the most difficult and should be attempted when you're pain-free in other positions).
Dilation should take 10-15 minutes each session, depending on what you can bear. The pain level during dilation should never go beyond a 4 on a 10 scale. You want to be, as my PT put it, "at the edge of discomfort" until you are pain-free. There is no set amount of time it should take to move from one dilator size to another — just work with a dilator until you are pain free. This could be anywhere from weeks to just a day or two. Anytime you feel more than a 4 on the pain scale from a dilator, stop and move back down.
Always use a good amount lube when dilating, many people recommend Slippery Stuff. Always clean your dilators/pelvic wand with soap and water after each use.
Pelvic wand — This is often used alongside dilators. Pelvic wands are more precise in targeting and massaging trigger points in the pelvic floor muscles out. Intimate Rose has a very affordable pelvic wand on their website, the vibrating and heated ones are even better if you can afford those. Pelvic wands are skinnier than dilators and typically will fit someone who has worked their way through the first four in the Intimate Rose set, for a size comparison.
External exercises/stretching — As stated, this condition often connects intimately with the back, leg, and hip muscles. Many people find they are weak or tight in those muscles as well as the pelvic floor and only make significant progress (like myself) when they begin working externally as well as internally. Flower Empowered on Youtube is great for finding exercises that can be done at home. Many people also take up pilates or yoga.
One exercise you should NEVER attempt unless under the supervision of a PT is kegels. Kegels are clenching and unclenching your vagina, by definition. However, the clenching is the problem as most people suffering from vaginismus are already tight and have too much muscle tone in the area. The pelvic floor muscles need to be relaxed before attempting to strengthen them, or else you will end up making yourself tighter.
Sex therapy — Our emotional state has a great deal of impact upon recovery. The pelvic floor region is adept at holding in anxieties and emotional trauma. This disorder can be very emotional and open up a lot of wounds, especially if you have any history of trauma related to your sexual anatomy. When we are healing, we are reestablishing that relationship with ourselves, and for many, it can reveal things that are painful or that we've ignored for a long time. Additionally, many couples often find that they have difficulty giving up the sort of media/porn narrative of sex when this condition arises in a relationship. I always recommend seeing a therapist, but in particular a sex therapist, during treatment to unpack those feelings. You can find a sex therapist (even outside the US!) here.
If you are a victim of any sort of sexual assault or abuse (even if you never reported to police), please reach out to RAINN (Rape, Abuse, and Incest National Network) for support. They may be able to connect you with low cost or free therapy.
Downtraining — Downtraining, or training your mind to imagine visually softening and relaxing the muscles, is an important part in learning how to consciously relax your muscles during the day as well as during penetration. Typically before starting treatment, many people have no idea how much they are clenching. Establishing a mind-body connection is necessary to unclench. Download Insight Timer on your phone and listen to this track (5 minutes) for how to begin.
Masturbation — Having a positive relationship with your body and sex starts with you. Experimenting with self pleasure is so, so important because it establishes a positive connection in your mind with the vagina/vulva region. If you have never masturbated, taking a mirror and first examining your genitalia can be helpful. From there, lightly touching and seeing what sensations you feel and where are a great first step. Clitoral stimulation, or just lightly rubbing on the clit, is a wonderful place to start if you've never masturbated before. The Bad Girls Bible has a good guide here as well.
Medication — There are a variety of medication options available to make treatment easier. Muscle relaxers, valium suppositories, and anti-anxiety and depression medications are all commonly used. Estrogen cream is also extremely helpful in making the vaginal and labial tissues more moist and flexible for dilation. These require an ongoing prescription from your gynecologist.
Some people also report that being on birth control has caused or exacerbated their vaginismus. Please consult a doctor about this before getting off of birth control, especially if you live in a state without access to abortion or have endometriosis.
Some people find that marijuana (THC) or CBD alone helped ease their symptoms. Please make sure to try THC and CBD on their own in a safe environment to see how you handle these drugs before incorporating them into your dilation routine or PIV!
Taking street drugs, such as MDMA/ecstasy, ketamine, xanax, oxycodone/heroin, etc. have not shown any proven benefit for treating vaginismus and carry the risk of being laced with unwanted or harmful substances such as fentanyl. Please, please do not risk your life trying to cure vaginismus by getting harmful something off the street.
Sitz bath — Sitz bath is a small bath that you place in your toilet to relax and soothe your pelvic muscles. It is commonly used post-partum. Get a sitz bath, fill it with lukewarm water, and sit in it for 5 minutes a day and just relax. Dilating after this will be much easier as well.
Breathing techniques — Breathing is an important part of our self regulation and helps us concentrate on relaxation as well as moving our pelvic floor muscles for penetration. Many people use box breathing while they are dilating or during sex. The technique I used was the 4-7-8 breathing technique, which will help regulate your nervous system to reestablish the body/mind connection.
Botox — Botox is a paralytic toxin that is used in a variety of cosmetic and medical applications to stop muscles from contracting. Botox has been proven to help vaginismus recovery by injecting into the pelvic floor muscles that are contracting and causing the vaginal opening to close. The reason why it is so far down on this list is because it is often prohibitively expensive for most people ($2,000 - $6,000 per treatment), not covered by insurance, hard to find providers who are trained to do it, and it wears off after about 3 months so you do need to get another injection and keep dilating/doing the other treatment options on this list for a lasting effect. On the vaginismus subreddit, there are stories of people who have botox done that you can find by searching.
Reading/listening literature — Reading books on the topics of sex, gender, and vaginismus specifically can help reframe your perspective on this issue.
Vaginismus specific literature: -Sex Without Pain by Heather Jeffcoat -When Sex Seems Impossible: Stories of Vaginismus by Peter Pacik
Sexual intercourse specific literature: -The Great Sex Rescue by Sheila Wray Gregoire -Come As You Are by Emily Nagoski -Bodies: Sex Hurts (NPR Episode) by Allison Behringer
Gendesex perspective reframing: -The Second Sex by Simone de Beavouir -all about love by bell hooks
Body trauma: -The Body Keeps the Score by Bessel van der Kolk
Relationship advice: -Why Does He Do That? by Lundy Bancroft -She Comes First by Ian Kerner (a lot of sexual intercourse advice, but is a book mainly geared towards helping partners pleasure their female partners)
If you search in the vaginismus subreddit, you can find other literature recommendations.
Online courses — I put this last as I am always wary of non-medical professionals or people on the internet selling unregulated courses to cure this disorder. If you have tried everything else and truly feel you have no alternative, then you can look into these courses. However, I always recommend thoroughly researching them and trying to find other real people who can give unbiased testimonials on their experience. There are many people simply looking to prey on the vulnerable and desperate. Some selling these courses also have a religious motive that they are not upfront in disclosing. If you see someone on the vaginismus or any women's health subreddit trying to sell a course to cure vaginismus, be very skeptical and ask a lot questions up front. If something seems too good to be to true, it usually is. Most of the time, your money is better spent on going to a pelvic floor physical therapist or sex therapist.

HOW LONG DOES IT TAKE TO HEAL FROM VAGINISMUS?

The amount of time it will take you to heal from vaginismus varies vastly. For some people, it is years, for others, it is a few months. If you are working with a PT or you have botox, that can shorten the time. If you have emotional trauma or don't have access to dilators, that can lengthen the time. The most important thing is that you don't rush the healing process. You can heal, but you need to give yourself time, grace, and compassion.

HOW DO I TALK TO MY PARTNER ABOUT THIS? / WHAT OTHER OPTIONS ARE THERE FOR INTIMACY BESIDES PIV?

Here is a good starting script for how to tell a partner you have vaginismus:
"I care a lot about you and I wanted to share something that’s important. I have vaginismus. It is a condition where my pelvic floor muscles involuntarily clench and close the opening to my vagina, which makes it painful for me to have sex. It has nothing to do with you at all, it is just something I am medically struggling with. Right now I’m working on healing this with [insert therapies] because being pain free for my own well-being and having physical intimacy with you are important goals to me. I am hoping at some point we could try penetrative sex. I hope we can also be physically intimate in other ways though before then because I think it’ll help our relationship and my healing journey. You mean a lot to me and I’m so glad I have a partner like you who makes me feel safe to share this with.“
Any partner that makes you feel bad about this disorder in any way, pressures you to have PIV before you are ready, or ignores your sexual boundaries/needs does not deserve you and is not worth it. You do not "owe" a partner anything, especially sexually. Consent is at the core of every single positive sexual experience, and the goal of sex is for two people to come together to physically experience one another — not for one to dominate the other to get what they want. Our culture unfortunately pushes a narrative that men are owed PIV sex by women and that it is the goal of all sex to end up doing PIV, which is just not healthy or even true. Humans have been having sex in many ways outside of PIV since the beginning of time. While those of us who are suffering are usually doing a lot of work to try and fix this, it is incumbent on partners to also come to terms with having a partner who has this disorder and accepting that PIV sex is not an option. If that is something they cannot handle, then at that point there is a sexual incompatibility. Being single is better than being with someone who will only exacerbate your symptoms and make you feel worse about having vaginismus. Having a supportive partner while you're healing makes a world of difference in not only curing, but continuing to stay cured.
In terms of intimacy, you should always try to maintain all levels of physical intimacy (besides penetrative, obviously) with your partner while treating. So everything from just hugging and cuddling to sexual contact like oral and digital acts are encouraged. Thigh and tit jobs are also another way to simulate PIV without actual penetration.
If you are single, I want to emphasize that supportive, patient, and compassionate partners do exist! You are absolutely worthy of love even with vaginismus and there is someone out there for you. There is nothing wrong with you and do not settle for anything less.
One last final point here: you should always be healing for you and no one else! While having penetrative sex may be a goal in your recovery, your overall goal should be your own connection & relief within your body. If you are not ready to have PIV sex, or you simply don't like it, that's okay! It's your body and you set the rules. You can still find a partner and be loved. The whole recovery journey should make you feel empowered and in control of your body.

WILL GIVING BIRTH CURE VAGINISMUS? / WILL I BE ABLE TO ONE DAY HAVE CHILDREN IF I HAVE THIS?

A very common misconception is that giving birth will cure vaginismus or improve it because the muscles will be "forced" to "relax" in order to have the child. The reality is that this is not at all medically or scientifically accurate, and while there are people who it has happened to, it is exceedingly rare that vaginismus improves after giving birth. Giving birth is more likely to result with your vaginismus worsening. You should always attempt to treat and heal vaginismus before trying to have children. My PT told me herself she sees a variety of clients who developed vaginismus only after having children, or people who had a mild case beforehand and ending up increasing in severity post-partum.
Having children after being diagnosed with vaginismus is 100% possible, though. Obviously if you treat vaginismus and cure it, you will be able to reduce the risks of pregnancy to the same as someone without vaginismus. However, there are some people who are not ever able to fully overcome vaginismus and still want to have children and use the "turkey baster" method of impregnation. Labor and delivery itself is typically not impeded by vaginismus as there is a big difference between something going into the vaginal canal and something trying to come out. This page here talks more about vaginismus and pregnancy/childbirth and the risks associated with untreated vaginsimus while trying to have children.

OTHER TERMS RELATED TO VAGINISMUS

• Dyspareunia — pain during sex
• Endometriosis — medical condition where the lining of the uterus also grows on the outside of the uterus and causes extreme period pain, ovarian cysts, infertility, and other symptoms
• Hypertonic pelvic floor — pelvic floor muscles that are extremely tight at all times
• PIV — penetration/penis in vagina
• Vulvodynia — medical condition where you have pain in the vulva/labia

Please feel free to PM me if you have any questions, want advice, or just someone to vent to! I hope this guide is helpful for everyone who needs it.

https://academic.oup.com/jsm/article-abstract/20/Supplement_4/qdad062.037/7220192

Abstract

Objectives
To evaluate the psychosexual correlates of obesity and the Metabolic Syndrome (MetS) in a large sample of women consulting for sexual symptoms; to investigate the change in measures of arousal after weight loss obtained with Very Low Calories Ketogenic Diet (VLCKD).
Methods
In a retrospective study, n=322 women consulting for sexual symptoms were enrolled. The patients underwent a clinical, laboratory, sexual and psychometric examination and were studied by color-Doppler ultrasound with measurement of the Pulsatility Index (PI) of the clitoral artery. Twelve patients underwent a lifestyle intervention based on a VLCKD protocol and compared with patients treated with different strategies for sexual symptoms, in a 1: 1 case-control study.
Results
Clitoral PI was significantly higher in obese women (p = 0.018) and in those diagnosed with MetS (p=0.043). A statistically significant inverse correlation emerged between WC ≥ 88 cm and FSFI Arousal score (R=-0.126, p=0.028). In patients undergoing a lifetsyle intervention (n = 12), after a mean follow-up of 20±2 weeks, BMI showed a reduction of 6.7±2.8 kg/m2 (p <0.001). At follow-up, the total FSFI and FSDS-R scores significantly improved (17.0±13.6 vs. 11.2±7.9, p=0.016, and 7.4±8.3 vs. 13.3±10.6, p=0.039, respectively). A significant increase was observed in FSFI Arousal (p=0.035), whereas clitoral PI displayed a non-significant reduction (p = 0.218). At multivariate analysis, the change in Total FSFI was correlated with the improvement in Body Image (BUT-B PSDI score: β=0.744, p=0.031; Eating Disorder Evaluation “Shape” domain: β=0.523, p=0.043), after adjusting for confounders. Finally, in the case-control study (subjects matched for age, BMI and menopausal state), the improvement in FSFI total score was more relevant in cases than in controls (p = 0.046).
Conclusions
Our data suggest that weight loss obtained by VLCKD is associated with an improvement in sexual function, and in particular in Arousal, which could be mediated by improved body image.
Conflicts of Interest
LV received scientific research grants, advisory board attendance and speaker honoraria from Therascience, Theramex, Bayer Schering Pharma, Intercept, Lipocine, Ibsa. EM and SC have nothing to declare.

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The Beginning: Minnesota, Appleton, Wisconsin, and London
I present my story in-depth to show the physical and emotional, and also academic strain this placed on me, but I also love discussing all of these issues and am interested in pursuing this academically to help others. I have now seen a total of 50+ doctors from different disciplines, 8 pelvic floor PTs, 5 orthopedic PTs, and 4 cognitive therapists.
For my whole life, I have been an athlete. I did ballet and pointe for 9 years, tennis, crossfit, and I loved to run long-distance. Never did I ever anticipate that I would experience chronic pain and disability that would prevent me from enjoying these activities.
My gynecological issues manifested first back when I was in my teens upon getting my first period. I had terrible dysmenorrhea (painful cramps) and also menorrhagia (heavy bleeding). I attempted to insert my first tampon in at the age of 13. It was painful so I shrugged it off as I failed my attempts to do so. Each year, I tried again and continued to fail. A few months later, I asked my PCP what could possibly be wrong, and she said "give it time."
When I was 16, I asked my family medicine doctor to assist me. I wanted to learn how to insert a tampon as I thought I was doing it incorrectly. My doctor had mentioned she had helped others before so I thought she would be instructive and compassionate. Instead, she spread me open forcefully, and I yelped as she shoved it in. The pain was tremendous. I was not expecting that.
At the age of 22, I was misdiagnosed with vaginismus even though I had some external pain at the opening and vestibule. I had to work hard to get past the comments made by providers that my anatomy was normal and there was nothing wrong. Even my first two gynecologists had marked on their notes I had external pain, but they did not tell me this could have been more consistent with vulvodynia/vestibulodynia symptoms. My doctors thought that my vaginismus was psychological, and didn’t want to push me too hard with dilating. The recommended course of treatment for me was to find a good pelvic floor therapist. I was abroad at that time so I didn't think it was necessary quite yet. However, my physical symptoms never went away.
In 2018, one of my gynecologists recommended a hymenectomy to help give me that extra push, so she referred me to a surgeon. The surgeon attempted to perform a regular pelvic exam with a speculum before my surgery, which was not successful. While she had warned me that I needed pelvic floor physical therapy, and that the vaginismus would not disappear on its own, it never occurred to them that I didn't only have vaginismus. She proceeded to use a q-tip and exclaimed, "I can't even get inside! You definitely have vaginismus." Looking back on this experience, she was not getting the full picture because the q-tip was touching the vestibule. However, I decided to pursue the surgery and they performed a pelvic exam while I was under anesthesia and she clipped a small part of the hymen. She got two fingers inside and reported that my anatomy was normal.
Maryland/ Washington D.C.
I went to my first pelvic floor therapist in early 2019. This business was supposed to be the best in the city. I could not get past the 1.5-inch mark with the dilator which I found later was just barely in the introitus which I thought at the time was a key sign of vaginismus. We did a mix of myofascial release, stretches (happy baby, piriformis stretches, child’s pose, etc..), and manual therapy. However, we still failed to identify that the pain was primarily external in the vestibule and labia minora. During this time, I went to cognitive therapy with several different people where we worked on breathing techniques and relaxation for solely vaginismus, but I still had 10/10 pain in my vulva despite working on progressive desensitization and relaxation. I made use of an abundance of meditations and breathing exercises and it hardly made a difference with the pain.
I continued pelvic floor PT with two separate people, but it still did not provide any results. Even my dysmenorrhea worsened. We did lots of alignments, stretches, manual therapy, and trigger point exercises to relax and release the pelvic floor. I had indicated I had pubic bone pain and they said it was very tight, but they didn't know how to solve that. Every time I came back to my sessions, the physical therapists were thrown off by how my body had come out of alignment. Their reasoning was that my body was taking time to adjust to the changes. When I did not make any progress after eight sessions, despite doing all of their recommendations, they told me we had to work internally in order for me to improve. They thought my pain was psychological. I finally told them that I thought I had pain externally which due to my low health literacy at this time was prolonged. They recommended I get a hormone test, but they did not explain why, so I neglected to get the test as it was so expensive.
I went to a pelvis clinic in New York to have 100 units of botulinum toxin injected vaginally to relax my pelvic floor muscles in March of 2020. I had heard they had great success rates, and they told me I was a perfect candidate for this procedure as my “symptoms sounded like vaginismus." The clinical study had great success, and I had previously spoken to several patients who had done this procedure. I told them I had vulvodynia as well which was not completely taken into consideration. I was very nervous about this procedure and was worried it would not work. However, I had been told that we needed to do more internal work at physical therapy so I felt this was a much-needed procedure. I thought I needed the extra push, but I couldn't have been far from wrong
During the procedure, the largest dilator of the Pure Romance set is inserted under anesthesia after the botox is injected. I believe my hips were pulled in the dorsal lithotomy position as the nurse practitioner said I "resisted" while I was sedated. I kept the fourth largest dilator in for 22 hours and came back for my next session of dilating. It was difficult and they basically had to force the dilator in. Immediately after the procedure, I had extreme urinary urgency, pain in my lower abdomen, back, groin, hips and had chills and a fever for several days. My vulvodynia and PN symptoms also increased after my procedure for at least 11 months.
I visited doctor after doctor and even ran to Urgent Care. I did many urinalyses (urine tests) as I was worried that I had an infection because I had a mild fever and pelvic pain. All of my tests came back negative. I ended up visiting a urologist who told me that I needed to do a pelvic exam in order to be fully evaluated. I told her I couldn’t do it and tried to come up with alternative ways for both of us to find a solution to make it work including not using the stirrups or having me insert the speculum (I got these ideas online). She dismissed every single idea and shamed me in the process. She said I wouldn’t be able to get away with not doing a pelvic exam as every doctor would have to perform one. Additionally, she prescribed me medications for bacterial vaginosis even though there was no indication that I had it. I took the medications anyways which had no effect.
I finally met a very compassionate sex medicine and urologist. I still work with her from time and time, and she is the standard for where medicine is headed. We had a long, comprehensive virtual visit, and she believed at the time I had hormonally-mediated vestibulodynia. I had been on birth control in my early teens for four years for heavy periods and had low estradiol and testosterone. I had wanted to think that I had the hormonal sub-type so we decided to approach that one first as it is more conservative. For the rest of that year, I spent quite a bit of time treating my hormonally-mediated vestibulodynia diagnosis for a few months while applying hormone creams, but nothing improved. A few months later around September 2020, I got two MRIs, a "sacrum MRI with visualized pelvis", and a lumbar spine MRI was normal and had no abnormalities. I had very bad lower back pain as I lay in the MRI machine for one hour. The sacrum MRI read that I had bone marrow edema with sclerosis and that it was consistent with sacroiliitis (SI joint inflammation).
While I wouldn’t have expected to improve in a month as these issues take time, I was getting progressively worse every time I went to pelvic floor PT. It only temporarily took away my pain for a few hours. I was still able to walk around and do light cardio, but nothing too strenuous. I had chronic abdomen pain, pubic bone pain, lower back pain, hip pain, groin pain, and upper abdomen pain. I told my PT that the pain was all over and she said that it was my brain remembering the pain.
I Moved to Houston: More Pelvis Interventions
Around October 2020, we moved to Houston as my fiance was promoted to senior scientist at age 33. I went to pelvic floor PT to attempt to treat the sacroiliitis and my pelvic pain with my fourth and fifth physical therapists. We did a mix of treatments consisting of manual therapy, relaxation, progressive desensitization, lengthening, warm and cold therapy. They handed me a packet full of SI joint treatments and pelvic pain stretches. It was standardized and not tailored to individual patients. However, during the treatments, I became aware that I had pretty severe groin pain, buttock pain, pubic bone pain, and hip pain/weakness/clicking constantly. I became worse and worse with each PT session, so I stopped attending. They said I should do less and less at home despite my frustration and complaints that I didn't feel this was right at my age. They said, "why would you walk 1/2 mile if it hurts? Why don't you try 1/4 of a mile." They were missing the point. By the time I stopped attending this practice, I could barely even walk half a mile. This just did not feel right for a 26 year old.
I visited with several sports medicine doctors whom my physical therapists referred me to. I started bringing my fiance into these appointments as I thought he could advocate on my behalf. He often catches things I missed and he as a scientist understands medical terminology. I also believe I get a better outcome with two against one. The doctors thought that my strength looked normal, including the strength in my hips. I was told I could possibly have complex regional pain syndrome, or that the pain was in my head after receiving the SI joint diagnosis as nothing was seemingly wrong with the joint. I had severe sensitivity in my shin to the point I could feel the water running down my shins in the shower. The recommended treatment for me at this time was to continue with pelvic floor physical therapy as they thought I had a pelvic injury and were not sure what to do. They said my hips were "normal."
Around Christmas in 2020
, I wanted to try THC for pain management. I was in a tremendous amount of pain daily and it HELPED for two days. However, on my third day of trying the THC, as we went to bed, my heart rate spiked to 170 suddenly. It would not go down and I felt like I couldn't breathe. My lips got dry suddenly and my head felt like it was going to explode. We ended up calling 911, the ambulance came and did an EKG in my bedroom, and then they took me to the hospital for sinus tachycardia (elevated heart rate over 150+), auditory and visual effects, and hallucinations. Due to Covid-19 rules, my fiance could not be with me. The staff treated me cruelly as if I were a drug addict though it was my first week of attempting cannabis for pain. It was unfortunate as they were not familiar with my any of my conditions, and they had no bedside manner compared to what I was used to. I asked them to check for hernias as I had pain in my groin and the doctor barely performed a physical evaluation believed I had no hernias.
The cannabis remained in the system for two weeks as it was clear I had accidentally overdosed. It took weeks for my heart rate to calm down as it kept spiking to over 140. I experienced nausea, vomiting, and other issues as the drug left my system. We ended up running to another emergency room where they deemed it as a "panic attack." When I talked to my psychologist about this experience, she said that panic attacks only occur for 30 minutes at a time so it was unlikely it was a panic attack as the body cannot maintain that state for long periods of time. My elevated heart rate remained for more than 12 hours at a time for several weeks until January 1st, 2021.
I went to another pelvic floor physical therapist at this time in Jan 2021 as instructed by my providers after the emergency room fiasco as my previous pain symptoms were decreasing (from doing nothing). The appointment was disappointing as the focus was more on the mental aspects. I was more anxious than normal, because I had just gotten out of the hospital from the emergency room. She gave me a lot of the same exercises I had previously and did a full physical evaluation again. She said that there was nothing seemingly wrong with me and that it was unlikely I had a strain. She told me my hips were fine. She also thought that my brain could have been remembering pain so I had to retrain my brain and nervous system/or that I had an overactive nervous system (true in a lot of cases). At this point, I could barely even do child's pose or easy stretches so I do not think their assessment of me was entirely accurate. If the overactive nervous system is used in place of a diagnosis, this can result in delayed diagnoses.
The Turning Point
I went to a new pelvic floor PT again towards the end of January. I requested an advocate and she ignored it. I was also given the self-correcting alignment (I had received three unique alignments with three different pelvic floor PTs over the last year) which did not help and actually worsened my conditions again. She continuously told me she was very good, yet I felt my hips pop out several times in their sockets or it felt like they were being ripped apart. Her assistant asked me to take off my pants despite the fact I had not given consent on their form. I was not able to do an internal exam and I knew it would be impossible so I declined. Later on, the PT made me take my pants off because she only knew one method of showing me how to do pelvic flicks, which were basically reverse Kegels. I was intimidated by her, yet I complied due to stress. During this same session, my leg lengths were found to be uneven (which is a major symptom of hip dysplasia) due to the fact that I “was out of alignment." I had mentioned several times that the SI joint issue was not the main problem due to my doctor’s saying so, but this PT didn’t know what to do and still followed the MRI report that said “sacroiliitis/ SI joint inflammation.”
After this specific visit, I had sharp pain, pins and needles all over my groin going down to my leg. I was simply crawling on the floor. I kept getting worse and worse. I went back one more time to give her another try as she said she was confident she could help me and make me better, but I got even worse. I asked her if this was symptomatic of a nerve issue and if she treated pudendal neuralgia and she ignored me and said it was on her website. My body spasmed so bad during the dry needling session as well and she tried massaging my calves which further excerbated my shins. As I now I have Ehlers-Danlos syndrome, massaging is a big NO for weak ankles and calves. I couldn’t move my leg at all or stretch it out to lay down, climbing stairs wasn’t possible, and my fiancee needed to wheel me around the house with our laptop chair for several weeks. The biggest thing I regret about this whole experience was that I did not walk out of the appointment. It took me six weeks to recover from this pelvic floor PT experience and she even called me at 8:00 PM on a Saturday without my consent.
I was devastated. I didn't understand how it could be psychological at this point as I was getting progressively worse. At 27, I was unable to walk more than one block outside. The main problem was that I was stuck in a vicious cycle. Many of my doctors lacked the skill set for talking about the muscles, and told me that I needed to go to PT, but couldn’t tell me what to do at PT. Then the pelvic floor physical therapists wouldn’t know what to do with my pain symptoms and try to fix everything without understanding.
A week later, I went to the referred physiatrist, that all my pelvic floor PTs wanted me to go to, at a pelvic clinic. She told me to get a hip MRI and an abdominal MRI. Having heard good things about this clinic, I decided it would be worth my time. This physiatrist was confounded by my issues and did not seem too confident at all. She also rolled her eyes at all of my previous treatments and did not know what clitoral adhesions were, or benzocaine lidocaine tetrocaine (BLT) cream was. She mentioned I could have labral tears, but she didn’t think it was the case. They also wanted to set me up with a pudendal nerve hydrodissection method without a real diagnosis, which I declined. I read the studies and realized it was extremely costly with no proven successful outcome. After getting the MRI, even those images (abdominal, left hip) came out as negative. When I left the appointment, I could barely walk still from my previous PT sessions and this person's rough maneuvers of FADDIR and Thomas test. The pain was sharp in the anterior of my hips.
This is where I decided to take action on my own as I could not believe nothing was wrong. I had been in shape for my whole life and none of this seemed normal. I reached out to several Facebook groups where I posted my x-rays and MRIs, and they said it looked like I had hip issues. I also performed the measurements myself and compared my images to other hip abnormalities. I decided on my own to get another opinion from a hip doctor. I am so glad I did.
Finally an answer! The Hips
In Feb of 2021, I expected to walk out of the hip doctor visit with no results. I went to one doctor and he forwarded me to his colleague. I also sought another opinion with another surgeon in Dallas, another skilled hip dysplasia specialist. All three were very compassionate and genuine, and it was a relief to have some straightforward answers. I was in so much pain that I was limping into the appointments.
After more image testing and another physical evaluation, they diagnosed me with bilateral hip dysplasia (shallow hip sockets with a lateral central edge angle of less than 25. Mine were 9 degrees and 14 degrees), cam impingement, chondral labral separation (almost labral tears) and SI joint degeneration not sacroiliitis, and to correlate clinically. All of this was discovered through many methods of physical evaluations (I'd never had before) and imaging; one pelvis MRI, 2 hip CTs scan, and X-rays. My hip doctor stated that "hip conditions need primarily 99% strengthening, 1% stretching" (glute exercises, abs). All three doctors agreed that I should have bilateral periacetabular osteotomy (PAO) and arthroscopy surgeries six months apart to reconstruct my hips and remove the discrepancies. I also was told to start hip physical therapy to prepare for the surgery, which I did.
Within two sessions of solely strengthening at orthopedic physical therapy in April of 2021, my vulvar symptoms had been reduced by 20%, I was up walking again and able to do the elliptical**, and a lot of my other pain symptoms decreased slightly.** This is a contradiction to the otherwise hypothesis that "it would take me years and years to have any pain relief," which I was told prior to going to orthopedic PT.
I had my first PAO with arthroscopy on June 10 with my hip surgeon and my second one, on December 2, 2021. Each surgery consisted of first, the arthroscopy, to remove the cam impingement and clean up the labrum, and then the PAO, which was an open surgery to reconstruct the pelvis (ilium, ischium, and pubic ramus). My hip surgeon gave me 23 more degrees of coverage with my acetabulums during each PAO. The surgeries were seven to eight hours apiece. The first surgery was very tough, but the moment I woke up, my left hip felt fixed despite having been cut into three pieces. I used the pain-controlled analgesia pump with hydromorphone and was very nauseated, but used scopolomine patches and zofran to combat it. Being forced to walk the next day after having surgery was the hardest. I could barely sit up during the process. The staff inserted a foley catheter during each surgery, which I kept inside two days post-surgery. My bladder appeared to be asleep after the removal of the catheter, and the nurses wanted to straight cath me so badly, which I fought against it. I told them I had vulvodynia and they did not seem to believe me. However, the internal medicine doctor gave me bethanechol and flow max to help jump start my bladder. It helped and the re-cathing was unnecessary. Just having the catheter removed was very painful each time even for a few seconds, which indicates I probably do have congenital neuroproliferative vestibulodynia.
I had to use a walker for six weeks straight almost post-surgery. It took almost 20 weeks for both sides to walk comfortably at the grocery store. The anti-gravity treadmill has been the most helpful in helping me gain mobility. Each recovery takes six months, but the second one was much easier as I was no longer dealing with one bad hip and one operated hip. I worked primarily with one PT who has been truly a joy in my recovery for both hips. She has a strong memory despite her high volume of patients and is great at adapting to my body as it flares a lot. Whenever I have pain, she adapts and switches to different exercises.
It became clear to me that I had gone to pelvic floor PT for three years (several of my doctor’s orders even without finding out the root cause of my problem) where I was only provided with stretches, lengthening exercises, laser therapy, heat, dry needling, massage, and manual therapy. The hip instability and weakness were causing the over activeness of my pelvis. Relaxing the pelvis was even more detrimental to my body as my pelvis was unable to relax due to the hip abnormalities as there are so many interconnecting muscles and nerves. The obturator internus muscle can play a huge role in hip and pelvis connection and bears a lot of strain when the hip is unstable and/or weak. I learned that the orthopedic issues need to be treated first before you can actually treat the pelvis, and sometimes the orthopedic issues don’t manifest until you’ve been treated by several people.
During all of the hip and pelvis issues, I also broke out in hives, which did not go away on their own. They spread all over my body randomly after the Houston freeze. I had to see several more doctors including dermatologists, rheumatologists, and allergists. I pursued Mast Cell Activation Syndrome and ankylosing spondylitis (sacroiliitis is a key marker of this autoimmune disease), but I was only diagnosed me with chronic idiopathic uticaria, which also has an association with acquired neuroproliferative vestibulodynia. The rheumatologist was confused as to why I had sacroiliac joint degeneration at age 27. In November 2021, my hip surgeon stated that the edema surrounding my SI joints was not present, which tells me that the unstable hips were causing the inflammation. In the last five months since my second PAO and arthroscopy, my lower back and buttock pain has disappeared. Additionally, my pelvis feels a lot more open.
Endometriosis
On May 2, five months after my second PAO and arthroscopy, I had a diagnostic laparoscopy and excision with an endometriosis specialist. He utilized the DaVinci robotic machine which is known to speed up recovery and for its precision with cuts. Prior to this, I had sought opinions for multiple endometriosis specialists who stated I have classical endometriosis symptoms. The surgery was 2.5 hours long and I woke up in a lot of pain. The staff scrambled to change my pain regimen. My bladder also fell asleep again and they had to re-cathe me despite having taken flowmax and bethenachol. Sadly, the staff lacked training in how to deal with a vestibulodynia patient and did not believe me as the etiology goes over their heads. They failed to insert the bladder catheter multiple times and I was screaming in the recovery area due to the pain. An anesthesiologist walked by and heard my screams, so he sedated me.
I stayed the night in the hospital. The gas pain was pretty significant, my abdomen was distended, and I was very nauseated. He told my fiance later that I had stage four endometriosis, primarily in the peritoneum, and it was likely that was the reason why I was in so much pain. I got my notes later which noted that I had endometriosis in a lot of places: Rectum, colon, abdomen, fallopian tubes, and covered my ovaries 60% and 30%. I had lots of adhesions, fibrosis, burn powder lesions, raised red blebs, early formation of chocolate cysts/endometriomas, partial obliteration of rectovaginal septum, and scarring. I also had a bilateral ureterolysis as my ureters were distorted from fibrosis of the retroperitoneal. Some lesions were deeply infiltrating my uterus. I had 16 biopsies, and all of them indicated inflammation. I also do not have interstitial cystitis as he performed a cystoscopy and zero Hunner's ulcers were present. I was so validated and shocked in the moment. I was expecting to walk out of the hospital with minimal endometriosis if anything or none at all. He told me that he removed all of the endometriosis, but I am worried about it recurring since I am still menstruating.
The first month of recovery was pretty miserable. The pain was not managed well and it was extremely high, much more than the PAO surgeries. I was on hydrocodone for a solid 27 days, and I ended up back on the walker for a few weeks. I could barely walk. I had sharp pain in my hips, especially the right one. Do not do an endometriosis surgery five months after PAO. While my hip surgeon had cleared me for this, I do not think my body was ready, and my hips being placed in the lithotomy position probably was also problematic. By week 9, I started to be able to move around much more, and then at 3 months I went to Montreal, and walked 5-6 miles per day.
At 3 weeks post-op, I was placed on norethindrone, a progestin only pill, which is supposed to suppress the endometriosis as much as possible. I asked for the continuous birth control, which is supposed to prohibit bleeding from occurring. I went off the norethindrone and then was placed on the Slynd. However, I went off that immediately as I had a lot of pain with that. None of the hormone therapies worked.
Now that I am eleven months out, I am not better. I am in a lot of pain 25/30 days of the month. My symptoms have not improved, they have been excerbated. I have tried cupping, some light myofascial release, lots of breathing and meditation at night. I have weird symptoms that I never experienced previously such as bladder pain, nerve sensations, bloating, pulling and tugging feelings (post-surgical adhesions and scar-tissue), and I can't seem to lay on my side or my stomach anymore. I went to on low-dose naltrexone recently, which did the bare minimum.
Hardware / Screw Removal
I had my hardware/ screws removed on August 11, 2022. I was able to void post-op and I was up walking after 1.5 weeks. The bilateral aspect was pretty tough. I returned to hip PT with some other physical therapists, and since the screws have been removed, my hips felt a lot better! It was truly a night and day different.
Ankles
I went to a foot and ankle specialist in April of 2022 recently as my shins and ankles have been still bothering me/preventing me from improving. I have bunions and had a previous accessory navicular surgery. He did not see anything in the x-rays and recommended tib/fib and ankle MRIs. Unfortunately, the MRIs got declined, which due to having endometriosis surgery I had to postpone the PT. Then my original PT left and my prescription got lost in the shuffle. We decided to combine hip and foot PT together, but then the front desk lost the prescription as they had a staff change. I started working with two different PTs and somehow they seemingly forgot about the foot and ankle issues, or didn't read it in my notes. I had been running on the altra G with no improvement for 10 months post first PAO and second PAO prior to all of this. I wanted to give it a try so I didn't say much about it at first, and pushed through the pain. I hoped that it would resolve, yet it did not. My hip surgeon was also convinced that it might just resolve on its own as I had structural issues with my hip instability.
On October 18, I started foot physical therapy with a different foot PT, and have already seen improvements after one session due to the addition of toe spacers and more strengthening based exercises. He truly excellent with feet. Prior to this, some of the others had me stretching out my calves. To be fair, I didn't know I had EDS at the time, but it shouldn't be on the patient to figure everything out on their own and one of them already suspected it.
Vestibulodynia
My endometriosis surgeon performed a vestibule biopsy which he arranged with my urologist to disconfirm/confirm congenital neuroproliferative vestibulodynia. Due to my inability to spread during exams, this was an usual ask. Three months later, I finally received word that I in fact have an overgrowth of mast cells - 8xs the normal amount, consistent with the neuroproliferative.
I met with my vulvar specialists to discuss findings and try to plan for a vestibulectomy. I am not happy about having to do this at all. I am conducting a review on the barriers that patients face when seeking treatment for vulvodynia and vestibulodynia, and I've read way too much about vestibulectomy. It appears that partials fail more as opposed to full vestibulectomies. I'm not 100% convinced that removing the 12'oclock region is safe either though.
In August, I made the effort to call around to find a pelvic floor PT as I was not improving with my endometriosis on my own. I refuse to go to someone without talking to them first after my previous experiences (one was borderline re portable as my consent was never given) as it would be a waste of both of our times to see that we would not be a good match. Many of the hospital systems do not let me talk to the PT beforehand and they placed me with someone who just recently graduated. I do not expect people to have all the answers, but I expect that they can work with me and help me find things that work for me through creative problem solving, providing many exercise modifications, and recognizing their own strengths and limitations at the same ime.
On my own, I asked around and I recently found a compassionate pelvic floor PT who did one rep at a time with me making sure the exercises felt good, which was a relief for once. We didn't do any stretching and we did things very slow and guided. While I did not make much progress in three sessions, my body did not collapse and I was not crawling around in worse pain. She also always had my consent and she did not deem things as mental**. I also liked that she strives to make her patients independent and give them the tools to succeed at home on their own. She also let me bring my fiance in twice to teach him some techniques. This is the type of care I should have received at the start of all of this.** However, this is where PFPT falls short. She continued to discuss the overactive nervous system, despite not having all of my diagnoses there.
Ehlers Danlos Syndrome
A few months later around August 2022, I completed a genetic test that revealed I had several variants for Brittle Cornea Syndrome, which is a subset of Ehlers-Danlos Syndrome. Having read the symptoms, I have bilateral hip dysplasia, bilateral bunions, arachnodactyl, astigmatism, myopia, and hypermobility. I saw an opthamalogist who confirmed I had high myopia and astigmatism. I had also hoped to investigate if I had blue sclera or keratcoconus. In October, I saw a shoulder specialist who confirmed I had bilateral shoulder instibility and posterior shoulder impingement. I've had pain in both shoulders from tennis and lifting. In my past, I've also experienced dental issues, epistaxis, and hand pain. It would make sense that I have some type of connective-tissue disorder.
Present (GI Doctor, Shoulders, Feet, ER, and More )
In January of 2022, I ended up in the ER again with severe rib pain, abdomen pain, back pain, shoulder pain, and hip pain. Everything felt like it was ripping apart. It happened after I did something in PT, and I needed to take hydrocodone every single day for a month. I believe it's in line with slipping rib syndrome, which I recently learned about. My shoulder doctor later told me I had been doing the wrong treatments in shoulder PT, which upset me because he had only assessed the anterior portion of the shoulder previously. Why not assess the shoulder? He also diagnosed me back in October with bilateral instability and posterior shoulder impingement.
I ended up seeing two spine doctors. They told me I was having a musculosketal issue and to return to PT.
I ended up back at my favorite hip doctor, who sent me for more diagnostics (neurogram, bone density scan). I went to my vulvar doctor who scheduled me for surgery, and I consulted a gastrointestinal doctor who is scheduling me for an endoscopy and colonscopy in March. I went back to my foot doctor, and we finally got the MRIS scheduled. He told me I had arthritis at the achilles heel too based on the images. The MRIs came out negative so far, so I know they will be referring me to neurology.
I consulted FOUR more endometriosis specialists and one more ISSWSH doctor, and we all agreed that I may have more endometriosis, even diaphragmatic endometriosis, adenomyosis, and maybe even pelvic congestion syndrome due to the venuous presence in the alcock's canal. The pain has progressively gotten worse and worse.
Colonoscopy and Upper Endoscopy
On March 23, 2023, I had a colonoscopy and upper endoscopy where one small polyp, one ulcer, and rectal hemorrhoids were discovered. The doctor was very thorough. He took a lot of pictures, and gave my husband the full run down of what happened. He said that I didn't have a hiatal hernia. The worst part was the bowel prep and the mouth guard they put me in my mouth prior to being put under. The staff were very kind.
I had my large surgery laparascopic excision for stage III endometriosis, total hysterectomy with salpingectomy, cystoscopy and appendectomy on June 14, 2023 where they found adenomyosis and even removed the appendix.
Takeaways
I have learned a lot from my experiences and I hope you can gain insight from my story as well. What you can takeaway is:

• You are your own advocate and only you know your body best. Don't stop asking questions.
• Do your research: Come into appointments prepared, bring an advocate, use social media, and do your reading, look at surgeon reviews online (take notice of themes, those that have too many positive reviews without any specification of outcome is a red flag). Good personality and bedside manner is only a nice to have.
• Plan ahead before surgery
• Ask for second, third, or even fourth opinions even for imaging tests. The doctors that rely on the report may have overlooked something.

Along with dilating, stretching my pelvic floor has helped greatly with my primary vaginismus (not cure yet) AND ability to orgasm clitorally. I did some physio last year and she never suggested stretches alongside dilating. Here are some resources I shared in another subreddit:
My boyfriend found this amazing book about vaginismus, by Dr. Julia Reeve, full of stretches that I don’t have access to but I’ll share the images: https://imgur.com/a/ZS5QES6
This website has some great ones I do when I’m lazy in bed (#2, #3): https://www.yogajournal.com/poses/anatomy/pelvis/yoga-for-pelvic-floor-dysfunction/
One that I haven’t been doing but I will start (as achieving orgasms in this position has become possible) is the Bridge pose (#10): https://aeroflowurology.com/blog/10-yoga-poses-strong-pelvic-floor
Any sort of pose that opens your legs up and you can feel that stretch in your inner thighs/pelvic region is great. I would suggest trying a bunch selecting a few that are comfortable for you. For me, the poses where my knees against the ground are very uncomfortable. Then you can construct your own 10-15 minute routine you can do a few times a week. I will also stretch here and there when I’m brushing my teeth or sitting at my desk to make it a habit.
I hope this helps someone as much as it has helped me!

Salam, Cw: talk of female genetalia, sexual satisfaction. Which is why I would prefer women and/or professionals to answer.
So what is the deal with female circumcision in islam? I have done a lot of reasearch on this online and have gotten a lot of mixed responses ranging from all the hadiths are false to it is obligatory to mutilate your whole vagina.
The first and most prominent argument I found from Islamic doctor scientific papers where that the hadiths come from weak sources and that the person who collected them all even said that he get this information second hand and there was a good chance they were weak. Here is the link: https://www.unfpa.org/sites/default/files/pub-pdf/De-linking%20FGM%20from%20Islam%20final%20report.pdf And: https://www.unicef.org/egypt/media/3576/file/FGM%20Summary.pdf And : https://www.reviewofreligions.org/33788/is-female-genital-mutilation-an-islamic-practice/amp/ And: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260090/
However is you read the last article, they mention of how the removal of the clitoral hood could be beneficial to women’s sexual satisfaction. There is also the bonus mentioned in other articles of preventing the build up of germs under the hood along with preventing other diseases. As mentioned here: https://my.clevelandclinic.org/health/treatments/22259-clitoral-hood-reduction And: https://aljumuah.com/circumcision-for-the-muslim-woman-part-1-of-2/ And here is an interesting source coming from a women who was circumcised the supposed “right way”(which I would agree with if I was to support the opinion that it is mandatory or highly rewarded): https://www.greenprophet.com/2022/09/circumcised-muslim-woman/
However, in another website (which I lost) and mentioned in a few of the above, the purpose of the clit hood is to protect from uncomfortable or even painful friction that could be put apon the area due to daily activities. Just imaging your underwear and clothese touching there all the time, sounds almost painful. So there is benefit in the hood, so why cut it all off? Are only the overly large ones supposed to be?
I also found one interesting additonal argument online that says that the clit hood cannot be harmed but the labia minor can be reduced, making the circumcision. I do find this very interesting and a possibly option. https://asharisassemble.com/2014/01/24/the-truth-about-islam-and-female-circumcisionfgm/
Finally we have arrived at the more anti-women’s pleasure side of the argument: https://islamqa.info/amp/en/answers/45528 And : https://www.askimam.org/public/question_detail/19678 They seem to argue that it is both manditory/extremly reccomended because not only does it have health benefits (which seems to be true) but also decreases “excessive sexual desire” or having too much libido or the clit being too stimulated during sex. The last point makes me a little upset, because women in general seem to have less libdio as it is then men, why decease it? Wouldn’t the wife having less sexual desire cause strain to a marriage?
It should also be mentioned, and I would like you all’s opinion on the matter, that one of the two they quote to say it takes away from libido, dr. haamid al-ghawaabi, i cannot find other than people bringing him into their argument for female circumcision. The other woman, Sitt al-Banaat Khaalid, i could also not find much about.
This is why I want to ask, are these two reliable? Women who have been circumcised (properly or not), did you have a decrease in arrousal?
Although the website does not explicitly state it, they do seem to be in support of reducing/removing the clit in some way. However, the hadith that many quote says not to cut too deeply (aka not the clit, only the skin/hood above). “A woman used to perform circumcision in Medina. The Prophet said to her: Do not cut severely as that is better for a woman and more desirable for a husband.” The hadith is also stated in a way that says it (the clit) bring brighteness to a women face (pleasure/orgasm) and is desirable for the husband (possibly so he does not need to over exert himself to make his wife orgasm after he already has).
There seems to be a lot of people who agree with this though. Looking at accounts from women in Africa and Southeast Asia where many people believe in this practice, whos clit has been partially take off haven’t had less desire, instead more sexually frustrated as it is very hard to archive an orgasm during sex. Or even totally taken off (may Allah swt help them), have had their lives ruined to say the least.
And the argument that we wouldn’t want our women to have desire in fear of zina is sexist and ignorant to say the least. It would be equivalent to cutting the head off the penis, but with 1000x more damage in the aftermath (inferility, pain in peeing, sex, birth, period and disease for a start). Yes it would decrease desire I suppose, but at what cost? Is one of the major test of this world not staying away from zina by your own accord?
Finally I would like to end by saying that any damage to the clit seems to be totally haram to me, is the purpose of marriage not to satisfy both spouses? Are women not allowed to divorce their husbands if they fo not satisfy them sexually? Is Islam not even more so a religion that allows and encourages the orgasm and satisfaction of women (in a halal manner) more than damaging their bodies? It should also be said that the Quran forbades inteninally harming our bodies, or causing harm to others in general really. And the Quran is of course 100% authentic.
This situation has been really bothinging me and I would love it if I could get some others insight on the matter, thanks

https://academic.oup.com/jsm/article/20/Supplement_2/qdad061.051/7165530

Abstract

Introduction
The role of obesity in female sexuality is controversial and there are no intervention studies aimed at evaluating the effect of the Very Low Calories Ketogenic Diet (VLCKD) on female sexual function, in particular on arousal.
Objective
To evaluate the psychosexual correlates of obesity and Metabolic Syndrome (MetS) in a sample of women consulting for sexual symptoms; to investigate the change in measures of arousal after weight loss obtained with VLCKD.
Methods
In a retrospective study, n=322 women consulting for sexual symptoms were enrolled. The patients underwent a clinical, laboratory, sexual and psychological examination and were studied by color-Doppler ultrasound for the evaluation of genital vascularization, with measurement of the Pulsatility Index (PI) of the clitoral artery. They completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale - Revised (FSDS-R), Body Uneasiness Test, Eating Disorder Examination Questionnaire (EDE Q), and Middlesex Hospital Questionnaire, for psychiatric symptoms. Twelve patients underwent a nutritional intervention aimed at weight loss, based on a VLCKD protocol. These cases were compared with patients treated with different strategies for sexual symptoms, in a 1:1 case-control study (matched for BMI, age and menopausal status).
Results
In the total sample, clitoral PI was significantly higher in obese women (p = 0.018) and in those diagnosed with MetS (p=0.043). A statistically significant inverse correlation emerged between WC ≥ 88 cm and FSFI Arousal score (p=0.028). In patients undergoing a nutritional intervention with VCLKD protocol (n=12), after a mean follow-up of 20+-2 weeks, BMI showed a reduction of 6.7+-2.8 kg/m2 (p<0.001) and WC of 14.3+-5.2 cm (p<0.001), with fat mass loss of 14.6+-5.4 kg (-37.1%; p<0.001). At follow-up, the total FSFI and FSDS-R scores significantly improved (17.0+-13.6 vs. 11.2+-7.9, p=0.016, and 7.4+-8.3 vs. 13.3+-10.6, p=0.039, respectively). Among the FSFI subdomains, Arousal showed a significant increase (p=0.035). We also observed an improvement in EDE total score (p=0.032), Shape (p=0.008) and Weight subscales (p=0.011), BUT-B Positive Symptoms Distress Index (p=0.009) and BUT-A Body Image Concerns (p=0.043), and MHQ total score (p<0.001). The clitoral artery PI at follow-up showed a non-significant reduction. At multivariate analysis, the change in the Total FSFI was correlated with the BUT-B PSDI score change (p=0.031) and the EDE Shape change (p=0.043), when including DeltaMHQ and DeltaWC as further covariates. Finally, in a 1:1 case-control study, a significant difference emerged in the improvement of FSFI total score, which was more relevant in cases than in controls (p=0.046); on the other hand, there was no difference in the change in FSDS-R score between cases and controls.
Conclusions
Our data suggest that weight loss obtained by VLCKD is associated with an improvement in sexual function, and in particular in Arousal, whose change could be mediated by improved body image parameters. The effect of weight loss on cardiometabolic risk factors related to sexual dysfunction requires dedicated longitudinal studies, with the use of objective methods.

PMHx:
- 21F, East Asian, 125 lbs, virgin
- Depression, Anxiety, ADHD (mild); diagnosed recently. Symptoms of these fluctuated throughout my life.
- Got my period at 11 y/o. Started having inconsistent periods at around 14 y/o (periods 2-3+ months apart). Started getting body acne (back, butt, chest, bikini area).
- Experienced immense stress and anxiety my whole life, however, libido was still present. Would masturbate 1-2 times daily with no issues getting aroused.
- When I was 15, I noticed my libido dropped *drastically*, it disappeared overnight. Had bloodwork done with the OBGYN. Everything came back normal - Androgens, thyroid, etc. Took birth control briefly but stopped due to side effects. Had ultrasound - NO cysts.
- Period started being more consistent at ~19 y/o. However, no libido improvement.
- Was on SSRIs for ~4 months (@ 19 y/o), but that was way after sudden libido drop.
Bloodwork/Imaging (Taken ~19-21 y/o):
- Elevated prolactin (15-20ish units above range)
- constantly elevated FSH:LH ratio (measured twice)
- HOMA-IR > 3. Insulin resistance?
- low vitamin D (now supplementing OTC and normal)
- Thyroid has been consistently normal through the years. DHEAs normal. Progesterone, Estradiol, Testosterone (free + total) - all normal.
- Had an MRI with contrast; there was no tumor. Was still prescribed Cabergoline for elevated prolactin by endocrinologist; it helped lower it (and sometimes even go below range), but there was no libido improvement at all. Helped periods even out significantly; periods are now 30-40ish days apart.
Current medications/supplements:
- Cabergoline 0.25mg, to be taken every other week; however, I have not been compliant due to the awful side effects. I have been taking it more like 5-7 weeks apart because I struggle with very severe side effects (fatigue, restless legs, dizziness, lightheadedness). Additionally, when I take it as prescribed, my PRL drops to 0.
- Spironolactone PO 25mg daily (prescribed only a week ago for body acne); I am aware it may affect libido, however, I decided to take it anyway since I am insecure about my body acne, AND my libido is already completely gone.
- Zinc, magnesium, Vitamin D, vitamin B12 once daily, as recommended by doctor
- Taking Ovasitol 4000mg daily (supplementing on my own for insulin resistance)
- Was prescribed Metformin but it did not improve HOMA-IR, recently stopped taking after 2 months
- I've STOPPED taking any SSRIs for a year now; took them for ~4 months. When I took them, I noticed genital numbness. Genital sensitivity recovered shortly after stopping them.
Current Issues:
- I have been able to achieve orgasm through the years, but they have felt less pleasurable, and more recently, almost nonexistent.
- I don't feel horny. Masturbation used to feel like "scratching an itch," or "relieving myself." I'd feel butterflies in my belly, increased sensitivity to my vagina. The mental aspect is 100% gone. There are no sensations of arousal. This has not improved one bit. When I masturbate now, it's more of a chore. I'm not horny when I decide to do it. This is frustrating me.
- I have experienced vaginal dryness, but it has somehow improved. When I watch porn now, I have no issue getting wet. However, I feel no mental arousal, and I cannot stay wet for long. Additionally, my clitoral and vaginal sensitivity have drastically decreased in the last year or so - it is almost numb. Notably, nipple sensitivity has decreased.
- I am having a harder time achieving orgasm, and usually I am not wet enough to continue masturbation.
What I've Tried
- I used to masturbate while watching porn very frequently. I stopped watching porn for a while, but there was little to no improvement.
- Taking more time to relax and get in the "mood," but I eventually get frustrated that I can't orgasm and just give up.
- Lifestyle changes - eating a low glycemic diet, exercising, losing weight, sleeping more. Decreasing stress and anxiety levels significantly. All these efforts have NOT improved my arousal and vaginal sensitivity at all. I have not been the same since that sudden libido loss.
- I am still grappling with mental issues: body image, self esteem, depression, and anxiety. I have been in therapy, tried antidepressants. I understand these may all contribute to low libido, however, I am tired of being dismissed for my libido issues when I bring these issues up. It has been years since I've experienced this, and I desperately want my libido back; something has been "switched off" in me for years. I haven't been the same, or seen any improvement.
I know there's an underlying physical/hormonal aspect to this - and I've been to multiple doctors, but no solution has helped. Please help me, I'd appreciate any possible insight!

PMHx:
- 21F, East Asian, 125 lbs, virgin
- Depression, Anxiety, ADHD (mild); diagnosed recently. Symptoms of these fluctuated throughout my life.
- Got my period at 11 y/o. Started having inconsistent periods at around 14 y/o (periods 2-3+ months apart). Started getting body acne (back, butt, chest, bikini area).
- Experienced immense stress and anxiety my whole life, however, libido was still present. Would masturbate 1-2 times daily with no issues getting aroused.
- When I was 15, I noticed my libido dropped *drastically*, it disappeared overnight. Had bloodwork done with the OBGYN. Everything came back normal - Androgens, thyroid, etc. Took birth control briefly but stopped due to side effects. Had ultrasound - NO cysts.
- Period started being more consistent at ~19 y/o. However, no libido improvement.
- Was on SSRIs for ~4 months (@ 19 y/o), but that was way after sudden libido drop.
Bloodwork/Imaging (Taken ~19-21 y/o):
- Elevated prolactin (15-20ish units above range)
- constantly elevated FSH:LH ratio (measured twice)
- HOMA-IR > 3. Insulin resistance?
- low vitamin D (now supplementing OTC and normal)
- Thyroid has been consistently normal through the years. DHEAs normal. Progesterone, Estradiol, Testosterone (free + total) - all normal.
- Had an MRI with contrast; there was no tumor. Was still prescribed Cabergoline for elevated prolactin by endocrinologist; it helped lower it (and sometimes even go below range), but there was no libido improvement at all. Helped periods even out significantly; periods are now 30-40ish days apart.
Current medications/supplements:
- Cabergoline 0.25mg, to be taken every other week; however, I have not been compliant due to the awful side effects. I have been taking it more like 5-7 weeks apart because I struggle with very severe side effects (fatigue, restless legs, dizziness, lightheadedness). Additionally, when I take it as prescribed, my PRL drops to 0.
- Spironolactone PO 25mg daily (prescribed only a week ago for body acne); I am aware it may affect libido, however, I decided to take it anyway since I am insecure about my body acne, AND my libido is already completely gone.
- Zinc, magnesium, Vitamin D, vitamin B12 once daily, as recommended by doctor
- Taking Ovasitol 4000mg daily (supplementing on my own for insulin resistance)
- Was prescribed Metformin but it did not improve HOMA-IR, recently stopped taking after 2 months
- I've STOPPED taking any SSRIs for a year now; took them for ~4 months. When I took them, I noticed genital numbness. Genital sensitivity recovered shortly after stopping them.
Current Issues:
- I have been able to achieve orgasm through the years, but they have felt less pleasurable, and more recently, almost nonexistent.
- I don't feel horny. Masturbation used to feel like "scratching an itch," or "relieving myself." I'd feel butterflies in my belly, increased sensitivity to my vagina. The mental aspect is 100% gone. There are no sensations of arousal. This has not improved one bit. When I masturbate now, it's more of a chore. I'm not horny when I decide to do it. This is frustrating me.
- I have experienced vaginal dryness, but it has somehow improved. When I watch porn now, I have no issue getting wet. However, I feel no mental arousal, and I cannot stay wet for long. Additionally, my clitoral and vaginal sensitivity have drastically decreased in the last year or so - it is almost numb. Notably, nipple sensitivity has decreased.
- I am having a harder time achieving orgasm, and usually I am not wet enough to continue masturbation.
What I've Tried
- I used to masturbate while watching porn very frequently. I stopped watching porn for a while, but there was little to no improvement.
- Taking more time to relax and get in the "mood," but I eventually get frustrated that I can't orgasm and just give up.
- Lifestyle changes - eating a low glycemic diet, exercising, losing weight, sleeping more. Decreasing stress and anxiety levels significantly. All these efforts have NOT improved my arousal and vaginal sensitivity at all. I have not been the same since that sudden libido loss.
- I am still grappling with mental issues: body image, self esteem, depression, and anxiety. I have been in therapy, tried antidepressants. I understand these may all contribute to low libido, however, I am tired of being dismissed for my libido issues when I bring these issues up. It has been years since I've experienced this, and I desperately want my libido back; something has been "switched off" in me for years. I haven't been the same, or seen any improvement.
I know there's an underlying physical/hormonal aspect to this - and I've been to multiple doctors, but no solution has helped. Please help me, I'd appreciate any possible insight!