Tag: Pain during sex

Reading My Broken Vagina by Fran Bushe

Much like with Lara Parker’s Vagina Problems, I don’t think it’s entirely appropriate for me to ‘review’ Fran Bushe’s My Broken Vagina because the content is so close to home. I’ve also seen Bushe’s one-woman show Ad Libido three times, discussed it several times on this blog and written about it during the same module of my MSc that I discussed in my last blog. I’m a big fan and completely biased, so instead of reviewing My Broken Vagina, here are some thoughts I had while reading it.

My Broken Vagina is a frank, funny and warm book where Bushe describes her experience of feeling like her vagina is broken and her quest to fix it: spoiler alert, the only thing that’s broken is sex education. As soon as I started reading My Broken Vagina I felt like I was being hugged by Ad Libido. Each of my three viewings of Bushe’s show marked significant chapters in my own relationship with my broken bits but having its wisdom captured in a written form that I can return to and share beyond the limits of the theatre feels very special. Just like her play, Bushe’s book is laugh-out-loud funny, genuinely educational and wonderfully moving. As an added bonus, it’s filled with amazing, poster-worthy illustrations.

Among many important points that come up in My Broken Vagina, is one that I am always particularly fascinated by: ‘the conversation’. That is, the great pleasure of telling a potential new intimate partner that they might need to change their expectations of sex because of sexual pain. Perhaps it sounds simple but it’s been something of a minefield for me for many years and I was thrilled to find it in Vagina Problems and now My Broken Vagina too. It’s refreshing to see it being discussed openly because advice about talking to a partner about sexual pain nearly always assumes you’re in an established, monogamous and heterosexual relationship. It’s likely I relate to Bushe and Parker’s musings on the subject so much because we’re all discussing experiences of being single with sexual pain as white, cis women dating men, but there are definitely similar threads running through discussions of ‘the conversation’ that I think are worth talking about. Take a look at these quotes from My Broken Vagina and Vagina Problems:

‘Yeah, haha, and by the way, I might never be able to have sex with you. But I’m still pretty funny and I can make decent banana bread.’
Lara Parker, Vagina Problems – 114

‘At what point on a date with someone new, do you say, “Hey, I know we are probably going to go back to mine and bang it out/make sexy magic, but I want you to know … I might find this very painful”.’
Fran Bushe, My Broken Vagina – p.36

Recently, I got over my fear of ‘the conversation,’ by coming to the remarkable discovery that it doesn’t matter. It doesn’t matter for two reasons. First of all, it is a complete distraction from the actual important bits of getting to know someone and figuring out if you even want to get intimate with them:

‘I nodded when I was supposed to and laughed on cue, all while thinking about what it might be like to tell him that I might not ever be able to have penetrative sex with him.’
Lara Parker, Vagina Problems – p.115

‘The fear of having this conversation with a stranger not only meant I had never had a one-night stand, it also meant I’d stay in bad relationships longer than I should.’
Fran Bushe, My Broken Vagina – p.37

Secondly, it doesn’t matter because no matter how you present the information, you cannot control the other person’s reaction. Nothing has ever been more out of your control and, if I’m totally honest, a person’s reaction to that revelation can often be a good test of character. The last time I told someone I was dating that sex might not be what they were expecting or used to but that it could still be fun and good if they kept an open mind, the guy in question went quiet for a moment and became very focussed on the beer bottle in his hand. I was about to panic babble when he suddenly became very animated and asked me why his ex-girlfriend had instructed him to stuff a head of garlic up her vagina to prevent UTIs. It cued internal howls of laughter and shook out all the anxiety I had about ‘the conversation.’ Shock therapy? There is no way I could have anticipated that response (nor any way I could have answered his question.)

This subject and many others are built upon in much funnier ways in Bushe’s writing. Bushe’s play came to me (steady on) by chance when I was still feeling very much alone in my experience of sexual pain. The Gilmore Girls gif I used to describe how Ad Libido made me feel the first time I saw it is still better than any words I’ve found to describe that feeling. The idea that some scared teenager discovering their body might find My Broken Vagina before sifting through the heaps of unhelpful and incorrect information and advice Bushe and others like myself have had to sift through warms my soul. I wonder how my former Catholic all-girls school would feel about a sudden library donation? I think I’ll find out, because at the heart of My Broken Vagina is a lesson we can all do with reminding of from time to time: that there’s a big difference between feeling broken and being broken.

You can buy My Broken Vagina from all good bookshops now and until 19 June you can stream Ad Libido online here – I think I’ll be getting my fourth viewing in! P.S. Speaking of vaginas, if you’re in London get to the Vagina Museum for what looks to be an amazing exhibition, ‘Periods: A Brief History,’ featuring the amazing Hazel Mead. Wish I could get there!

June 10, 2021
Vindication, endometriosis & some Douglas bloke | Pleasure Moans #3
In my last blog I detailed my hesitation and resistance to my gynaecologist’s suggestion that I have a second diagnostic laparoscopy (keyhole surgery) to look for endometriosis. It feels weird then, almost two months later, to be writing that this week I had that surgery.

My hesitations varied from not wanting to repeat another painful and probably pointless surgery like the one I had in August 2017, to wanting an endometriosis specialist to be the one to go in for a second look, rather than a general gynaecologist. Once I received a date for the operation I was more certain than ever that I was going to be withdrawing my name from the waiting list, but I had an upcoming appointment with a different doctor that I had set as the deadline for my final decision.

This other appointment was a bit of a cock-up – I was supposed to have been referred to a specialist gynaecology clinic in London but wires were crossed and somehow I ended up with a referral to a sexual health clinic in London that specialises in sexual pain. The problem was, the only female sexual pain the clinic deals with was superficial pain, relating to pain that occurs externally or on entry, like vaginismus and vulvodynia. While I have had some run-ins with superficial pain, my most persistent symptom over the last few years has been deep dyspareunia – that’s deep, internal pain during vaginal penetration.

When I got to the appointment I was, as expected, greeted with, ‘why have you been sent here? We don’t deal with deep pain, that’s gynaecology.’ But I was kind of hoping I might be referred to that hospital’s gynaecology department because it’s one of the best. He decided to examine me anyway, and I realised this was going to be something of a new experience when he said, ‘oh we use stirrups a little differently here…’ One bizarre examination later and he agreed with me that superficial pain was not a primary issue but that it was present. He also said I appear to have some pelvic floor dysfunction which doesn’t surprise me at all. Physio is something I’ve been increasingly curious about over recent months.

When it became clear that he wasn’t going to refer me to the hospital’s gynae unit, I just decided to ask, ‘do you think I should have a second laparoscopy?’ He took a sharp inhale and said something along the lines of, ‘I’m sure you get this a lot and are pretty fed up of it, but it sounds like endometriosis to me.’ He was right, I have been getting that a lot, increasingly so. He suggested some urological and gastrointestinal causes too, but then he went on to explain endometriosis to me in a way no one else ever had before. He said, ‘some women will be struggling with infertility, have absolutely no pain and a laparoscopy will find endometriosis in abundance. Other people will have serious, chronic pain and yet when endometriosis is found it will be a really small, localised amount, probably on or very near a nerve.’

This, pardon the pun, really struck a nerve. My symptoms have improved so much since going on the pill that it seemed to me that if I did have endometriosis after all then there couldn’t be very much of it. So I started to focus in on the one symptom that hadn’t changed – deep dyspareunia. I asked around, did a lot of research (I’m particularly grateful for the resources on the Nancy’s Nook Endometriosis Education Facebook page) and discovered that deep dyspareunia is often associated with rectovaginal endometriosis and endometriosis found in the Pouch of Douglas (POD).

‘POD’ struck a chord. Why did I know those letters? I started sifting through my (now finally organised) records of appointments, examinations and scans and discovered that on one of my more troubling scans, where a persistent hemorrhagic cyst (commonly associated with endometriosis) was found, a very small, uneventful comment was written: ‘some free fluid seen in POD.’ The POD, evidently named after some Douglas bloke, is also known as the ‘rectouterine pouch’ or the ‘posterior pouch.’ It’s the seemingly useless ‘cul de sac’ between the uterus and the rectum. Intelligent design, eat your heart out. The more I read about endometriosis-related dyspareunia the more it all seemed to marry up with my symptoms (retroverted uterus, constipation after sex, deep dyspareunia).

It was this discovery, as well as my first debilitating period in a year, that pushed me to say I would have the surgery in April after all. I was pretty steady in this decision, up until a week before where I promptly freaked out. My initial fear was that I going to die and it was all going to be my fault, but most of all, I was crippled by the fear of going through the entire process again to be told there was nothing wrong but to continue to be told that my symptoms sound like endometriosis. It’s an incredibly frustrating cycle. Once I talked myself off of that ledge I was determined to be as prepared as I possibly could be for the surgery. Looking at it now, I think I did a pretty good job.

I had a full sheet of questions and concerns that I wanted to run by my gynaecologist before I let him operate on me, all of which he respectfully and sincerely answered. A few included:
1. Please don’t stretch my vagina, as you suggested you might – OK
2. Since deep dyspareunia is my most persistent symptom can you please check my POD and look out for rectovaginal endometriosis – it’s unlikely but sure, I would have looked anyway
3. Will you open up my old scars or create new ones? A bit of both, personally I prefer going in from the left, so that would mean a new scar
4. If you find endometriosis how will you treat it? Burn it
5. Is excision surgery not an option? I hear that it’s better. If it’s significant then I would excise it, yes.
Ecetera, etcetera.

Reassured by his answers and our rapport, I was readied for surgery and sat reading Chamber of Secrets until they came and got me.

Inhale.

A couple of hours later, exactly 20 months after my first disheartening surgery, my gynaecologist swaggered into recovery (where I was crying and swearing because my drugged-up self had come to the conclusion they hadn’t found anything) to tell me, ‘I found endometriosis in your Pouch of Douglas, it’s not in your head!’

Exhale.

Sore, surprised and a little smug

It’s only been a few days and I’m still processing. It was a really tiny amount of endometriosis, but as I’ve been reminded time and time again, the severity of endometriosis does not correlate to pain. Giving myself endometriosis imposter syndrome at this point will help nothing.

I can’t help but wonder what role my own advocacy and research played in finally get an, albeit tentative, answer. Would he have double-checked my POD if I hadn’t specifically done the research and asked him to? Would painful sex ever have been the symptom my doctors focussed on if I hadn’t forced them to? A widely touted statistic about endometriosis is that on average it takes 7.5 years to get a diagnosis, but that’s actually contested between 7 and 12 years. I’ve got here, where I’m not sure I have a diagnosis exactly but where I have had endometriosis discovered and treated, in three and a half years. But reaching this point has been a hell of a lot of hard work, physically and emotionally. I’ve been misdiagnosed with vaginismus, spent months attending psychosexual counselling, been placed on a pill that’s wreaked havoc with my skin and mood, taken anti-depressants for pain management, stopped running, stopped having sex, stopped socialising like a normal twenty-whatever-year-old. I’ve gained a lot too, knowledge, friends, writing gigs, a novel, job opportunities, a post-grad pathway I didn’t expect, a blog – but I am constantly curious about what the last three years might have looked like if my pain had been believed earlier, taken seriously sooner and treated promptly – by myself and by others.

It’s not yet clear whether this is the beginning or the end of this particular experience. I have a million questions for my post-op appointment and I won’t know if the surgery has actually improved anything for months. But to have had the hysteria label lifted is hugely gratifying. Honestly, I feel vindicated because in my head the pain was never in my head. If that makes any sense at all.

Of course, summer arrived the day after my op so I’ll be sporting some DVT stocking tan lines this year!
April 20, 2019
The fun part? | Pleasure Moans #1
1. Try not to intellectualise your bodily experiences (much too late for that)
2. If you start dating again, you’re likely to unconsciously pick someone with erectile dysfunction (can I unknow this?)
3. When you’re ready, try penetration but on your own (oh shit, here we go)
Those are the three nuggets of wisdom my sex therapist gave me when we finished our sessions together in the autumn. She made it clear to me that she expected to see me again, or that I would see another psychosexual counsellor at some point in the near future. I was being discharged a) because my sister’s Danish health insurance had dried up and b) because we’d hit something of a brick wall in terms of progress. My generalised pelvic pain had improved and I was beginning to handle the upsetting side effects of the pill, the only thing left to test was the penetrability of my vagina. The fun part, right?

I was in no rush to test this theory, partly because I was so encouraged by the way everything else had improved. Even in terms of vaginismus, we had come to the conclusion that any superficial, psychological pain and reaction I had was situational and secondary. We also agreed that I wasn’t ready to try penetration again. I was happy with the progress I’d made and while it was a really big deal to test the theory at some point, it was nice to live in the pain-free-ish, worry-free bliss for a little while. And it was worry-free. Until…

A letter arrived announcing the date of my next appointment with my gynaecologist. I knew exactly what it meant. If I went into that appointment and said “yep, all good, pain’s reduced, periods are lighter, plus I’m handling the acne and mood swings” that my gynae would say “job done” and discharge me – rightly so. Honestly, I felt ready to be discharged. But in the back of my mind, the deadline of this appointment deeply worried me. I needed to test the theory that everything was fixed. I could foresee how upsetting it would be to be discharged and only then discover the horrible deep pain during sex was still there, meaning that if I needed more gynaecological care I’d have to start again, again, again.

Despite the advice of my well-intentioned friends to ‘find a lad’ in order to test my internal mechanics, I knew exactly what to do, or at least, where to go. The Vaginismus Network has hosted a couple of its events at a Shoreditch sex shop called Sh! Women’s Erotic Emporium that has proven itself to be deeply knowledgable about unwanted pain during sex. Months of avoiding this big ominous question but one letter had me on a bus to a sex shop after class. Whatever it takes, I guess.

Sh! hooked me up with a dilator set. These are specially designed vaginal trainers of different sizes, mostly used to treat vaginismus. While I wasn’t specifically treating vaginismus, I was advised that it was the best option for testing the water again, especially since I didn’t know if vaginismus was going to be part of the process or not.

I was so sure it was going to be alright, because (have I said it enough?) everything else had genuinely improved. So I tried the smaller two. No pain, no vaginismus. I stopped there for a week or so, but this really bolstered me. I had reached the dream articulated by Fran Bushe in Ad Libido, I had fixed sex.

And then I tried the third one.

Pain. Pain, pain, pain. Deep, cramping, breathtaking pain. Shortly and sharply followed by a different pain and resistance: vaginismus.

What’s worse, the deep pain didn’t go away. It was like I had just turned my pain back on again, all of it, like a switch. Two days later I vomited up my breakfast because of pain, something that hadn’t happened since I started the pill. And I hadn’t even tried the largest one yet.

Safe to say, I did. And it was agony and pretty upsetting. Not just for that moment but also because it was quite #triggering in ways I did not expect. I must have tried them for two, maybe three minutes. Not long at all. It just made me feel deeply disturbed, uncomfortable and worried by the fact I have had sex with that pain in the past.

As a bonus stroke of discomfort, I currently live with my parents. They were pretty aware of my situation and how much it had improved. So when I was suddenly in pain again I was really unsure how to mention, “oh I’ve been upstairs testing out my vag before I see the gynaecologist on Tuesday!” So I did the very rational thing of saying nothing, becoming a bit of a stroppy teenager and not being a very nice person to live with. Oops. Sorry, folks!

There are lots of things I hate about pain, but up at the top of the list is the exhaustion that comes with it. Whether it’s due to the cause of the pain itself or just by the toll being in pain takes, it sucks. I’ve found the masters draining and challenging, so adding some extra stress, pain and fatigue meant that by the end of term I just felt like a blob of matter floating around. Most of my diary entries from November and December start with “I am so tired,” “I’m fucking exhausted” “bloody exhausted” “you’d think I’d be used to exhaustion by now…” or various uncreative phrases of a similar ilk. I really thought it was just university, but my workload this semester is much bigger and yet I have had so much more energy and I wonder if it has a lot to do with my return to the regular use of painkillers and the fact I’ve stopped using the dilators for now.

I can’t tell you how much I’ve hesitated over writing this blog. At the LSE Gender Department there is a lot of talk of so-called Imposter Syndrome. I’ve certainly felt it there, but I’ve felt it in this respect too – how can I spend so much time writing about sex but feel uncomfortable discussing solo vaginal training? And yet I didn’t want to force myself to write about it. If I felt there was a new line being crossed then I was going to cross it slowly and thoughtfully. But I did want to cross it eventually. The rediscovery of this pain has opened up a whole load of new questions, like was my pain ever hormonal? Did the pill actually fix something or did my pain just improve because more time had passed since the last time I had penetrative sex? The other feeling of imposter syndrome came from the fact I had restarted the pain myself. Should I devalue this pain because I had unknowingly but voluntarily made it worse? These questions haven’t gone away and I think this part of the story is crucial if I’m going to tell the next part. And though it does continue on from the #Periodically blogs, which aren’t going anywhere, I’m going to do so under a new banner: Pleasure Moans.

This blog is already way too long so I’m going to end it here. It’s obviously not the end of this (never-ending) story. I didn’t want this post to be quite so depressing but it is what it is. I promise the second half of this ‘episode’ is more constructive and angry and funny. I’ll try to write it soon, rather than leaving it another four months, but I’m making no promises. Thank you as always for your support, kind words and patience!
February 11, 2019