Vulvodynia and Orgasms

Dear Ask The Doctor: Hi, I've been diagnosed with vulvodynia and have pain if my clitoris is directly touched. Manual stimulation is the only thing that bothers me (oral is fine), but I've been sexually active for 4 years and have never had an orgasm. I often have pain along with pleasure. Is there anything I can do that may take into consideration the possibility of pain yet allow me to be pleasured during sex acts?

Dear Lauren:

Vulvodynia can certainly interfere with your sexual experience and the treatments focus on relieving symptoms. No one treatment works for every woman and you may find that a combination of treatments works best for you. It may take weeks or even months for a new treatment regimen to noticeably improve your symptoms.

Tricyclic antidepressants that may help lessen chronic pain include amitriptyline, desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). Your doctor will need to prescribe them to you.

Biofeedback therapy can help reduce pain by teaching you how to control specific body responses. The goal of biofeedback is to help you enter a relaxed state in order to decrease pain sensation. To cope with vulvodynia, biofeedback can teach you to relax your pelvic muscles, which can contract in anticipation of pain and actually cause chronic pain.

Medications such as lidocaine ointment can provide temporary symptom relief. Your doctor may recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Your partner may also experience temporary numbness after sexual contact. And lastly if your pain is localized, surgery can sometimes relieve your symptoms, however this could be considered the last option. I would suggest you to consult your gynecologist for a more detailed evaluation and guide you with these treatment options.