Vulvar Vestibulitis/ Vulvodynia & Natural Birth

[kat.c.stevens]

Hi everyone,

I am 16 weeks pregnant with my first baby and was just diagnosed with Vulvar Vestibulitis. I had it mildly before pregnancy but now it is much worse- so that even a Q-tip touched to my vaginal opening is painful, and sex is REALLY painful. There is not a lot of information online about this condition, much less about how women with this condition manage to give birth vaginally, so I am hoping someone out there can help.

I am committed to having a drug-free birth (at a freestanding birth center that does not offer drugs) and plan to use a tub for as much time as possible. Does anyone have personal or even second-hand experience with natural birth despite this condition? What was the experience like? What did you do to cope with the pain? I am mainly afraid of the "ring of fire" that women without this condition describe as the sensation that accompanies crowning. If it's painful for even a normal woman, what can I expect to feel?

Thanks in advance. I am in real need of encouragement right about now.

[NSmomtobe]

Ooh, I'll join you in this thread, but I am also expecting my first baby. I am at 34 weeks though, so I'll let you know how it goes when the time comes.

I actually had my vestibulitis under control before I got pregnant, but of course I stopped taking my medication due to pregnancy. I have only had sex 3 times during this pregnancy (all in the 2nd trimester) and it was very painful. I'm going to start doing perineal massage this week, which sounds painful, but I'm hoping it will be okay and help me build confidence.

[helpmeet]

I gave natural birth with vulvar vestibulitis!

Hi Kat,

I just saw your post when I was searching for support groups for VV.

Let me just encourage you first, that I gave natural childbirth with Vulvar Vestibulitis (are you taking a breath of fresh air?).

I was not diagnosed until well after the birth actually, but I have had the condition since we got married and became sexually active. Sex has always been (at times, excruciatingly) painful without much relief from different treatments. I finally was referred to a specialist who diagnosed my VV (the q-tip test like you were talking about... owweee). I have not yet found a great treatment, but now I am considering holistic options (low-oxalate and candida diets) because the traditional medical approach hasn't worked.

You said, ""I am committed to having a drug-free birth (at a freestanding birth center that does not offer drugs) and plan to use a tub for as much time as possible. Does anyone have personal or even second-hand experience with natural birth despite this condition? What was the experience like? What did you do to cope with the pain? I am mainly afraid of the "ring of fire" that women without this condition describe as the sensation that accompanies crowning. If it's painful for even a normal woman, what can I expect to feel?""

Here is my encouragement to you: you can do it! Natural birth, I mean. I had decided to go vaginal and natural and am so glad that I did. I prepared like any non-VV person would, and it went well. Yes, it hurts... but that's childbirth! Of course I have no other experience with which to compare mine, but mine was definitely doable. I loved my experience. I will hopefully go natural again whenever we have #2!

Coping measures: for me it was mainly the tub (I labored at home for the most part and went to the hospital the last hour). I used the Bradley methods of relaxation and sought to completely relax through each contraction, allowing the body to do its work.

What you can expect to feel: You will feel pain, but it is a different kind of pain. It's a productive pain. Each pain brings you one step closer to seeing your baby (!!!) so it's doable. Expect transition to be very difficult but know that it is short. At the end, you will feel worn out. When it's time to push the baby out, you will feel it but it will also be a blur. Part of the beauty of natural birth is that you will feel your child come out, and also, you won't be able to wait (some women with epis are forced to wait for crazy amounts of time for their doctors, when their babies are sitting right there and ready- talk about sore!). It definitely hurt, but the pushing phase was so short in comparison to the rest, I do not think it was the hardest or most painful.

Prep: I would encourage you to do the perineal massage like NSmomtobe suggested. It was painful, but I used it as practice for labor by trying to relax as much as I could through the stretches. The perineal massage will also help prepare your pelvic floor muscles and hopefully aid in preventing tearing. Also, a large part of natural birth is mental. You will need to do some prep work to combat the fear that you are feeling (fear makes pain worse as I'm sure you already know). For me it was all about trusting the Lord completely.

I do hope this is helpful. Please let me know if I can be of any help to you during the process. You can do it.

Blessings on both of you and your new additions!
Sarah

[kat.c.stevens]

Thank you!!!

Sarah,

Thank you SO MUCH for your kind and detailed reply! I am greatly encouraged by your successful natural birth and I feel a lot better even now. I am aware of how fear can exacerbate pain, although I don't yet know techniques to deal with it. My Midwife gave me a book to read on Hypnobirthing and I plan to take as much as I can from it. I am also trying to read as much as I can to know what to realistically expect, so I can try to work with my body rather than freaking out about what it is doing during labor.

About the Perineal massage, is that done by me, by my husband, or by an actual professional? I guess I just don't know much about it, but I would be willing to try it. I've also been trying to do Kegels, although I don't think I am too good at them yet! I assume that also will help?

I am glad to hear that laboring in the tub helped you, since I plan to use one. I would like to deliver in the tub, too, which could help during pushing, right? I just cannot tell you how grateful I am to know that this is not only possible, but can be empowering just like any other (non vv) natural birth.

One more question, and this is for either you, Sarah, or NSmomtobe: Did you ever try using lidocaine topical gel for pain during sex? I was given some to try by a specialist and I would like to see how it works. I just really hate the thought of going the rest of this pregnancy without sex- both for the impact on myself and on my husband, who has been so patient with all of this. Thanks again so much for your kindness and willingness to share!

If I don't hear from you before then, have a wonderful Thanksgiving!

~ Kathryn

[kat.c.stevens]

NSmomtobe- I am glad to know I am not alone and that we are in this together. Thank you for being so open about your experience, too. This can be a difficult thing to talk about and not many women open up about this type of pain.

How has the perineal massage been going? Is it something to start only later on in pregnancy?

[helpmeet]

Hi Kathryn, I'm so glad that you were encouraged. We all need that encouragement, as there is much fear (mostly of the unknown!).

Yes, Kegels are great. I honestly did not do them, and I will definitely do them next time. I think that would have helped tremendously.

I would also do perineal massage earlier than I did (I was in the third trimester). I'd have to look that one up, but I'm sure it's safe throughout pregnancy. Personally, I had my husband do the massage. I used it as an opportunity to relax through pain (practicing for labor). It was good for my husband, made him feel like a part of things I think. My doctor recommended using pure almond oil, and I had hubby use gloves just to be safe. I am sure you can find good resources on that on the internet, but if you need more help, I'm happy to help!

Good for you about wanting to work with your body. That is so key, no matter which coping mechanisms you end up using. Just knowing that your body is doing a natural thing, that you need to relax and let it happen-- I think this is the big difference maker!

I tried the lidocaine, and it helped for a while. I hope it will bring you some relief; I figure anything is worth a try!! Sex is so important in a marriage! The lidocaine worked well in conjunction with high arousal, relaxation, etc. Right now I am trying to cut some things out of my diet to see if I have a food sensitivity (right now I am attempting a low-oxalate diet, something recommended by the Vulvar Pain Foundation; after that, I will explore the Candida diet if I need to). I am attacking the problem holistically since I have not gotten anywhere with my medical doctors. I will let you know if I find anything promising!

I am excited for you both! I loved natural birth so much! It makes me giddy when I see that others are interested in it! Keep me posted and let me know if I can help. Blessings on both of you! And Happy Thanksgiving .

[nashvillemidwife]

I have severe VVS. I don't think the ring of fire is going to be any worse, in fact that specific moment may not seem as intense to you as to most women since you have been living with that sensation every day. Also, it is indeed just a single moment or two, and then it's over (and for many women the symptoms do not return after they have pushed a baby through there).

I absolutely would not do perineal massage. I'm not a proponent in general since I don't believe it really reduces the incidence of tears. The real benefit is in helping you to focus on relaxing that area, and in the case of vestibulitis it is only going to cause you undue pain that may make things even worse.

I'd be happy to discuss it with you further if you want to pm me.

[nashvillemidwife]

Originally Posted by kat.c.stevens

One more question, and this is for either you, Sarah, or NSmomtobe: Did you ever try using lidocaine topical gel for pain during sex? I was given some to try by a specialist and I would like to see how it works.

I use topical lidocaine regularly, regardless os sexual activity. In times of severe flares I have also done lidocaine injections. One of the treatments I've tried was a series of weekly injections of a lido/anti-inflammatory mixture. I've also been through PT, atropine/estradiol creams, and capsaicin therapy (makes it burn so bad it kills the nerve endings; it could be curative but unfortunately I've never been able to withstand the treatment). The only thing that has ever brought me real relief is large doses of Neurontin (gabapentin).

[mi_amor]

I have also had this problem off and on since I was married and became sexually active. I was worried about giving birth as well because I wasn't able to have sex the whole time I was pregnant because of the horrible pain.

I laboured at home in the bathtub, and then a warm shower which was very helpful for me. I didn't experience the ring of fire, which was great.

I wasn't able to have sex until almost a year after I had my DS. However, I learned that I became sensitive to the contraceptive method we were using (lubricated Durex). I also found most lubricants really made things worse to the point that I could not have sex.

Things have improved now though, although I do experience some pain initially and then it goes away. (I hope this isn't TMI).

Interestingly, my accupuncturist told me that accupuncture would really help and that women in Asia sometimes have accupuncturists there when they give birth to relax their muscles. I was too chicken to try it, but if I continue having this problem, or it gets worse, I might try going to a female accupuncturist to try it.

[NSmomtobe]

Well, I see there are a lot of different opinions and perspectives in this thread, which goes to show that this is by no means a consistent condition--what works for one does not work for everybody.

Lidocaine: Yes, I have used this for sex, and it did not help me. I don't remember the details, because it was 4 years ago, but it could have been because the dose was too low (2%?) or because we had to use condoms in order to ensure that DH was not frozen as well, and condoms always made things worse for us. In any case, I didn't use it for very long before I stopped using it entirely. But obviously it does work for some people.

Kegel exercises: I believe these are a good idea for both pregnancy and vvs. However, I remember my vvs doctor being concerned about making things too tight (strengthening the vaginismus reaction) and told me to focus on "reverse kegels" (I just looked up this term and all I can find are articles on men's sexual health) but my understanding was that it is important to focus less on tightening the muscles and more on relaxing them. Tighten to feel them, and then push down and breathe out so they are fully relaxed before repeating.

Perineal massage: This is something that is typically done later in pregnancy (my doula recommended 34 weeks), although as helpmeet said, it probably wouldn't hurt to start earlier. I was scared, so I put it off until a few days ago. I went out and bought vitamin E oil, as that was one of the recommended types, but I find it very sticky, like honey, which was not comfortable for me, so last night I just used my regular vaginal lubricant instead. I felt it was important for me to do it myself at first, so I could be in control, and for me it is about building confidence. Naturally, it hurt a little, but with breathing and relaxing my muscles it was quite bearable. Once I get used to it, I might have my partner do it for me so I can practice letting go of control, and some health care providers will do it during delivery to help relax the tissue and prevent tearing (although the effectiveness of this is unproven, as nashvillemidwife pointed out). Talk to the person doing your delivery if you want this done (or absolutely do not want it done).

Also, I have heard anecdotal evidence from a few women who said that their vvs symptoms went away completely after a vaginal birth. Although it is certainly not the case for everyone, I just wanted to throw out that bit of hope.

[kat.c.stevens]

Thanks NS, for the tip about reverse Kegels! That totally makes sense and I definitely will focus on relaxing the pelvic floor muscles now, although it's difficult at first. I, too, think I would appreciate the mental practice perineal massage would provide, even if it does not physically help the tissues to prevent tearing.

I am glad that you have gleaned new information and (I hope) confidence from this thread, as I have. Any more women who want to reply or have experience with VV are more than welcome. The more input, the better!

[kat.c.stevens]

Mi amor~ I have heard about Acupuncture being helpful in long-term treatment of VV, but was not sure if I should try it. I am glad to hear you have heard of it, too. I will have to investigate that a little more seriously now...

[mi_amor]

Kat~ That is really interesting you've heard about Acupuncture helping this too! I haven't looked into researching this more, but now I am very curious.

[JENinOR]

I was diagnosed with vestibulitis a few months ago. I have read, read, and then read some more. I'm doing several things.

1. I'm getting an allergy test. Food allergies manifest themselves
1 of 2 ways. Skin stuff such as eczema and hives or internally with inflammation in pain. My vestibulitis diagnosis led me to discover that I also have Fibromyalgia with the classic tender points...more inflammation. I believe a lot of this is all food allergy related and will find out soon enough.

2. After finding out allergies and being off them 3 weeks, If I'm still having issues I will take the 6 weeks of diflucan my Naturopath prescribed. I don't want to do an anti candida diet diet the rest of my life...I want to be rid of yeast. I am the most natural person you will EVER meet, really, truly, but I am convinced by my research that Diflucan is the way to go. Read this if you suspect candida. http://www.endfatigue.com/health_art...vergrowth.html
I read of one woman who suffered from vestibulitis for years it was GONE after a few days of prescription antifungals.

3. Pelvic floor therapy with a therapist is my last resort and has helped soooo many women.

If you have any question please pm me or ask here. I would be happy to help further if I in any way can.

[chandasz]

I was diagnosed with this a couple years before DD1. I have since had 2 fantastic natural births with no issues and the sypmtoms are GONE.

Best wishes. I know how awful and painful this is

[JENinOR]

Originally Posted by chandasz

I was diagnosed with this a couple years before DD1. I have since had 2 fantastic natural births with no issues and the sypmtoms are GONE.

Best wishes. I know how awful and painful this is

Glad to hear your all better!! Did you do anything to help the healing process? Sometimes VV goes away on its own. Other times, women suffer for most of their lifetime with it. Hubby and I haven't been able to be intimate for 5 months and the year before that sex was SO painful it wasn't really worth it for me. For us as a healthy, sexually active couple the VV nightmare has been extremely FRUSTRATING!!! Sorry for yelling, but honestly, that what I feel like inside when I think about it.

[kat.c.stevens]

Hi Ladies,

Just an update from me on something that is making things better in the sex/ pain department. Partially as preparation for birth and partially as a coping method for VV, I have been trying to focus on my breathing and muscle tension during sex. Since my belly is getting in the way now, we tried sex with me on top, which I usually don't like. This time, though, I noticed that the VV pain was more manageable, probably because I was the one controlling the movements and pressure. (Sorry if this is TMI, but they are important details!- lol!) I am pretty sure this was a case of mind over matter, but even the thought that this improved things was a great encouragement. The pain of sex itself was still pretty strong, but not like I wanted to cry. And instead of lingering for over an hour after sex, the pain was gone immediately afterward this time.

I don't know if this will help any of you, but I hope it does. On another note, we just decided to do a home birth in our own tub, which is great news on the pain topic for me. I am hoping that by being in a familiar place for labor and birth, and being in water, I can minimize the pain as much as possible.

[NSmomtobe]

Hi Kat,

I have been reluctant to come back to this thread as I was somewhat traumatized by my delivery, but I am coming to terms with it now and I hope my experience can help you.

First of all, not related to delivery, I forgot to mention that I really think that taking fish oil (omega-3) has helped me with pain during sex. I don't know if it helps with tissue elasticity or lubrication but I do know that my pain decreased when I started supplementing and it got worse when I temporarily ran out. You are probably already taking omega-3 during pregnancy, but i just wanted to mention it. (I started taking it before pregnancy.)

Anyway, as for my labour, I had no problem whatsoever dealing with the contractions without drugs. I'm not actually sure when I switched into active labour, as I had contractions for 2-3 days that never seemed to get consistently close enough or intense enough to have me admitted to the hospital. my doula says that because my labour was slow to start/progress, my body was able to keep up very easily with natural endorphin production. Contractions were uncomfortable, but not painful. I just concentrated on breathing through them and I expected them to get worse, but they didn't.

Then I hit transition, where I felt like I had to poop really badly. I ran to the bathroom and felt my whole body bearing down and nothing coming out. I knew then that there was more going on. At that point, I was checked and told I was 8 cm dilated and I was rushed to the delivery room, where I was told not to push until I was fully dilated. This was hard for me, as my body seemed to be pushing, so the nurse actually helped pull my cervix the rest of the way back so I could. At this point, 3 different nurses had put their hands inside me, and it was uncomfortable--painful, even--but not unbearable. I was just so relieved to be allowed to push.

This is where things took a turn for the worse, however. The nurse on duty told me that I wasn't pushing properly and I would have to push longer and harder to get the baby out. I said that I wasn't ready for that yet--I wanted to follow my own urges--and I wanted to go slow so I wouldn't tear. my doctor had told me that controlling the speed of delivery is the number 1 thing that can be done to prevent or control tearing. Also, I was under the impression that you are supposed to pause from pushing when you feel the ring of fire in order to give your body a chance to stretch. The nurse told me that I needed to push through the pain and that "most first time mothers tear and trust me--it will heal." I knew that this was not the attitude I was looking for in the delivery room, so I said I wanted to wait for my doctor to get there. The nurse said that my doctor would have plenty of time to get there and didn't want to be there for the pushing part, and that I had to follow lead, which was to hold my breath, grab my legs, and push through the pain. teI really resented it, but it has been suggested after the fact that my son might have gone into distress if I hadn't pushed him out when I did.

The ring of fire stung up to my clitoris, which I wasn't expecting. It was a weird sensation, since I felt like I was pushing from my bum rather than my vagina, but it was my clitoris that really hurt--not at all what I was expecting. But I was coached to push through this, rather than giving my body time to adjust. And then he was out and then my doctor arrived (after the delivery) and said, "That baby must have shot out of there like a rocket" and then I had to endure 90 minutes of stitching for my second degree tear, and that was truly the worst part of the experience because I just wanted it to be over and the stupid local anesthetic didn't seem to be working, so they gave me gas to inhale as the doctor worked, and that just made me dizzy, and my dh held my son because I wasn't able to. It was all very frustrating.

But afterwards, I talked to my doctor about the tearing, and she said that because I tore up the sides of my vagina and into the labia, it took the pressure off my perineum, which only required 3 stitches. Normally, that's the part that takes the most damage, and it's kind of surprising, given my history, that it took the least damage. It's been almost 3 weeks, and I am starting to feel better physically, so I will get through this and you can too. I guess I will let you know how the sex is if we ever get around to doing that again. It won't be for a while anyway.

[kat.c.stevens]

Hi again NSMom (not "to be" anymore!),

I am so sorry to hear about the trauma of your birth! And don't worry, I am able to draw from your story what I hope will help me when I get there, rather than just getting discouraged.

I have never heard of the tearing you described, nor of the pain reaching all the way up to the clitoris, but I know it's good to be aware of all that can happen, and I really appreciate your honesty. I have been taking Omega 3's and I have also noticed my VV symptoms easing as I passed the halfway point of this pregnancy. As counter-intuitive as it sounds, it has helped me tremendously to apply direct pressure to my perineum during sex. From what you said, it sounds like the perineal massage you had been doing really did help to avoid more tearing in that area.

I look forward to hearing updates from you once your body has had more time to heal, and I really value your post. Thank you for sharing all of that with me. I hope my experience, being at home, and in water, will go a little slower (and thus be less traumatic), but I know I cannot control the situation any more than you could. That nurse of yours makes me mad, though!

Hang in there- at least that part is behind you now!

[NSmomtobe]

Yeah, I think if you can figure out the proper way to push, that would be most effective. I didn't really know ahead of time and I wasn't coached effectively during the delivery (I trusted that my doctor would help me, because we had discussed it, but she didn't make it in time and my doula really didn't help). But the way I tore was different from most people. I don't know if that had anything to do with my vestibulitis, but I doubt it. Good luck to you!