I had my follow-up appointment with Specialist Doctor this morning. I’ve gotten quite accustomed to the routine by now: Sign in. Validate parking pass. Get blood pressure reading. Step on scale. Enter exam room. Answer the assistant’s questions from her clipboard. Undress from the waist down. Cover self in flimsy paper sheet. Wait for Specialist Doctor. All normal.
So he comes in, female nurse in tow, and asks how I’m doing. I say that I can tell the Botox has frozen some of the inner muscles, but I’m still getting pain around the entrance, a kind of stretching pain. He frowns; this should not be happening.
“How about I check down there and see if I notice anything unusual?” He puts on gloves, and jokes around with the nurse, complaining that the other doctor switches up the brands too much. Probably trying to make me relax a little. He readies his finger, I brace myself for impact–
AUUUGGH. The sting is still there. All around the entrance I’m burning, even though I used more lidocaine before coming in.
“When we did the Botox, I injected a few units near the surface, around the hymenal ring. There’s some studies out there testing Botox’s effectiveness for vulvodynia.” He touches the hymenal ring. It stings. “But that doesn’t seem to have helped.”
More poking around. He’s hitting all the sensitive spots. I groan, twitch, spazz my legs.
“I’m seeing inflammation in here,” he says. “Let me check and see…” He starts doing the poke test. “I’m thinking here–”
OW!
“And here–”
FUCK!
“Yeah, that’s a painful one,” I say through gritted teeth. It’s like he just stuck his finger in an open wound.
After that, he has me do a Kegel test, then slowly inserts his finger deeper. “Okay, so I’m guessing you still have some stiffness — here?”
Yup. His finger’s about three inches in and it feels like he hit the same wall I was hitting earlier. So… it’s not supposed to be stiff there?
Apparently not. Those muscles are another part of the PC muscles, and these ones weren’t frozen by the Botox. Between one and three inches in, I’m golden, but 3+ is still immovable.
“For your next injection, we’re going to go in deeper,” he says, “And inject those internal muscles as well.” He pokes them. They twinge a little, and don’t move. So I guess I’m getting another round after all. No magic cure here.
And what’s going on at the surface, anyway? Is that the vulvodynia?
“I’m thinking you might have lichen planus,” he says, after finishing the exam. “It’s a type of skin inflammation. Normally we don’t see it in women your age, so I didn’t even think to check for it earlier.”
I sigh. “Well, it wouldn’t exactly surprise me to find something else wrong down there.”
He laughs a little, because, well, what else can you do when you realize your patient has no less than three different vulvo-vaginal disorders?
“I’m going to give you a prescription for a steroid,” he says. “A vaginal suppository. Use it for two weeks, and see if you notice any difference. We’ll do another Botox injection in three months, and I’m going to take a biopsy for lichen planus then too.”
He leans back and sighs. “We’ve tried lots of things, but nothing seems to be the ‘straw that broke the camel’s back,’ is it?”
When Specialist Doctor first saw me, he told me that the treatment path would be long, but it would succeed. “We ARE going to make you better,” he said, a year ago. But not this time. This time it’s “We’re going to try a few more things, see how they interact.”
Is that doctor-speak for “I have no idea if this will work, and maybe you’ll always be in pain, for the rest of your life”? Is this “Sex is just never going to work for you, you’re too defective even for me to fix”? If the doctor who specializes in urogynecology disorders can’t fix me… Where else do I go?
Now, I’ve done some research about lichen planus since I got home. It’s chronic, and difficult to treat; steroids are usually the first, and often only, option. On the plus side, it usually goes away within 18 months… But when it comes to vulvo-vaginal disorders, “usually” tends not to apply to me. And sometimes, lichen planus can turn malignant. Cancerous. It’s pretty rare, but when he mentioned taking a biopsy, I couldn’t help but wonder if he’s not only looking for a diagnosis but also making sure I don’t have cancer too.
I was so hopeful, for a brief little moment last night. I was really hoping I might soon be relieved of the dishonorable rank of Defective Woman.
Guess I’ve still got a few more battles to fight.
The Defective Woman 