The Vaginal Seismograph (Where Physical Therapy Goes High-Tech)

Okay, so I guess, given that I’ve pretty much abandoned this blog for six months, I should give a truly stellar explanation.

… I’ve got nothing. Feel free to insert some rambling here about job-hunting (a spectacular failure, I might add), a vacation in Florida, and beginning to search for our first house. Intersperse that with a heavy dose of depression, administered daily, until a satisfactory level of incompetence has been achieved.

I suppose, to start out with, I should probably catch myself up in the backstory. Next step, the physical therapy.

I’ve did over a dozen sessions of physical therapy between September and December, usually scheduled on the same day every week, so I could request them off of work. (I’m so thankful my bosses never asked what, exactly, those weekly “doctor’s appointments” were for… Though one did ask me how one of my appointments went, and I said, “About as exciting as physical therapy usually is. I’d rather be here.”) It became a routine, an endless, cyclical pattern; a nurse would lead me to an exam room, I’d undress from the waist down and be given a tiny probe to stick in my vagina. After I got that in, the PA-C would come in, make pleasantries (a strange thing to do as my ladyparts were on prime display), and hook up the USB end of my probe into a computer. I would follow a pattern of clenching and relaxing my muscles, in tune to the soft beep from the computer; and the monitor displayed a wavy blue line that rose and fell with my contractions. My therapists were largely just there to record the numbers that this vaginal seismograph spat out.

(I was rather amused to find out that coughing disrupted the whole system, and the blue line would jump off the chart. Apparently coughing causes a vaginal quake. Who knew?)

So in summary, most of my physical therapy didn’t help much. There was one PT, however, who did teach me a muscle relaxation technique that was really helpful, so for those still struggling with vaginismus out there, take note!

Instead of just clenching and relaxing, when you relax, make a fist with your hand (so you make a tiny little tube with your fingers), hold that tube up to your mouth and try to blow through it, as hard as you can. Push all your muscles down and out, even the ones around your bum; use it all to exert as much outward force as possible. This really did help me feel the difference between my default “relaxed” state (which was actually quite tense) and what REALLY relaxing those muscles feels like.

What I found most interesting about PT in general was getting the quantifiable feedback about my muscle tension. I mentioned earlier how neat it is that science enables us to measure that tension in an easy-to-understand, numerical way. I do like math and percentages; I find it easier to reward myself and take pride in my efforts when I see that my muscle tension has decreased from a 7.8 to a 6, whatever those numbers mean. (Hell if I know.) And the last couple of times I went to PT, I could occasionally bring my muscle tension down to beneath a 3, which is the threshold of “normal.”

Of course, those moments of normalcy were brief, little peppery bits sprinkled across a mostly spastic readout. But it’s healthy to take one’s victories where one can.

The Seven-Point Path (for Vaginismus/Vulvodynia Treatment)

Well, seems I’ve been neglecting this blog for far too long, so before I forget again, here’s what happened with the first visit to the specialist. I’m getting closer to catching up to the present day: this particular visit was in May 2011.

Walking into the female pelvic medicine office for the first time was a somewhat surreal experience. It was also on the highest floor of the megaplex, but this side was built like a private doctor’s office, with a flat screen TV broadcasting the weather and 4-foot-high posterboards advertising bladder control treatments and permanent birth control options. I had a choice of magazines between Good Housekeeping, some fancy sports car magazine for the husbands, and The Economist. (I chose The Economist. I’m a nerd.) Probably 90% of the patients in the room were over 50; I felt like my lack of wrinkles signaled that I wasn’t “supposed” to be here. Lots of other women were probably here for the usual post-menopausal problems with incontinence or frequent urination; I, however, had a defect. (I’m very good at feeling singled out, particularly when nervous and in an unfamiliar environment.)

But the moment I met my doctor, I felt hopeful again. He was quick, but intense. He introduced himself as “the doctor people come to when things go wrong.” Before I knew it, he had outlined an intensive treatment plan that would take me in every direction imaginable, from home therapy with dilators and Kegels to office-based physical therapy and “electrostimulation” to pain shots to muscle relaxants to Botox. I couldn’t really process the entire list at once, it was so expansive and aggressive. I started crying in the exam room again, as I’m wont to do when dealing with this condition, and I was shaking and stirring a whole cocktail of emotions together in my brain.

It was still so hard to believe that a doctor was finally taking me seriously. In this case, he was a specialist in pelvic disorders; just being able to see him legitimized my condition as something needing and deserving of treatment. But at the same time… Legitimizing the condition also forces me to accept that I DO have a problem, and it’s a difficult one, one that I can’t simply ignore and hope it will go away. This particular thought process is probably familiar to many vaginismus and vulvodynia sufferers out there; I don’t doubt that it’s a common part of the recovery process. Some days I want to hide it, and pretend that nothing is wrong with me; other days I want to fight it for hours on end until my entire body is slack from exhaustion, and neither of those routes are going to get me where I need to be.

What was needed, according to Specialist Doctor, was:

• Purchase a set of silicone rubber dilators (“Throw out your plastic ones,” he said, “don’t ever use them for dilating again, they’re horrible”), and dilate with them for fifteen minutes, twice daily;
• Apply a topical lidocaine ointment twice a day, as well as five minutes before every dilation, to dull the nerves;
• Kegel exercises, done 4-6 times daily, to strengthen the muscles
• Administer a local lidocaine injection, under anaesthesia (also for dulling nerves);
• Physical therapy once a week, which would involve electrostimulation (to relax the vaginal muscles);
• Potentially taking a prescription strength muscle relaxant, which would also have antidepressant/anti-anxiety effects;
• Local Botox injections in the vagina (to freeze the muscle spasms).

No pressure.