Savage Love: Vulvodynia, or vulvar pain, is very common and it sucks, but there are treatments and providers who could help you | Columns | Tampa

I am a 29 year old female and have a problem when having sex or masturbating. I still feel an annoying pain, a tingling sensation in my vulva, at the entrance to the vagina, which does not allow me to enjoy it, because the pain is too overwhelming. Unfortunately, this situation caused me to avoid having sex or masturbating so as not to feel this pain. I consulted several gynecologists, but no abnormalities or infections of any kind were found. With the last doctor we also talked about a possible psychological component but, apparently, even at this level everything seems normal. Do you or an expert have any advice for someone with a problem like mine?—Lost and bewildered inside America

“Vulvodynia, or pain in the vulva, is unfortunately very common, and it sucks,” said San Francisco-based clinician, pelvic floor specialist, and author Dr. Rachel Gelman. “But there are a variety of treatment options and providers that could help LABIA.”

Dr. Gelman says it’s good that you’ve already had an infection ruled out as a possible cause. But there are lots of other things that could be going on – nerve irritation, inflammation, hormonal imbalance, something genetic – and she urges you not to give up until you find an answer. And even if Dr. Gelman is too polite to say it, I’m an asshole, so I’m just going to say it: it’s shocking that none of the gynecologists you consulted referred you to a pelvic floor specialist.

“Muscles inside the pelvis, aka the ‘pelvic floor,’ and the surrounding musculature can contribute to or cause the pain described by LABIA,” Dr. Gelman said. “Just as tight muscles in the neck can cause pain in the shoulder, arm, or jaw, a tight muscle inside the pelvic floor can cause pain at the opening of the vagina. A pelvic floor physical therapist , like me, would be able to assess and treat this type of muscle dysfunction, which would reduce the symptoms of LABIA and allow him to regain sexual pleasure.

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But don’t just be referred to a pelvic floor specialist. “Because so many systems live inside the pelvis that impact the vulva, multiple specialists may be needed to investigate and treat potential causes of LABIA pain,” Dr. Gelman said.

So, in addition to seeing a pelvic floor specialist, Dr. Gelman recommends you see a vulvar specialist. (You can find a list of vulvar specialists on the National Vulvodynia Association website: go to and click the link to its “List of Health Care Providers”.)

“A vulvar specialist would be able to perform appropriate tests to sort out what’s going on beyond what a general gynecologist can look at,” Dr. Gelman said. “And it’s important to note that the tissue around the vaginal opening is highly dependent on hormones to stay happy and healthy. Certain medications or medical conditions can impact hormone levels, which in turn can have an impact on the vulvar tissues and lead to pain.There are also underlying inflammatory conditions that could also cause this pain.

And even if you don’t have an underlying mental or psychological health issue, LABIA, the pain you’ve been through—and the resulting sexual deprivation—seems like a lot, and talking to someone about it might help. to reconnect more quickly with your ability to take pleasure in this part of your body again. “The brain is powerful and having vulvar pain or any type of sexual dysfunction can be mentally draining, which can further exacerbate the pain,” Dr. Gelman said. “So a good sex therapist can also be a useful ally here. Ultimately, vulvar pain is common and usually requires a team of providers, but the help is there.

Find Dr. Rachel Gelman online at and via @PelvicHealthSF on Instagram.

I am a young gay man who needs to break up with his boyfriend. I know it, my friends all agree, I even think that’s what he wants. I’ll spare you the complicated details. I just need a push. Maybe if you tell me, Dan, I will.—Just another word

Marry him.

I’m a male in my thirties in Boston. I just got a ghost and want advice on how to deal with it. I matched with a woman online, also in her 30s, and the conversation seemed good and we agreed to meet for a drink. On the day of our scheduled date, I get a text saying, “Hey, I’m having a really bad day and I don’t want this to be your first impression of me, can we reschedule?” It seemed reasonable, so I agreed. Later that week, I asked her what she was doing that weekend. I didn’t receive a response until late Sunday: “I thought I had replied, I’m so sorry!” I took him at his word it was a mistake, and we rescheduled the drinks. The afternoon before our reschedule date for drinks, I texted to confirm where and when we were meeting. We agreed to meet at 7 p.m. At 6:40 p.m. I received a text from her number: “It’s Boston EMS. Gertrude wanted us to let you know she won’t be making the appointment.” I responded quickly, asking the paramedic what had happened and if Gertrude (not her real name) was okay, and the paramedic replied that she was fine and actually more worried about me than she -same. In the evening, I receive a text message from Gertrude saying: “OMG! I’m so embarrassed! I’m so sorry!” She explained that she had had a seizure. I texted her the next day to ask how she was feeling, but got no response.

Here is my riddle. I have no way of knowing for sure if both situations were out of her control (her bad day, her meltdown) and if she’s too embarrassed to answer my texts right now or if she’s asked me twice a problem in a really shitty way and used a health crisis as an excuse the second time around. I would love to hear your comments. I have attached screenshots of our text messages for your review.—Blatant lies or constant kerfuffles


The text messages Gertrude sent you were far less interesting – and far less revealing – than the little photo of Gertrude at the top of them. The woman in the photo is conventionally attractive (extremely: thin, toothy, blond, skinny), and she looks more like a teenager than a woman in her thirties. (Indeed, a Google image search of the image didn’t find a match, but all of the “very similar images” that came up were of teenage girls.) So I’m going to climb a very short, very robust here, BLOCK, and tell you that the person in the photo is not the person you messaged. That’s why Gertrude keeps coming up with excuses to cancel your appointments, excuses that are more and more ridiculous.

I mean, take that paramedic nonsense. Guy. If Gertrude was able to hand her phone to a paramedic and have that paramedic find a particular guy in his contacts and then send that particular guy a message canceling an appointment…then Gertrude was good enough to send you this message itself. And even if texting and canceling dates were services provided by paramedics — and they’re not — asking a paramedic to let a date know you’re having a seizure isn’t not something a person who has a seizure can do because that person has a seizure.

So here is. The issue here isn’t that Gertrude is too embarrassed to respond to your text messages about finally getting together for that drink, BLOCK, it’s that Gertrude is too non-existent to show up for that drink. You probably won’t hear from her again, but if you do, it will be a request for money. I shouldn’t have to say, “Don’t send him money,” but I’m going to say it just in case you really are as gullible as your letter sounds: don’t send him money.

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