Remember that iconic episode of Sex And The City where Charlotte York talks about having a depressed vagina? More recently, Ilana Glazer raised attention to another vagina-related issue in season four of Broad City when a sex therapist made her realize that she hadn't orgasmed ever since Donald Trump was sworn in as president. A few weeks ago, the concept of having a depressed vagina popped into my head again while I was listening to Tove Lo's sex-positive album Blue Lips, and thinking about how my own vagina has experienced happier days in the past. So is the whole depressed vagina thing a myth or is it actually a real thing that can be cured?
According to Dr. Rachel Gelman, the branch director of Pelvic Health and Rehabilitation Center in San Francisco, California, there's no such thing as a depressed vagina because depression is a mood disorder, but having pelvic pain or sexual dysfunction can certainly cause depression. "A person may report decreased vaginal sensation, lack of sexual appreciation or low libido," she says. "All of which can be addressed by a healthcare provider."
The closest thing to a depressed vagina is a condition called vulvodynia that is often treated with antidepressants because it diminishes some of the pelvic pain. People that are diagnosed with vulvodynia experience pain in the vulva that can be caused by an infection, inflammatory process, trauma (i.e. surgery or childbirth), hormonal imbalances, neurologic dysfunction or anxiety. There is even a society of doctors committed to raising awareness about patients with these issues through clinical investigations and research called the International Society for the Study of Vulvovaginal Disease (ISSVD).
We spoke with Dr. Gelman to learn more about this complicated condition and find out why vulvodynia continues to be misunderstood. Scroll down, take some notes and most importantly, take care of your vagina.
What are the symptoms of vulvodynia? How is someone officially diagnosed with the condition?
Symptoms will be pain in the vulva. It may be constant burning pain or pain when inserting a tampon, dildo, finger, etc. A patient may be diagnosed based on her symptoms and medical history. Lab tests may be performed to rule out an infection. The provider may perform a Q-tip test where they use a cotton swab to apply light pressure around the vulva and have the patient rate pain levels. A visual examination of the vulva is often performed. A physical examination to palpate the muscles of the pelvic floor may also help confirm the diagnosis.
Why is vulvodynia often associated with depression? Is it solely because of the antidepressants?
Apparently that Sex In The City episode where Charlotte was prescribed antidepressants for her pelvic pain and told her vagina was depressed made a huge impact because that idea of a depressed vagina has stuck around! Many women may be depressed and have vulvodynia. The two may not go together, but it's not surprising that having chronic vulvar pain might make someone depressed. Yet, someone may be depressed and not have vulvodynia. Tricyclic antidepressants may be prescribed as a treatment option for patients with vulvodynia based on how this medication modulates the nervous system which may decrease a patient's pain.
What are some common misconceptions about vulvodynia?
Many women think having vulvodynia means they will always have symptoms or be unable to have sex again. This doesn't have to be the case. There are many treatment options that can help women live with less symptoms, if not pain free and be able to engage in sexual activity.
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What treatments do you recommend for people with this condition? Is it curable?
It depends on the cause, yet most people need a multidisciplinary team and usually treatment is not one size fits all. For instance, one woman may need to address musculoskeletal restrictions through pelvic floor physical therapy and use topical hormone creams to address hormonal imbalance and take pain medication. However, another woman may need to address dietary factors, work with a pain psychologist and use a topical anesthetic.
Pelvic floor physical therapy is usually a first line approach as it is a conservative treatment method, and often patients with vulvar pain present with some form of pelvic floor dysfunction, however pelvic floor PT may not be the only treatment that a patient needs. Most patients require more than one provider and require an individualized treatment plan. It is important to choose a treatment plan based on the cause of a patient's symptoms, and there may be several factors involved in a patient's presentation.
Depends what you mean by curable, it is absolutely possible for a patient to be symptom free. However, there can be many factors involved that may mean a person still has symptoms, but they can definitely be given tools to help them manage the symptoms.
In your expert opinion, if someone isn't actively engaged in sex does that mean that their health is any better or worse off?
If someone isn't engaging in sex because of pelvic pain or another symptom and they WANT to be sexually active, then I would say that's a problem. I think engaging in sexual activity is a personal decision. if someone isn't having sex because they don't want to be or they aren't partnered or for whatever reason then I think that's fine. If someone wants to have sex, they should have sex--with a condom/protection obviously! Unless their level or lack of sexual engagement is somehow limiting them and/or affecting their life negatively then I don't feel that it warrants concern. Also, important to remember that many people have happy sex lives without engaging in penetrative intercourse.
Anything else you'd like to add?
If someone is suffering from vulvodynia/pelvic pain there are providers and treatment options for them. They can get better. If they have been told they're "crazy," that their symptoms are "in their head" or they feel dismissed by their provider, try to not feel discouraged because there are clinicians who will listen and can help!
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