cystocele, sex, relapse

Hi Judith

Not nice. When you say sex aggravates your symptoms, what exactly do you mean? Which symptoms?

L

Judith, you're 47, aren't you? You are probably into perimenopause.

Currently I will not too surprised if I don't get any more periods. I know that things started changing for me menstrually at about 45, in spite of the fact that my hormone profile was still measured normal. I am now 56, and my reproductives feel pretty quiet. I have had episodes of vaginal dryness on and off in the intervening time, some serious. I have also had vaginal 'rashes' at different times, and it does not seem to coincide completely with having a lot of regular sex. Sometimes it has been thrush, but sometimes not. It often disappears with easing off the sex and using vulva balm and peri balm for a while. There are times when just a finger feels like sandpaper. I am guessing that I would get a medical diagnosis of intermittent atrophic vagina. I have been through times when my POPs have been bad, then got better again. For 12 months or so I would get weeks at a time when they would be low. I would think a period was imminent but it would go on and on, then suddenly get better. I think my body was building up to menstruation then it just didn't happen. Currently the vagina is not too bad, but I have learnt to use lots of Bliss Balm to prevent the initial irritation, ie nipping it in the bud. My POPs are good too, but I am getting more urinary urgency when I have a full bladder, these days. It just keeps changing.

Holey moley, this menopause business is unpredictable! Even cessation of periods doesn't mean it is over. It is just a stage in the overall quieting of the ovaries.

Before you jump into sex again I would be getting some Bliss Balm and using it liberally for all sexual contact. I have also found that I have to specifically ask DH to be very gentle, and take it reaaaalllly slow. That way, the tissues themselves get aroused and plumped up before there is any actual penetration, and they can protect themselves better. Somehow, men don't seem to understand what 'gentle' means, when it is said by a woman. They think it means 'a little bit gentler than full on', where we mean 'so gentle that we can hardly feel it, and are begging for more' Sigh ...

Foreplay is so underrated by men. They can be such impatient creatures! They don't seem to understand that "not yet" does not mean "not ever", nor do they understand that "not yet" does not mean "I am going off the boil", but rather "I am not yet up to the boil".

How do you go with self-arousal? do you get the same irritation? ie Is it him or is it you? What about some self-arousal before you get together? That way your tissues will be halfway there before he even realises the game is on.

BTW, in spite of the fact that it costs a lot more than KY Jelly, I think Bliss Balm is quite economical. A little goes a long way.

Just perservere in any way you can to find a solution to this. I have found that an active sex life has been such an asset during perimenopause. There is nothing that makes me feel more female than good sex at a time when my femaleness is trying to tell me it is very tired and thinks it is going to die, and leave me as an androgenous old grump. No sex is enough to dry me up completely.

I may be way of the mark with these comments. Just ignore them if I am nowhere near. If we can't talk about these things here, where can we talk about them? Email me if you would prefer.

Cheers

Louise

Hi Judith

We must have in-synch menstrual cycles and be in the same stage of shutdown. My dates are very similar to yours. I don't know whether vaginal dryness/vaginal atrophy and their ugly sister, LS resolve. I think I remember Christine saying that the final quietening of the reproductive cycle happens when LH levels finally dwindle away to almost nothing, but that may be ten to twenty years away for us. Who knows?

Your pain seems to be from the rectocele. I can see why you on your back, legs together, may lead to that pain. Think about the mechanics of it. I find that arms above my head works for most of introitus, but towards climax (TMI warning) I want to clench my buttocks which counternutates my pelvis and flattens my sacrum. It might be different for you. Think about what your body does during coitus. Think about the direction of pressure within your pelvic cavity. Think about where DH's penis is directed. Think about where your uterus, and particularly your cervix is. This is real Masters and Johnson stuff.

From what you say, your rectocele gets draggy after coitus. Are we talking evening, morning or during the day. (I can't believe I am asking you these questions either!) Is it OK while you are lying down? Or does it start when you are up and about again? Do you get yourself back into WW posture as soon as you get up? I would also consider staying on elbows and knees for a bit before getting up, or nauli, or firebreathing to allow your organs to reposition before you go about your day.

Come to think of it I sometimes get lower back pain after coitus, but no rectocele pain, or is it the same thing? I think I might contract my lower back muscles too much during coitus. I think I also contract my hammies with the glutes.

Stretching hammies and glutes seems to help alleviate this and gets me back to relaxed WW posture. There are a couple of exercises that alleviate it too. The first is hands and knees, eyes to floor, raise right arm straight to horizontal, along with straight left leg. Hold for 20sec, then reverse. Then lie on tummy and do the same thing, but only lifting the hand and opposite leg slightly, from the hip. Hold 20 secs then reverse. Then kneel and flop forwards, arms straight out on floor, forehead on floor to stretch the lower back muscles. Then onto hands and knees and drop the hips towards the floor, holding shoulders square, to stretch the rectus abdominus. From there, I could probably come up into downward dog to stretch all the muscles down the backs of my legs. Also, for some reason, leg raises, forwards, backwards and to the side also helps. Muscle spasm has always been an ongoing problem for me. It comes and goes.

Other positions to try would be you on top, astride with your lumbar curve in place *and* belly relaxed. If you slide forwards and back, rather than up and down, it may help DH's penis to push all your organs up and forwards, and out of the way. It is very deep penetration. The penis may even go past them, when you think of the length of a penis, compared to the length of a vagina. Without the lumbar curve I would think they would be likely to get direct backwards pressure, right onto the rectum. I am wondering if direct backwards pressure is at the root of your discomfort.

I am also curious about disturbance of the pudendal nerve in a lot of this discomfort we experience. Remember the Pudental Nerve Neuropathy posts? There are branches of the pudendal nerve running all through the area where coitus moves tissues around. When the endopelvic fascia doesn't keep organs where they should be it may be that the disturbance of tissues, and sexual arousal irritates (arouses) these nerve branches.

PNN is often a chronic problem for women who have had hysterectomy and the pelvic area structures are thereafter changed. It can literally lay women out horizontal, 24/7 with no prospect of recovery. They are unable to sit without pain. Standing is best. This is one of the scariest aspects of hysterectomy for me.

The pudendal nerve becomes stretched for some reason, and trapped between two ligaments (I think) up near the sacrum where this nerve emerges from the spine as a single nerve. It branches below the irritation, which is why the pain some women experience is so widely experienced, the branches supplying the labia, the anus or rectum and the bladder(?). Details are hazy as I have not done any reading on this for 12 months or so. You can find out about it at www.tipna.org. The end of the PNN story is that the pain is to do with the irritation from being stretched, and lifting the vulva and perineum would relieve this stretching. This is what we do with WW posture, so I am wondering if what happens during sex is getting in the way of your reestablishing your WW posture afterwards. If this is the case, then exercise and stretching post coitus may be the solution, or a big part of it.

Back to the detective work.

Cheers

Louise

is that it still feels good to do it!
Why don't you try to stay in bed a while afterwards. Then perhaps a nice warm salt water sitz bath?
I have had soreness after sex long before I ever had a baby. I just figured it was normal to sometimes feel that tired feeling after lots of penetration. Then after baby it didn't really happen as much but still did sometimes.
In the early Postpartum period I sometimes ice after sex- I guess it never seemed weird to me- (having in the past been an athlete- my first thought is to treat any soreness with ice) and ice works for me.
So ya
go for the heat or ice and elevate your hips.

Also- you can support your perineum with your hands (and have the added bonus of stroking your partner) during-especially on the pulling out stroke- just apply light pressure all around the introits-
another thing that might help is to have more in strokes than out.
if you go woman on top you can rotate your hips and have a good time and not have a ton of in and out- more like lots of in-
and I promise I am not your mom :)