The Patient: Sara, a 43-year-old attorney and mother of one.

Why she came to see me: Following an unexpected divorce after the birth of her daughter, Sara deliberately chose to be single and celibate for three years—she wanted to focus on her career and child, and to take the necessary time to grieve her marriage. But when an attorney named Seth joined her firm, they struck up a flirtation that led to four months of courtship.

When Sara walked into my office, they’d been intimate but had had sexual intercourse only once. “It was dreadful,” Sara said. “I love him, and I see a future with him, but the sex itself was excruciating.” Pelvic pain during intercourse was accompanied by burning, stinging, achiness, throbbing, and a feeling of being “raw.” A self-described “problem solver,” Sara was determined to seek out natural help not only for her relationship with Seth but also, and most importantly, with herself.

How I evaluated her: Sara and I began with a candid discussion about sex and her overall health. Prior to her pregnancy, she and her ex-husband had relished a robust sex life. After their daughter’s birth, however, she found herself turning away from him. Stretch marks, a “sagging belly,” residual weight gain, and new-mom fatigue made her feel far from desirable. Moreover, she’d had a grueling labor—so much so that the mere idea of intercourse filled her with anxiety. When she and her husband did have sex again before their separation, it was agonizing. While certainly not the reason for their unanticipated but amicable split, Sara had become fearful of sex ever since, even admitting it may have been one of the reasons she shunned the idea of dating.

Outside of the bedroom, Sara was in terrific health: She practiced yoga daily, went on long hikes, swam, and played in the park with her daughter. Sara rarely drank, and followed a nutrient-rich, flexitarian diet. In addition, her menstrual cycle had returned to normal two years earlier.

To rule out any underlying health problems, I ordered a full gynecological exam and a urine test. In particular, I wanted to test for a UTI (bladder infection), ovarian disorders and cysts, a yeast infection, sexually transmitted diseases, and cervical dysplasia (abnormal cells that grow on the cervix and can become cancerous). When these tests came back normal, I also ordered a 24-hour urine collection test to evaluate for oxalates.

What my evaluation revealed: To our relief, most of Sara’s examinations came out clean, but my inability to see a blatant reason for her pain was indicative of a pervasive problem. Pelvic pain—which can be experienced in the vulva, vagina, or anywhere else in the pelvis—can be difficult to diagnose or treat. Solving pelvic pain can not only transform one’s sex life, it can also unburden one’s libido and encourage well-being.

Given the symptoms Sara described, as well as a vaginal exam that revealed slightly inflamed, swollen tissues (though no latent signs of tearing from childbirth) and the high levels of oxalates in her urine, I suspected she had vulvodynia—a rather elusive pain syndrome, characterized by irritation, tenderness, burning, and painful intercourse, that may affect as many as six million women worldwide. While the cause of vulvodynia remains inconclusive, researchers list possibilities that range from frequent antibiotic use to trauma—like the arduous delivery Sara experienced.

How we addressed her problem: To take Sara from pelvic pain to pelvic pleasure involved a multi-pronged approach…

  • Removing possible irritants. I encouraged her to switch her chemically-laden detergent to an all-natural, perfume-free brand, and to use soft, unscented toilet paper to minimize the risk of irritating her her vulvar and vaginal tissues. Likewise, I advised her to start using chlorine- and perfume-free tampons and pads. Since she both swam and worked out regularly, I asked her to remove wet or damp clothing (such as her swimsuit and yoga pants) immediately after use, and to start wearing all-cotton underwear. Further, I suggested refraining from using bubble bath, which can intensify symptoms.
  • Low-oxalate diet. The late Clive Solomon, PhD—a researcher specializing in vulvar pain—discovered that many women who suffer from vulvodynia (VVD) secrete, like Sara, high amounts of oxalates in their urine. (Whether oxalates are a cause of VVD or simply aggravate vulvar tissue that is already irritated is not known.) Oxalates are commonly found in many foods we ordinarily deem “good” for us: leafy greens, soybeans, wheat germ, leeks, green peppers, beets, sweet potatoes, berries, and peanuts, to name a few. If one’s vulvar tissues are unhealthy, oxalates can generate irritation, histamine release, and pain.
  • The right supplements. I recommended that Sara take 200 mg of calcium citrate three times a day, as calcium citrate can reduce the effects of oxalates in the body, making it more difficult for them to irritate one’s tissues. Her supplement protocol also included taking 250 mg of N-acetyl glucosamine (NAG) twice a day to strengthen the connective tissues of her vulva. I also urged her to begin taking a probiotic to encourage more “friendly” gut bacteria. Intestinal problems can exacerbate—even create—oxalate sensitivity.
  • Physical therapy. I advised Sara to work once week with a therapist who specializes in women’s pelvic pain. In addition to muscle and soft-tissue release techniques, the therapist also did biofeedback with Sara to help her strengthen and release the muscles of her lower pelvis.
  • Vaginal steam baths. Traditionally used in Korea and parts of South Africa, vaginal steam baths can loosen and relax one’s pubococcygeus (PC) muscle, promote increased circulation (always a boon for better sex), and may allow for easier penetration during intercourse for those with pelvic pain.
  • All-natural lubricant. To encourage delightful, pain-free sex, I proposed trying a product such as Aloe Cadabra, to both replicate the effects of Sara’s natural lubrication and to hydrate her vulvar and vaginal tissues.
  • More foreplay. Abstinence can change a woman’s sexual response time (in short, extra arousal may be needed).
  • Talking openly about sex—and more. I gently encouraged her to communicate with Seth to nurture their relationship as a whole. For as helpful as my suggestions might have been, there is no greater aphrodisiac and pain reliever than a loving, solid, and honest partnership.

The patient’s progress: Taking her sexual health into her own hands proved to be hugely beneficial to Sara. Within two weeks of starting our treatment plan, she returned glowing from head to toe. Changing her diet had not only mitigated her pelvic pain but it also led to smoother skin and smoother digestion. She found vaginal steam baths particularly calming and nourishing, allowing her much-needed time to focus on her body’s needs and wants (her favorite bath-enhancement was rose essential oil—a fitting choice, given that rose can bolster feelings of safety and self-esteem). As for sex—and her relationship with Seth? “It is so much better,” she said, “most likely because I’ve never felt so empowered.”

To learn more, visit Dr. Laurie Steelsmith’s website,, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.

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