Confused by Diagnosis

[nyc1459]

Many thanks in advance for your help!
I am a 27 year old healthy female, never had an STD before and was tested within the past year.  Have only had sex with monogamous partners prior to this month, all long-term relationships.  On New Year's Eve I met a guy-a friend of a friend-and we ended up having protected sex that night, during which I realized that he was by far the largest partner I had ever had and since I had not had sex for about 4 months (have been single for a while) I was not surprised when it hurt (I am also very petite in general and am often really tight when first having sex).  This new partner stayed in town for several more days, during which we had sex about 7 more times, some of them unprotected (I know-bad decision on my part).  The pain during sex became increasingly worse from day to day, which I just attributed to soreness, my partner's size and irritation and figured it would go away within a few days.  The last time we had sex was on 1/4, and it actually was so painful I had to have him stop.  I thought that perhaps I had caused a small cut or tear due to all the friction, which has happened before with another partner.  3 days later I was still in a lot of pain and thought i might have a UTI so I tried to go to my doctor (all booked) and ended up at the STD clinic in my city.  I had not seen any blisters or lesions around the outside of my vagina, but like I said it felt like I had rubbed myself raw, so to speak, inside the labia, near the top of the vagina.  The doctor said that i had a very shallow blister spot inside the vagina that looked like herpes (i freaked) and did a culture test right then as well as other STD tests with bloodword (all negative). The doctor said when he got the culture results back that he did not see "the type of cells that we like to see when diagnosing herpes" (not sure what that really means), but he gave me Acyclovir which I have been taking 3 times a day for 2 days now.  He did say that the cultures they took to check for a yeast infection came back with high yeast counts so he also treated me for a yeast infection (just monistat).  Am feeling much better now, far less pain but like i said there aren't any readily visible sores to check to see if they are scabbing over or anything.  About 3 years ago i also thought i had herpes because of painful sex with my boyfriend at the time but my doctor told me then that it was just "honeymoon syndrome" (we were long distance) and that i was not lubricated enough and had irritated myself during sex.  Do you think this might be the same thing or is it more likely to be herpes?  I will try to get to my "real" doctor for a blood test soon but wanted a 2nd opinion.

Thanks! I have been freaking out a bit...

[H. Hunter Handsfield, M.D.]

Despite your excellent description of the situation, I cannot accurately judge between herpes, trauma of sex, and other possibilities like yeast infection.  It sounds like your STD clinic doesn't do cultures for herpes simplex virus (HSV), but relies on the Tzanck test--looking under the microscope for cells that suggest HSV infection.  It's a lousy test, and a negative result doesn't mean much; you could easily still have herpes.

For herpes:  most common cause of genital ulceration and pain; apparently the provider saw a blistering lesion; improvement on acyclovir.  (But the improvement could be due to thhe Monistat if you have a yeast infection.)  Against herpes:  association with trauma as an obvious potential explanation.

Your plan for blood testing is the way to go.  It would be good to have a test quite soon, which you might expect to be negative (for HSV-2) even if herpes is the explanation.  You would then need a follow-up test in a few weeks to see if it becomes positive.  (If you wait and have only a single test and it's positive, you won't know for sure whether you were infected recently or sometime in the past.)

In addition, you should speak with your partner. Absence of a history of genital herpes won't mean much, because many infected people are asymptomatic and don't know about their infections.  But if it turns out he has had it, or any past suspicion of it, that would obviously be a clue about your diagnosis.  If there is any doubt, he could have a blood test as well--and he definitely will need that if herpes turns out to be your diagnosis.

Bottom line:  If I had to guess, I think herpes is less likely than the trauma and irritation of sex--partly because that has happened before.  Penis size probably doesn't have much to do with it; I'm more suspicious about quality and quantity of lubrication.  Perhaps monkeyflower, an STD forum regular who is quite knowledgeable in this area, will have a comment for you.  Or you might consider posting a question about it in the sexuality/relationships forum.

Good luck--  HHH, MD

[gracefromHHP]

Definitely get yourself some lube!!! Even if you think you are "wet" enough - a little extra lube never hurts especially if your partner is rather large. You'll both enjoy the sensation of some extra lube. You can try some of the ones on the drugstore shelves like astroglide or ky but it's well worth ordering a few online and trying them to see which one you like best.  Even lubricated condoms aren't lubed up enough so always have some extra on hand - even stop in the middle of things to relube up - your body will appreciate it!!!  Also make sure he puts a little lube on the tip of his penis before he applies the condom - it will help it glide better and will help keep it from tearing :)

grace

[monkeyflower]

Like Dr. Handsfield and Grace, I'm wondering about the recurrent pain you have with intercourse. Are you well lubed? Very aroused? If not, that's the place to start. When you're aroused, not only do you generally lubricate more, but the inner two thirds of your vagina opens up, lifting your cervix and making deeper penetration possible/comfortable. Always, *always* use waterbased or silicone lube, but also make sure you get all the mental and physical stimulation you need to get and stay aroused. Some women find they enjoy partner sex more if they come before intercourse, some prefer during, some after, and some all three. You might experiment a bit to find out what you prefer.

Since it sounds like intercourse is often uncomfortable/painful for you, it's especially important to slow down and spend lots of time enjoying each others' entire bodies. See, the tricky part about painful sex is that it tends to be a  self-fulfilling prophecy; it hurts, so you tense up, so it hurts more. The next time you already expect it to hurt, so you're extra tense, so it hurts worse... you get the idea. So I definitely think you should avoid intercourse as long as it's painful. Remember that sex is a LOT more than just intercourse. Use toys, hands, mouths, whatever. There are lots and lots of ways to pleasure each other.

And I would also look up vaginismus. That's an involuntary tightening of the muscles around your vagina; basically, it's a physical response to anxiety. It can make intercourse (or any penetration) anywhere from uncomfortable to impossible. Can you have comfortable pelvic exams? Use tampons comfortably? While you can have one and not the others, it's usually more likely that all penetration is difficult. You could check out the book "Private Pain", by Katz and Tabisel, as well as their site, www.womentc.com. Read some of the stories. If this resonates for you, treatment usually is done with a sex therapist and sometimes a physical therapist (to help you tone your pc muscle). Sometimes it's just a matter of education and getting in touch with your body and its sensations; doing your kegels, using fingers or a dildo regularly, masturbating, fantasizing, etc.

If any of this resonates for you and you'd like more specific info (or if I'm completely, totally off base), you could post more and I'd be happy to try to help further. This probably isn't the appropriate forum, though; maybe the women's forum...