I was raped when I was 12 and had sexual disease testing regularly since out of paranoia, always normal. I was sexually active around age 20, at that time had frequent UTIs, bleeding between periods, cramping, vaginal dryness, and frequent yeast infections. It stopped when I became celibate again, I have a latex allergy, and have had yeast infections whenever I’ve taken antibiotics. I had a bad pap at age 26 (ASCUS), I was told not to worry. My next PAP age 28 was also bad (ASCUS), then one normal but inflamed a couple months later. Age 28 I was diagnosed with Multiple Sclerosis. Age 29 another bad pap ASCUS and had colposcopy, results were borderline dysplasia.

Problem:

I am now 30, and again sexually active. My partner was married for 20 years no partners aside from me since, both were monogamous. We tried condoms and KY, I have reduced sensitivity as well as dryness they weren’t pleasurable for either of us. Due to depression and sensitivity to hormones I am not willing to try any hormone based contraceptive. We switched to the Today Sponge, which caused some irritation but not extreme enough to discontinue, lubrication increased but was still an issue. I had a UTI one evening and was passing blood clots, horrible urgency and pain, no burning. Urine was coke colored. Went to ER was put on standard UTI sulpha antibiotic for three days. I then developed a yeast infection and took a generic over the counter one day treatment. My labia swelled and hardened (very painfully!!!) they were huge! Went to doctor who diagnosed it as an allergy, however no yeast found on culture. Roughly I week later urgency and blood clots in urine returned (along with cramping intermitent cramping nausea and cold sweats) I was put on Cypro…this caused tremors, short term memory loss, confusion, and depression. However I completed the treatment…near the end I began to get what I assumed was another yeast infection (typical thick white, discharge causing itching and redness). The first night I noticed it (the same day I’d taken the last cypro pill) I used vinegar and water douche to wash off all yeast inside and outside my vagina. This seemed to work, did it a second time a few days later and seemed okay again. We had intercourse again (doctor had said I could as soon as I felt up to it). I was dry we had run out of the sponges and were using spermicide film for contraception. My partner developed split skin on his penis around the base of the head, I developed split skin along the back wall of my vagina (between vaginal opening and rectal opening) but nothing like his. We waited several weeks for him to heal (mine seemed okay soon after). After the next time he had intercourse the skin split again his fairly severely causing scabbing, (he I think got eager before being fully healed) mine again mild in the same spot. We don’t have rough sex, but I think the location of the split was possibly due to position? (missionary with my legs on his shoulders). Again were waiting for him to heal.

I had a mild MS flare, parasthesias left hand. I’m a college student and refuse to take the disease modifying meds since they impair my cognitive function, cause depression and quite frankly the disease itself is better than the side effects of the interferons (I’m allergic to Copaxone). I didn’t tell my neuro about the flare because it was about midterms and I couldn’t afford to miss any more school this semester. Plus the cortiocosteroids cause me terrible side effects. (if you haven’t noticed I am very sensitive to medications) I worked through the flare with physical therapy and rest.

We were still waiting for him to heal (he thinks it’s from the dryness) and I started spotting. I at first assumed it was my period, but the spotting kept on and on and on. At first it was brown, with dark blood clots, then red mucus. This continued for two weeks with occassional mild PMS like cramps. (Internet research pointed toward chlamydia, but I’d been tested when I had the yeast infection last month for that and a couple other STD’s as well as having a pap. All were normal) The spoting, bloody mucus and clots got heavier and heavier and I am now having what I assume is my period (it started at the right time and I had all the normal indicators).

Any ideas what is going on here, and what we can do about it? He’s healed up now, but it would be nice to have sex more than a couple times every month or two.

Medications:

Daily: Wellbutrin 200 mbs bid (depression), Adderall 20 mgs bid (MS fatigue/ADHD), Fish Oil 2400 mgs bid (MS, depression)
As needed: Valium (10-20 mgs, 0-2 times a month, spasticity), Loritab (5-10 mgs once every 4 months or so spasticity/joint pain) I tried Neurontin and Trihexyphenldate (spelling??). Trihexy made me groggy/brain fog/high as a kite (unable to even drive). Neurontin gave me tremors and amnesia.

Dr. Joshua’s Answer:

Vaginal dryness is a common problem. Multiple sclerosis is associated with increased vaginal dryness. There are various ways to treat it. Douching is definitely not recommended as it disrupts the vagina’s own lubrication systems. Especially avoid vinegar, soap or any similar douches. This includes the so-called “natural/alternative” douches. Never use hand lotions or soaps inside the vagina. Avoid bubble baths or any other situation where soapy substances enter the vagina.

Any underlying infection such as vaginosis and yeast should be treated first. Ask your GYN about this. Your Gyn can also perform a microscopic examination of vaginal discharge to evaluate the estrogen effect. Your latest Pap smear was normal - this is good, but you should definitely have the Pap followed as you have had dysplasia.

The most effective treatment for vaginal dryness is estrogen treatment. Local estrogen such as Vagifem vaginal tablets increases estrogen levels locally in the vagina, and this way you can avoid having to take hormones orally if you are sensitive to them.

Oral contraceptives are also worth considering, as they would increase your choices of lubricant and eliminate the need to use sponges, films, condoms and other irritating/inconvenient methods. An interesting side note is that oral contraceptives may reduce the risk of developing MS (Reference: Alonso et el., Harvard School of Public Health: Archives of Neurology 2005;62:1362-1365), although there is no evidence that oral contraceptives will be beneficial to those who are already diagnosed with mutiple sclerosis.

I recommend that you try another type of lubricant - vaginal lubricants such as Replen have a more lasting effect and than KY Jelly, and they are also compatible with condoms.

The significance of intimacy and foreplay is often overlooked - make sure you take the time to be intimate with your partner, and explore different ways of getting aroused before intercourse. This can make a big difference in lubrication.

Finally, just a thought: As you are 30 and have a partner, consider getting married and pregnant. After the age of 35, female fertility starts to decrease significantly, and the risk of complications increase. Also, pregnancy may protect against MS flare-ups while pregnant, although the risk of an exacerbation is somewhat increased after childbirth. There seems to be no effect of pregnancy and childbirth on the long-term outcome of MS.

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