Women's Bodies, Women's Wisdom (67 page)

Psychological and Emotional Aspects

Some women with chronic vaginal infections fail to respond to any treatment. Some, too, are not open to trying any but the most conventional treatments, convinced that “there’s a reason for this that you doctors are simply not finding—so do more tests.” These situations present a very difficult dilemma for both the patient and the health care practitioner.

For a true cure of the problem, the emotional aspects of chronic vaginitis and vulvovaginitis must be looked at and worked through.
⁵⁸
This is not to say that the problem is just in those women’s heads. What might have begun in the head becomes physical. Studies have shown that many women with these infections have antibodies that work against their own immune and reproductive cells.
⁵⁹
Mona Lisa Schulz, M.D., Ph.D., once did a reading on one of my patients who had a chronic vaginal condition. The intuitive said, “She’s got Doberman pinschers in there. You go near there, and you’ll lose a limb.” As it turned out, this woman had experienced incest as a child. She came to see that one of the decisions she had made in her early teens was that no one was ever going to get near her vagina again. Because she had not made this de cision with her intellect, on a conscious level, it manifested through her body. This is nearly always the case. If we were conscious of the conflicts that were driving our diseases, we wouldn’t manifest them physically.

Chronic vaginitis is a socially acceptable way for a woman to say no to sex. For some women, saying “No, I’m not interested in having sex with you tonight or the rest of the week” is not acceptable, given the mate they have chosen and the home in which they grew up. If they believe that sex is one of their duties, regardless of whether they derive pleasure from it, no matter how unconscious this belief may be, chronic vaginitis may well represent an out for them. But the immune system is never fooled.

Another common problem associated with chronic vaginal and vul var infections is infidelity by the woman’s partner. Even when a woman doesn’t intellectually “know” that her husband is having an affair, her body may well be aware of it. I’ve seen several women in whom chronic vaginitis began at about the same time their mate started an affair. Of course, we might explain this by saying that the husband was bringing something home to his wife in the form of germs, and that does hap pen. But in most of these women, I’ve been unable to find a physical cause for the vaginitis.

In a woman who has been in a monogamous relationship for years, a sudden onset of primary herpes, fever, general illness, geni tal sores, warts, or other obvious infections can be classic indicators of infidelity. For reasons already discussed, however, this is not always the case and is almost impossible to prove. Women may also have vaginal problems exacerbated by guilt over affairs that
they
are having.

It’s not uncommon for a spouse to lie if he is confronted about having an affair. Several of my patients, especially premenstrually, have had dreams that their husbands were lying to them. After years of questioning their own sanity, they’ve found out that the dreams were correct—they had in fact been lied to. And guess what? A woman’s body knows it, often long before her intellect accepts the information.

Joyce: Vaginitis as a Message

Joyce was fifty-three when she first came to see me. For almost twenty years she had had chronic vaginal infections that always returned after treatment. When I met her, she was bitter and angry over her recent divorce. Her husband of many years, a wealthy and charming alcoholic, had left her for one of her own friends. She felt abandoned and cast aside, even though further questioning revealed that her relationship with her husband hadn’t been satisfying for a long time. His drinking and worka holism had been constant problems, and her sex life had been com plicated by painful intercourse and frequent infections for almost twenty years.

Joyce’s physical exam on this first visit was basically normal, though her vaginal tissues were thin and tender. As long as she wasn’t having intercourse, she didn’t have any vaginal infections or other discomforts, and no treatment was necessary. Over the next several years, I saw Joyce for her annual exams. Each year she was a little less bitter about her ex-husband and was slowly able to see how much better she felt without him. She then remarried. When she moved in with her new husband, she had a dream in which their house was part hospital and part school. This dream was very meaningful for her because it symbolized this new marriage as one in which both healing and learning would take place. She felt cared for for the first time in her life. She realized that she had never experienced true intimacy before her marriage to this man.

Her sex life with her new husband was wonderful, she reported. In fact, she had never dreamed that it could be so good. She has never had another vaginal infection, and her vaginal tissues are normal and healthy in every way. She has come to see that for years her body, through chronic vaginitis, was sending her a message about her prior relationship, before her intellect “got it.” It is entirely possible to heal chronic vaginitis once the stage is set for healing.

Katherine: The Body’s Wisdom

Katherine came in for her annual visit complaining that she had had several recurrent vaginal infections in the previous two months. But by the time of her visit, these infections had started to go away by themselves and she was already vir tually free of the symptoms. She had recently ended a relationship that she’d been in for only two months. She said, “When he said to me, ‘I want to keep you all to myself and keep you away from the world,’ I knew I had to get out of there.” After leaving this man, Katherine thought she would feel better—but instead she found herself bingeing on food a great deal.

As we talked, I suggested she look back over her life since her last visit a year earlier, when she had just gotten out of a ten-year relationship with a drug addict and was in a group working on incest issues. When I asked her if she’d listened to Pia Mellody’s tape on love addiction, something I’d suggested the year before, she replied, “I don’t even dare to.” We both laughed, and I reminded her how much progress she had made. As we were discussing the fact that the body gives us signals long before the intellect is willing to hear them, she said, “You know, I developed endometriosis in the second month of my relationship with that drug addict, and I knew at that time that it was probably caused by the stress of the relation ship. But I didn’t let my intuition speak to me.” Now, however, she was able to appreciate her body’s wisdom, both in her long-term relationship and in the one she had just ended.

A NOTE ON SEXUALLY TRANSMITTED DISEASES

Our current media-driven atmosphere often leads women to believe that it’s both desirable and expected to have sex on the first or second date with a person who is almost a complete stranger. Simultaneously, we’re all more aware than ever about the risks for contracting sexually transmitted diseases (STDs) of all kinds, including AIDS—a risk that increases with the number of sexual contacts that we (or our partners) have. This double message—sex is expected of you, but make sure you don’t catch anything or infect someone else—has resulted in virtual sex ual paralysis for some women, and outright risky behavior in others who are fortified mostly with denial. From 1991 to 1996, HIV infection in people over fifty, the generation that began the sexual revolution back in the sixties and seventies, rose twice as fast as among younger adults—a direct consequence of this denial.
⁶⁰
I’ve seen the unpleasant consequences of behavior at both ends of the spectrum. I’ve sat with women who reacted to a diagnosis of herpes as though their lives were over. And I’ve seen many others who’ve ended up with pelvic inflammatory disease and subsequent infertility—the result of sexually transmitted infections that did their damage before treatment was started. There is a better approach. For a sexually active person, there is no guaranteed way to avoid exposure to sexually transmitted diseases. Despite this, exposure in itself does not make developing a sexually transmitted dis ease inevitable. Even in the case of AIDS, the overall chance of contracting HIV from one act of intercourse with an infected person is about one in a thousand.
⁶¹
And even with repeated exposure to HIV, some people have not become seropositive.
⁶²
Immune function depends in part upon how safe and secure you feel in the world throughout your life in general, or during a particular time. A large individual variation in immune status is common. This information is certainly not meant to suggest that a woman should ever neglect safe sexual practices and condom use. Instead, I present it as evidence that there’s a great deal of potential within the human body for resilience and health. A woman’s biggest defenses against sexually transmitted diseases are taking commonsense measures, such as using condoms and being discriminating about sex partners, as well as having self-respect, self-esteem, love and acceptance of her sexuality and genitals, and a functional immune system (which goes hand in hand with intact and healthy vaginal mucosa).

You have only two choices when dealing with STDs:

1.
Become so paralyzed by fear that you make a vow of celibacy, don’t touch anyone—including yourself—“down there,” and sterilize everything in sight. (This doesn’t work—the world is crawling with germs, and so are we all.)

2.
Keep your vaginal mucosa healthy through the power of safe sexual practices as well as your thoughts, diet, and emotions. Practice safe sex as best you can un til you’ve made a monogamous commitment—always follow Frank Pittman, M.D.’s hard-and-fast rule of con dom etiquette: “Bring it up before he gets it up.”
⁶³
Accept yourself for who you are and what your natural talents are; expand your under standing of what sexuality is and how your views of it affect you; and eat healthfully and take a good multivitamin-mineral supplement.

A Word About AIDS

I am not an authority on AIDS and I don’t treat AIDS patients. I
am
often asked questions about it, and have sent many women for testing. Of the estimated 1 million-plus people in the United States who are infected with HIV, about 21 percent of them don’t know that they are infected, thus jeopardizing their own care and putting others at risk.
⁶⁴
Though the number of new cases of AIDS increased in the mid-1990s, it declined slightly after 1999 and has been stable thereafter, at approxi mately 55,400 new cases a year.
⁶⁵
The incidence of HIV infection is greater in certain at-risk populations, including men who have sex with men, blacks, Hispanics, and women—all of whom are disproportionately represented among people who are HIV positive, have AIDS, or both.
⁶⁶

Though it is a much more serious disease, AIDS is related to herpes and warts in that one of the modes of transmission is sexual contact. Because people can have HIV for years before it shows up as AIDS, there are potentially
no
safe sex partners until we have been monoga mous with someone for at least eight to twelve months and both have negative HIV tests. (Even a negative HIV test is not a 100 percent guar antee, because you can have the virus when the test is taken but not yet have the antibody in the blood that is the basis for the HIV test.) The concept of the asymptomatic shedder of the herpes virus (one who potentially sheds the virus and infects someone else without ever knowing that he or she has it) essentially applies, in my opinion, to almost
all
infectious diseases, especially the sexually transmitted ones.

I believe that the AIDS epidemic is a consequence of a large-scale breakdown in human immunity, resulting from such factors as chronic drug and alcohol abuse, relationships in which sex is the central focus, pollution of the environment, soil depletion, poor nutri tion, and generations of sexual dysfunction and repression. AIDS has been called a metaphor for the breakdown of planetary immunity as a result of excessive dumping of toxins into the earth’s—and thus our own—lymphatic systems.
⁶⁷

Fortunately, the number of long-term AIDS survivors is increasing. Since antiretroviral ther apies were introduced in 1996, there’s been a marked reduction in the rates of illness and death due to HIV infection in the developed world. HIV is now considered a chronic disease, and life expectancy after diagnosis can be decades. In a 2005 article on the subject in the
New England
Journal of Medicine,
Scott Hammer, M.D., an HIV researcher, writes, “An otherwise healthy person with asymptomatic HIV infection and no coexisting illnesses . . . should be advised that decades of productive life, which can include intentional pregnancies if desired, are possible with proper care.”
⁶⁸
I am also certain that the fact that HIV is no longer an automatic death sentence is immune-system-enhancing in and of itself.

Several years ago, I met a university professor who has been HIV positive since she was originally infected back in college in the 1980s. Though she has had occasional bouts when she’s been really sick, for the most part she remains healthy and functional. She told me that she finds hope and solace in the Buddhist approach of nonviolence and endeavoring to live in peaceful coexistence with the HIV virus instead of seeing it as “the enemy.” It’s certainly working. And yes, she also takes antiretrovirals.

CHRONIC VULVAR PAIN (VULVODYNIA)

Women with chronic vulvar pain and burning—known as burning vulva syndrome—have a condition known as vulvodynia or vulvar vestibulitis syndrome. Women with this condition experience searing pain at the opening of the vagina during intercourse and sometimes also have unrelenting pain and burning, stinging, or redness. There is acute tenderness to pressure in the ring of vestibular glands that are lo cated just outside the vagina. This may preclude intercourse altogether. Because vulvodynia patients may have seen many doctors without finding a straightforward cause or cure, they often require a good deal of compassion. I’ve put together the best options I’ve found for this problem, but I must stress the importance of the mind-body connection for anyone who desires permanent relief from this condition. (The same ap proach applies to those with interstitial cystitis; see pages 310–312.)