Sex advice: There was only one solution to my problem … down there. It’s opened up Pandora’s Box.

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How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!

Dear How to Do It,

Three years ago, I decided to have my right Bartholin’s gland surgically removed (after two years of over five painful surgeries that attempted to repeatedly drain an infected Bartholin’s abscess that never fully healed). This turned out to be a good decision since I won’t be needing surgery for this ever again, but it did come with its consequences: My vulva’s sensitivity has dramatically changed. Sex doesn’t feel the same way it did three years ago, and it’s really taking a toll on my mental health. My partner and I are at a loss on what to do since we don’t really have the money to see a sexologist or a specialized therapist, and every gynecologist tells me there’s just nothing to do.

To be clear, I am still able to enjoy sex sometimes, when the stars align. I would really like to be able to change that to “always.” Before the surgery, I was able to feel both my Bartholin’s glands fill up with lubrication when I got aroused, and that really turned me on. I could also feel them pulsating whenever I had a strong orgasm—that’s how sensitive my body is. Now, whenever I get even slightly excited or have an orgasm, my left gland hurts as if to overcompensate. Penetration can also hurt if we’re not careful, and let’s be honest, sometimes we forget to be careful because we like rough sex. Even soft fingering feels uncomfortable if the scar is particularly sensitive that day. We’ve tried everything we could think of: trying out different lubes and positions, toys, lots of foreplay, slow and gentle penetration, masturbating together, focusing on stimulating the clitoris, focusing on non-penetrative kinks, focusing on other parts of the body… and anal is not an option because I also have a scar in my anus from a previous horrible (and bloody) experience with an ex-partner.

At the end of the day, penetration is just that important to me, and I get really frustrated if I can’t at least have a good five to 10 minutes of pounding. Also, feeling pain while orgasming is not fun, and it makes me scared to even masturbate. We’re a communicative couple, and he knows all of this, but that doesn’t make the scar any less painful. I hate this. I hate that I feel pain in my vulva, I hate that the scar has hanging skin with its nerve endings dead from so many surgeries, and I hate that I can’t even get aroused without feeling my left gland swell with too much mucus. I feel mutilated, even if mutilation was the only possible solution in the end. Are there any options I might have overlooked? Is my attitude the main problem here? Because having re-read this, it’s quite an angry letter.

—Mangled Sensitivity

Dear Mangled Sensitivity,

When we’re talking about attitude being the problem, we can unintentionally minimize the difficulty of the situation or the difficulty of finding ways forward. There is a point where you’ll need to let go of trying to return to what was and focus on your current possibilities, in order to make the most of what you have now. You have to do the letting go part first, though, which usually requires allowing yourself to feel the loss and associated emotions.

This surgery changed your body in a way that affects how you live your life. The sensations, appearance, and function are different. From one angle, this is an incredibly common part of the human experience—whether by accident, medical issue, or simple aging, almost all of us find ourselves permanently unable to do something the way we used to at some point in our lives, and those changes can be profoundly life-affecting.

Until I read your last line about your letter being angry, the main emotions I saw in your letter were frustration and exasperation. Anger is a reasonable reaction to what you’re experiencing. So are frustration, exasperation, annoyance, irritation, mourning, and sadness. Throughout the history of this column, Rich and I have shared the belief that we cannot control our feelings, but we can control our actions. If you haven’t told yourself this yet, please hear it from me: It’s OK to feel angry. If your partner is up for it, he can be a place to express and process those feelings. So can friends. Pelvic pain support groups exist in local in-person formats, online meetings, and forum-based structures. You might have an easier time accessing affordable therapy to work on accepting the change in your physical capacity and your feelings toward your body than a specialized sexologist or sex therapist. Make it clear at the time of consultation that what you’re wanting to work through involves sex and your vagina, and let them tell you where their boundaries are. None of these suggestions will alleviate all of the pressures involved, but each can help you work on one or more threads of the tangle.

When you’re ready, getting curious about what feels good to you in the current moment can help you and your partner start building a new routine based on what works best most of the time. It probably won’t look exactly like sex did before. I don’t have any particular gadgets in mind, but I do wonder whether a soft silicone tube with a flange might allow the kind of penetration you prefer by covering the scar area in a way that insulates it from being bumped or otherwise bothered. An internal condom seems likely to backfire as the rims are quite firm and tend to move around, but perhaps something like this. You’ll want to have the exact measurements of your anatomy and compare them to the measurements of any device you’re considering. If part of what makes pounding enjoyable is the cervical stimulation, could your partner’s fingers stay motionless while inserted from the first or second knuckle down and rely on a sort of flipping motion with the tips to give you that sensation? You’ll likely have to get creative (unless one of those support groups leads you to a specialized resource), and that’s easier to do when you’ve passed through the grief and given yourself a mental rest.

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Dear How to Do It, 

I’m a 26-year-old agender, queer person in a polyamorous relationship. My primary partner is only interested in bottoming, which is nice because of the problem I’m writing to you about.
Years ago, I moved back in with a boyfriend I’d been seeing for a couple of years, first in person and then long-distance. He was controlling and abusive, but I didn’t want to admit how bad it was until we were in an apartment together and he started regularly coercing and sexually assaulting me.

I got out of there a few months later, but ever since then, I’ve had huge problems with receiving penetrative sex. As I said, my primary partner now is only interested in bottoming, so I’ve been a stone top with a handful of decently successful attempts at receiving penetration, but I usually have to be out-of-my-mind intoxicated or in a heavy kink scene to get into it enough. Even fingers or slim toys make me close up down there and get anxious, whether I’m alone or partnered.

I was just about ready to accept this, invest in more external toys, and call it good for the foreseeable future, but now I’m on testosterone hormone replacement therapy (HRT), and … oh boy. I’m horny 24/7 now! Sometimes I’ve been getting a craving to try penetrative play again, but despite my therapist’s advice to take it slow and back off when I get nervous, I literally can’t get anything inside of me. I can be aroused, lubricated, willing in mind and spirit, but the flesh is weak, I guess. Any tips for this? (My gynecologist suspects I have vaginismus, but had no recommendations or advice about it, and I can’t see a therapist for another few months for financial/scheduling reasons.) I just want my options open again!

—Give Up and Try Anal?

Dear Give Up and Try Anal,

I love the proactive energy here (and finding out how anal feels might add some useful information). That said, any situation where vaginal penetration is consistently difficult can be quite a puzzle to solve. The good news is that between medicine and psychology, there are several interventions with solid success rates, so there’s hope. The bad news is that most people really do need to be working directly with a professional for more than a couple of sessions to achieve those outcomes, and both your budget and schedule are tight. The subject is nuanced and tangled, so professionals without the required specializations tend to be apprehensive about potentially making the situation worse.

Whether what’s causing your vaginal tension is physical, mental, or a mixture, engaging in any kind of sex when you’re out-of-your-mind intoxicated, much less pushing at boundaries that seem to be tied up with both physical sensation and the psychological effects of a really awful relationship, is immensely risky. Being inebriated at all reduces your ability to read your own body and mental state, and that of others. Yes, people do mix sex and substances, and often avoid inflicting significant harm on anyone involved. But that’s not always the case, and when you’re playing with stuff that’s difficult or complex while under the influence, you’re laying a bunch of kindling around a situation that is already inherently combustible. If you won’t exercise caution for your own sake, think of how bad your partner will feel if they hurt you in a way that wasn’t planned, agreed upon, and done for the sake of kinky pleasure.

I’m an advice columnist and coach, and count myself as one of those professionals who are apprehensive about causing inadvertent harm. Since you’re already pushing hard on this issue, I’ll encourage you to focus on slowness just before crossing the threshold into penetration and during the first stages. Think “just the tip of the very tip,” or the early steps of insertion, rather than trying to get a finger or toy significantly inside yourself. Part of how that slowness (and sobriety during these sessions) can benefit you is by allowing you to notice more of the sensations and emotions you experience, and note them down accurately. You might note whether your thoughts go anywhere and, if so, where; the context of your day, and the sex (whether solo or partnered); and qualitative descriptions of the physical sensations, and where exactly those sensations are located. The more detailed and accurate you can get before your eventual meetings with your therapist, or any kind of pelvic floor therapist, the more likely you are to help those experts evaluate what might best help you, which should help you be efficient with your time and money.

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Dear How to Do It, 

I’m having an unexpected, unexplained oral herpes outbreak after never having had it before. I’ve been in a monogamous, committed relationship with my girlfriend for three years, and she’s really upset and freaked out by it. Obviously, we’re holding back from kissing, sex, and shared utensils right now, but she’s also expressed concerns about trust. I haven’t cheated on her, or even ever gotten close to that line, but there’s no way for me to prove it. We’ve never had trust issues before, and I’m hurt and upset. Also, I’m not happy to discover I’m sick. At the beginning of every monogamous relationship I’ve been in, my partner and I get tested for STIs, and I’ve never come up positive, but my doctor told me they typically don’t test for oral herpes. What can I do here?

—Ouch

Dear Ouch,

Johns Hopkins Medicine has a short explainer that gets into just how common this virus is: 50 to 80 percent of adults living in the United States have oral herpes, otherwise known as herpes simplex virus 1. Now take a look at their explainer regarding birth-acquired herpes, and specifically their section on HSV-1: “…spread by infected saliva, via the infection site or toys, cups, cosmetics, etc.” Now think back to being a child: How many cups did you share with peers, how many random toys did you put in your mouth, and, depending on what the norms were in your family, how many relatives gave you a totally familial and innocent but still mouth-to-mouth peck on your little puddin’ face or might have had herpetic whitlow on their finger?

As far as testing, you can look back at all of your previous STI results and see whether HSV-1 (and HSV-2, while you’re at it) are listed in the document, which will likely confirm the accuracy of what your doctor told you; they don’t typically screen for herpes. This is partly motivated by the (improving over time but still present) accuracy issues with the tests that look for antibodies (if the test isn’t particularly accurate, what’s the point?) and partly due to the lack of evidence for any real health benefit to testing for it in most cases.

Meanwhile, three extremely widespread human tendencies are coming to bear on you, your girlfriend, and your relationship. The first is the way we make sense of the world through stories, which help us feel like life is manageable and also sometimes simplify things so much that it obscures the complex nature of facts and zones of the unknown. The second is how we often perceive bodies and nature as more orderly and predictable than they are. But sometimes a scientific discovery comes along that broadens or changes our entire understanding of something like, for instance, viruses. Other times, something mutates, or a relatively new environmental factor affects how our bodies react to something that was previously well understood. The third is a set of beliefs—any type of herpes is a sex-only thing, and sexually transmitted infections are a discrete category and objectively dirtier than those that aren’t sexually transmitted—that are not factual.

It’s quite possible that you contracted oral herpes as a child, had an initial outbreak that was minor enough to go unnoticed or be forgotten, and are experiencing this outbreak now because you’re overwhelmed by stress. Or a partner (previous or current) was shedding the virus but didn’t have visible sores at any point (and, those pesky tests and their accuracy again, may have even had a falsely reassuring false negative result on a blood test) and passed HSV-1 to you without ever knowing they carried it themselves. Attempting to solve the mystery of how you acquired oral herpes has an extremely low (realistically zero) chance of success and a significant risk of stressing you out so much that you prolong this outbreak or invite another one.

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When we look at the HSV-1 in your body through the context that all of us are home to trillions of microorganisms, including other viruses, bacteria, and yeasts that are often essential to the healthy function of our own organisms, you’ve got a really common virus that can mostly be managed by taking care of your body and (depending on the doctor’s advice and personal choice) taking suppressive medications. Yes, it can return from dormancy and cause another outbreak. So can many other viruses. If you have a soft spot for science fiction novels, the four main Ender’s Game books follow Ender through a path of escalating opportunities for cross-species empathy, culminating in him establishing friendly relations with a virus by developing a comfort with the fact that we—in the broadest sense of living creatures—share this universe in a delicate balance. If reading four entire novels set in outer space is not your idea of a good time, look for other ways to come to terms with your personal ecosystem. If you’re feeling stuck on the idea of “being sick” after a couple of months have passed, and can access therapy or counseling, that might help you reframe the way you’re thinking about this.

Your doctor can walk you through the finer points of outbreak prevention and preventing spread. (A herpes infection can be extremely serious for infants, for example, so you’ll want to be extra cautious around any infants in your life.) It is rude to knowingly spread infections around, and it is polite to behave as you currently are: refraining from exposing others during a contagious window.

—Jessica

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