Case Study- Pain During Sex After Hysterectomy Induced Menopause

a story I have thought about for years- how 6 acupuncture sessions in 6 days, following a clear pattern, can change lives.

I met Genevive* 14 years ago when I was an acupuncturist on Princess Cruise Lines. We were sailing though the Caribbean and her husband was seeing me for knee pain, which was resolving quickly. While he was relaxing on one of his sessions, Genevive and I had a chance to chat. She was so impressed with the resolution of her husband’s knee pain she was interested if acupuncture could work on a condition that had plagued her silently for a few years that is often too taboo to discuss.

I remember her leaning in close to speak conspiratorially though there was nobody else in the room. She said “I have pain during sex. It feels like glass shards in my vagina whenever my husband is inside me. It has ruined my life.” Genevive had a history of fibroids that ultimately was resolved with a total hysterectomy. The removal of the uterus and the ovaries induced menopause, which was accompanied by many menopausal symptoms, such as hot flushes, insomnia, urinary incontinence, weight gain, vaginal dryness and terrible pain during sex. Her hormone replacement therapy reduced most of the symptoms to manageable, but the pain during sex made sex so painful that she could no longer have sex with her husband. After seeing doctors, sex therapists, and a pelvic floor specialist, she and her husband decided that they wouldn’t be having sex anymore, and they ended up getting a divorce. Happily, they remarried- and committed to a companionate and spiritual love.

Dyspareunia is the medical term for pain during intercourse, and it can be caused by many different conditions. It often occurs during menopause and is associated with vulvovaginal atrophy or vaginal dryness. It can also occur after pelvic infections, fibroid, endometriosis, physical trauma from surgeries (hysterectomy or c-section) or vaginal birth, and psychological trauma from sexual abuse. In Genevive’s case, she had a history of fibroids, hysterectomy and surgically induced menopause. People often don’t discuss sexual disorders with their doctors (and doctors don’t ask) because they assume it is “a normal part of getting older” or “it is embarrassing”, which is a shame because losing sex can be devastating. Depending on the etiology and the severity there are many treatment options, including hormonal and non-hormonal treatments, pelvic floor therapy, laser therapy (potentially promising treatment, but can result in further scarring and can exacerbate the issue), cognitive behavioral therapy, and acupuncture and herbal medicine.

Looking at her tongue, I could see a deep purple color on the back of the tongue, indicating there was a lot of “blood stagnation”. I took her pulses as well, and the character was choppy, giving further support to my blood stagnation pattern theory. It indicated to me that there was a lot of scar tissue and adhesions left after the surgery, which could interfere with the functioning of the pelvic floor and the muscles and nerves in the vagina. While I assumed some vaginal atrophy due to menopause and the lack of sexual stimulation over the past few years (which in Chinese Medicine often is a kidney yin/yang deficiency), the majority of my treatment was to work on this apparent blood stagnation pattern.

We did a session a day for the remaining 6 days of the cruise. I used acupoints on Liver, kidney, ren and chong meridians, which traverse the genitals and are often used for moving blood stagnation and enriching yin fluids. I used electroacupuncture on points on her low abdomen and inner thighs and a heat lamp on her lower abdomen. After the first session, she reported that a feeling of warmth replaced a cold sensation that she didn’t know had existed in her lower abdomen and vagina. After the 3rd session, she and her husband had sex with lubrication and there was none of the “stabbing glass like” pain she had previously experienced. After the 5th session, she reported that she and her husband felt “like teenagers” and that she was achieving orgasms! She was sore after sex, but there was no stabbing pain. She also reported that she wasn’t waking to urinate at night and that she was experiencing better sleep and fewer menopausal symptoms in general. After many months, Genevive found me online to report that there was no recurrence and her sex life was better than ever.

This is a story I have thought about for years- how a simple round of acupuncture, following a clear pattern, can change lives.