Anyone have experience of vaginal birth with pre-existing vulvodynia / vaginismus or similar?

[palmaviolets]

This is my first baby and I have long-standing vulvodynia and vaginismus, bad enough to make internal exams pretty impossible due to severe pain. I don't want to dismiss a vaginal birth out of hand if it would be better for the baby, but I'm not very confident that I can do it. My consultant is supportive whatever I decide, but I would love to hear other peoples' experiences.
My main worries aren't so much about the pain of birth itself, when I know the pain relief will help:

• how would I manage initial internal exams in advance of getting an epidural?
• does vaginismus make birth more difficult?
• how would I cope afterwards with management of tears / other damage (I'm thinking epidural would make forceps more likely...)?
• how might a vaginal birth affect future experience of vulval pain?

I have vestibulodynia (luckily fairly mild) so I really sympathise - it's something I definitely think about as I don't have children yet! You can definitely handle a vaginal birth though, especially with an epidural. As far as I understand the process really takes over and vaginismus is no impairment at all. For exams could you request a lidocaine cream first? My pain is very localised and completely disappears with a dab of cream, so that would work for me. As for longterm pain, I haven't heard any reports of women have increased pain after a vaginal birth, but there are no good studies of course! Forceps is probably something I'd want to avoid, but the incidence of you needing them is still low. Regarding tears, you pretty much keep them clean and leave them alone, so you would not be poking at the area or anything like that.

It is scary, I know - did your consultant have any advice on any of this?

Thanks for replying Bue Its a problem because I don't find lidocaine is quite enough for this kind of thing (internal exams / procedures etc, not the childbirth bit!) - and don't know whether you can use it in pregnancy anyway?

My obs is very supportive, but I dont think she realised how much a problem it might be, and i guess its not her specialism. I really need to hear about successful experiences / read proper research about it being a possibility before im brave enough give it a go if that makes sense!

palmaviolets, do you know the cause of your vulvodynia? That might make a difference if you know the cause (if there is one, I know lots of vulvodynia is unexplained). I have lichen sclerosis, which is one cause of vulvodynia. I had a CS on the basis that the condition of my skin basically wouldn't not be able to handle a vaginal birth (too inflexible and fragile), so can't advise on what a VB's like.

Is there a gynaecologist, preferably a specialist in vulval disease, you could see to discuss your birth options? You can see who's closest to you from this list of vulval clinics. There's also this page on vulval pain and pregnancy from the Vulval Pain society.

You can use lidocaine (it's what is given prior to episiotomy and suturing) but if it's not going to be adequate then that doesn't really help!

ghislaine is right, you should see a consultant with specialism in the area of vulval pain. Most maternity care providers don't know a lot about this area unfortunately.

Thanks for ideas I'm not 'in the system' at the moment with a specialist gynaecologist, and doubt there's time for a new referal, but I have seen several in the past, who haven't really helped. I'm mainly 'unexplained' - biopsy showed negative for LS, although I tear easily which I think doesn't bode well for VB, and there's always lots of inflammation. I suspect endometriosis may be involved (which I also have). I think I'm going to go for a CS unless I can find something concrete to suggest a VB would work for me & baby - otherwise I'll be going into this terrified of more damage and making things even worse, which would probably labour up and make the whole thing harder... Oh well, as long as the baby comes out safely, that's the main thing. I just wish we could have a lovely natural birth

palmaviolets, I've PMd you with the names of a couple of specialists.

All done!