Dear Dr. Queen,

My question concerns vaginal injury. Recently (around New Year's) I was kicked in the crotch by a very angry kid. I am so worried and upset about what happened, and when I went to see the gynecologist the next day, she didn't seem to know what she was talking about and I didn't feel like she took me seriously. It still really hurts when the area is touched. My orgasms have changed and it's not as easy to have them, they don't feel as good. There's no blood in my urine any more, as there was at first, and now the clitoral hood is what hurts the most. I hate it! Can you help or refer me to someone? I'm so scared the damage is permanent.

--Injured and Afraid

Dear IA,

In medical school, doctors specializing in gynecology are especially focused on learning about the reproductive system -- that's what modern med schools primarily teach when it comes to sexuality. Your gynecologist might have less information about the pleasure-related sexual structures and organs in your body, and perhaps this is why she seemed unhelpful to you. (She might even be uncomfortable enough about sex that your concern -- and openness -- about orgasm freaked her out; this should never be true of an MD, but all too frequently it is the case.) In any event I would have expected her to refer you to a specialist, since you had blood in your urine initially; I'm glad to hear that symptom has resolved.

This is probably not a true vaginal injury, since the vagina is inside your body. You probably have a soft-tissue injury to the vulva and pubis that might have several effects. The closest I can come to a comparison is the type of injury you might sustain if you came hard off a bicycle and your crotch landed on the center bar -- or if you slipped when climbing a fence and came down on it. This would result, as you are no doubt aware, of bruising -- even if you can't see black-and- blue bruises on your labia and surrounding areas, there is likely some deeper internal bruising. When this happens you have the pain of the bruise to deal with, of course, and you might have a fair amount of swelling. In this case, cellular fluid and blood have flooded the area, and the trauma of the kick created enough damage that all this can't just drain away. Ordinarily your genitals become engorged through arousal, and the blood that caused the engorgement is able to subside again after you're done with sexual stimulation. In your case at present, fluid may already be there, you may be having difficulty becoming engorged in a normal way, and the fluid in the area isn't able to drain away -- I suspect that this, as well as the ongoing pain, would be enough to affect your ability to orgasm.

Ordinarily, erotic stimulation and arousal alleviate pain -- many women find an orgasm during the first days of their period relieves cramping, and this is also one of the secrets of SM play. ("Why do they do things that hurt?" non-SM folks ask, and the answer often is: "Because it turns them on and so it doesn't hurt, to them.") It is possible that later, as your injury heals, you will again be able to enjoy pain relief when you masturbate or have partner sex. But right now, because of where your injury is located, you are directly irritating it when you attempt sexual stimulation. So go easy. I don't mean "Hands off" -- gentle touch is probably a good idea, in fact. Massage the affected area, if you can -- your body will send you signals when you have healed enough for more vigorous stimulation.

Another possible effect of the kick: nerve damage. This, too, could have affected your ability to orgasm normally. It is not necessarily *permanent* damage -- but I would try to see a neurologist, if you can, especially one who has some expertise in sexual matters, with extra points if she or he has worked with pubic injury in women. Another specialist you might consider is a urologist -- but again, choose one with some sexual expertise, and make sure too that the doctor you see is not primarily focused on treating men. Many urologists see far more men than women.

Your clit hood is just the tip of a clitoral system that is mostly inside your body, and you and your doctors won't be able to tell just by looking what kind of injury might have been sustained. The hood (and external clitoris, as well as its internal shaft) was probably bruised from within by your pubic bone and from without by the kicker's foot, so I am not surprised to hear that's where the pain remains greatest. Your clit also has internal legs extending around the sides of your vagina like a wishbone.

Time is the great healer, as the saying goes, and it sounds as though time has made some difference for you. I know you're scared, but you may have to be patient for a bit longer -- soft- tissue injuries can take a while to get better. But getting other medical opinions is a very good idea -- I certainly can't diagnose you from afar, and in fact I am not a medical doctor at all. Among other things, you will need a doc to prescribe anti-inflammatory and pain relief meds, if these are appropriate in your case.

If you go to a specialist who *isn't* especially fluent in sex-related injuries, give them the comparison I made above -- a bike injury. (Don't say that's what happened to you, but tell them you've been told the damage might be similar.) Way more bike injuries come to doctors than kicks to the clit -- this might help them get their footing and realize they *do* have some useful information for you. If you feel you need support in talking to your doctors about this, have a look at _Health Care Without Shame_ by Dr. Charles Moser -- it is a book by a medical doctor/sexologist that can help you get the most out of talking about sexual issues in the doctor's office. It's available through Good Vibrations. To find doctors who will already know what you're talking about, I would see whether the Sex Information and Education Council of the United States (SIECUS), the Society for the Scientific study of Sexuality (SSSS), or the American Association of Sex educators, Counselors, and Therapists (AASECT) have MD members in your city or region. All three organizations have informational websites as well as office staff who may be able to refer you. Even if you only track down a local sex therapist, that individual might be able to make an educated (and sex- positive) referral to a doctor.

Finally, you have suffered not just physical trauma, but possibly also psychoemotional pain, and you may want to have a session or two with a sex-positive therapist. And stay away from that kid -- talk about "hitting you where you live"! Good luck with your healing process.