Another month, another medical wonder
The sheer number of acronyms in medicine can be dizzying. So when a 60-year-old woman told her primary care doctor that she had a “WAP,” he figured it was some obscure condition he hadn’t heard of or that she was mispronouncing something. Wrong. Loretta had in fact diagnosed herself with an uncontrollably wet vagina. Without prodding into details, her doctor promptly referred her to specialist Dr. Rachel Pope. Certainly Dr. Pope could help this woman who was using pads just to keep her underwear dry.
Dr. Pope is a vagineer (vagina engineer,) she jokes. She spent three years at a hospital in Malawi reconstructing vaginas of women without access to advanced obstetric care. As a result of complications of childbirth, these women were leaking urine into their vagina and having trouble convincing health care personnel that something was wrong. This seminal work aligned closely with Dr. Pope’s lifelong pursuit to help marginalized people. She helps construct vaginas for transgender women and has established herself as an expert in female sexual health here in Cleveland, empowering women at every opportunity. And while she’s used to all types of conversations that would make many people blush, she now had to figure out how to help Loretta in her precarious situation – non-stop orgasms.
When Dr. Pope met Loretta it was clear the patient was suffering, even if Loretta tried to maintain a sense of humor. Her issues, ongoing for months, included clear-ish discharge from the vagina, about 10 unprompted orgasms throughout the day, and an extremely uncomfortable near constant state of arousal. The patient tried wearing loose clothing, as to not stimulate her clitoris. She also tried masturbating, thinking she might just need to scratch the itch and move on with her day. She hadn’t been with a partner for a while, maybe she was having a renascence of her sexuality following menopause. But, this arousal was neither prompted by anything romantic in life nor did it disappear after self stimulation.
Dr. Pope performed a vaginal exam as quickly as possible knowing that the patient was aroused at nearly everything. She checked for an infection, for leaking urine, and made sure the vagina was structurally normal. She identified the excessive fluid as normal vaginal lubricant, a combination of fluid from increased blood flow and mucus being secreted by glands that are around the vagina.
For patients with mysterious conditions, validation from a doctor can be extremely therapeutic. Dr. Pope believed Loretta that these symptoms were abnormal and that the orgasms were unwelcome, even uncomfortable. Dr. Pope’s patients in the past have often not been taken seriously for issues with their vaginal or sexual concerns. She even gave Loretta a diagnosis, PGAD (persistent genital arousal disorder.) Dr. Pope had just heard a presentation on PGAD from the nation’s foremost expert. And while the disorder is quite mysterious, she thought it might have something to do with the nerves that are connected to the genitals.
The pudendal nerve carries the scintillating signals to the brain from the vagina and clitoris. Loretta did have back pain and was on a nerve medicine for this. Dr. Pope asked Loretta to stop taking the medicine, suspicious that it might be causing a disruption in the pudendal nerve. This medicine, called pregabalin, usually can subdue the signals of nerves and has even been tried to treat PGAD patients. Doctors must remain open to all possibilities when it comes to conditions where our understanding is evolving, reverent to the fact that what works for one patient may not work for another. Unfortunately, Loretta had no luck by stopping the medicine.
The timing of Loretta’s back pain worsening was suspicious in that it correlated with the beginning of these daily orgasms. The pudendal nerve travels just below nerves often implicated in low back pain. The back pain and PGAD had to be connected, it seemed. Dr. Pope talked with Loretta about her theory, and they decided to get an MRI of her lower spine. Loretta would try anything. For months now she had trouble doing normal things, like baby-sitting her grandchild or going on a walk without intruding sensations. Months into this ailment, patients with PGAD can be quite depressed. If the problem isn’t resolved, a person can even become suicidal. There is a dark truth in the dangers of too much of a good thing.
Dr. Pope wasn’t surprised when she got the MRI back, which showed a tiny cyst near the spine. These cysts, called Tarlov cysts, can be found in 5% of the population and can be innocent, causing no issues. But there are emerging thoughts among specialists dealing with PGAD that these cysts might be causing some nerve disturbance in their patients. Dr. Pope, hopeful that she might have a solution for Loretta, called a neurosurgeon. To their dismay, the surgeon wasn’t convinced that this cyst was involved and Dr. Pope was left searching for someone else to help.
Loretta was now seeing a new pain doctor for her back, so Dr. Pope rang him. They reviewed the MRI together and talked shop, agreeing that this little cyst abutting the pudendal nerve roots might be involved with Loretta’s PGAD. They were hopeful that injecting the nerves in that area for her back pain might somehow disrupt the never ending cycle of orgasms. It did just that!
After a steroid injection just outside of the spine, the orgasms stopped. What a relief. The excessive vaginal fluid slowed, and the indiscriminate arousal quieted.
Dr. Pope reported the case to her colleagues across the country, helping to consolidate the knowledge that specialists were gathering. And while she has vagineered some 3,000 vaginas, enabling orgasms all over the world, she was happy that Loretta’s unstoppable orgasms had proved treatable. At a follow up appointment, Loretta told Dr. Pope that she isn’t back to dating just yet.
Dr. Corey Meador is a practicing family medicine physician in Cleveland who has written for PBS NewsHour and The Washington Post. He obtained degrees from Loyola Marymount University School of Film & Television in Los Angeles and Drexel University College of Medicine.