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Hi Betty,

I had a 4th degree episiotomy during childbirth which means that I was cut from my vagina through my anus. On top of it, I also tore towards the inside, several layers of my anal muscles had torn and I needed over 30 stitches. The doctor did a very bad job stitching me up and the next day all the stitches became loose and hanging so the doctor cut them and left me to heal on my own. I have some very bad looking scars down there but the biggest problem is that my perineum is virtually gone, there is less than 1/8 inch of perineum left. Because of the anus being so close now to the vagina - every time me and my husband have vaginal intercourse - I feel like he is in my anus. I went to the OB about this and she said that there is no open connection between the two parts, but the wall between the anus and the vagina is thin and damaged.

I enjoy anal sex occasionally (when I feel like doing something wild) but it really bothers me when I want to have vaginal sex (which I prefer) and since I am not in my wild mood - this causes physical pain - as if someone would forcefully have anal sex.

The doctors suggested reconstructive surgery, which I don't believe it will help and I don't trust them to do it right anyways. No one is touching me with scissors in that area anymore, that's for sure. SO what do you suggest? How can I overcome the pain and enjoy sex like I used to? I am only 32. Do I have to live with this for the rest of my life?

Dear J,

Another horror story of surgery gone wrong. I'm so sorry this happened to you. I suggest you write up your experience and post it on some of the medical sites under episiotomy. The idea behind doing this type of surgery is to prevent a ragged tear that would be more difficult to stitch up.

In terms of my own experience, when I did both anal and vaginal penetration, (a dildo in my anus while my partner did vaginal penetration) I primarily felt the anal stimulation more than vaginal. It's true for all of us that only a thin membrane separates these two canals, and in many ways, the anal canal seems to offer more sensation than vaginal. Of course either form of penetration for me was always accompanied with holding a vibrator on or near my clitoris. We also always used an abundance of extra lubrication. This became one of my favorite kinds of partner sex. So I understand the feeling that your husband is inside your anus because I would lose touch with my vagina altogether. However, I'm not clear why you suffer pain from vaginal penetration. Scar tissue usually dulls sensation. Do you always use additional lubrication?

If you ever reconsider and decide to investigate corrective surgery, I would check in with Dr. Marci Bowers who does a lot of reconstructive surgery on FGM women. In a sense your genitals have been mutilated and removal of some of the scare tissue might help. Dr. Bowers specializes in Gynecology, Pelvic and Reconstructive Surgery and practices in San Mateo CA and Seattle WA. She is highly regarded in her field and it would be worth the effort just to get her opinion. Please let me know how you solve this problem.

Dr. Betty