What happens to desire when your body starts treating sex as a threat?
Sara Sturek is a writer and founder of Writing Shamelessly (writingshamelessly.com), whose essay on living with vulvodynia appeared in Women's Health magazine. She has had hormonally-mediated vulvodynia since she was 21. In this episode, Sara traces her full diagnostic journey - from a first gynaecologist appointment that sent her home with Advil and a suggestion to try warm baths, through months of worsening pain, to the pelvic floor physiotherapist who finally identified a hormonal component. What makes this conversation distinct is how honestly Sara explores what chronic pain does not just to sex, but to desire itself.
The diagnostic odyssey: from dismissed to finding a hormonal cause
When Sara first experienced vulvodynia symptoms at 21, nothing in the medical system pointed her toward answers. Early appointments produced generic advice while the pain continued. The process of reaching a diagnosis took years of self-directed research - threads on Reddit, trial and error, and the particular exhaustion of knowing something is wrong while being repeatedly told it isn't serious. She eventually found a pelvic floor physiotherapist who could identify what was actually happening.
The hormonal component of vulvodynia is frequently missed in standard consultations. Going off hormonal contraception was a turning point for Sara, shifting her symptoms in ways she hadn't been prepared for. This episode explores how hormonal changes - including the pill's effects on vaginal tissue and nerve sensitivity - can drive vulvar pain that looks inflammatory on the surface but responds better to targeted hormonal treatment. The "boiling pot" framework her physiotherapist gave her for understanding flares is one of the most practical tools she took away from the whole process.
"She had surmised that I had hormonally-mediated vulvodynia. So she recommended I go off of my birth control... once I went off that birth control, I did start seeing a lot of relief. I didn't really feel that rawness anymore."
Desire, dissociation, and what vulvodynia does to wanting
For many people with vulvodynia, the clinical conversation focuses entirely on the physical experience of pain - and stops there. Sara goes further: into the fear that can slip in before sex even begins, the mental exit that happens when the body anticipates hurt, and the quiet shift in her relationship with desire over time. This is what the appointments consistently missed - not just the pain, but what the pain was doing to her inner life, and to her sense of herself as someone who wants.
Dissociation during painful sex is a common but rarely named experience. The body's strategy of mentally leaving the situation as a protective response can feel like a personal failure but is a recognisable nervous system pattern. Understanding it as protection - rather than weakness - was part of how Sara began to rebuild a different relationship with intimacy. She also names the moment she realised she was the only person in the gynaecologist's office who cared about her pleasure; everyone else was focused on managing the pain.
"I kind of dissociated at some points. This pain was kind of me in the Advil versus the world... it just became so part of my norm."
What sex therapy adds that physical treatment alone can't
Pelvic floor physiotherapy addressed the muscular and hormonal drivers of Sara's vulvodynia, and that work was meaningful. But a sex therapist offered something different: a framework for thinking about desire, arousal, and intimacy that wasn't oriented around restoring penetrative sex as the goal. The distinction matters because a lot of standard treatment advice - dilators, lubricants, pain management - is implicitly aimed at a fixed endpoint that may not actually be the right one for a given person.
Working with a sex therapist helped Sara recognise that desire doesn't have a correct form that pain has temporarily blocked access to. It helped her move toward rebuilding a relationship with her own sexuality on her own terms, rather than toward a previous version of herself that no longer applied. For listeners who have done the physical work but still feel disconnected - from themselves, from partners, from wanting - this section of the conversation is likely to be the most useful.
"Think of it like this boiling pot of water - what is making it boil more, and what is your flame? What is even turning it on to begin with? It could be many reasons, which was really hard."
Writing Shamelessly: why putting language to pain matters
Sara founded Writing Shamelessly as a creative writing consultancy, and the act of writing about vulvodynia - in Women's Health and elsewhere - has been part of how she makes sense of her experience. She talks about why writing about chronic illness is different from writing through it: the challenge of putting language to something the medical world still struggles to describe accurately, and why finding an audience for that writing has mattered to her.
For listeners who are trying to make sense of their own experience, or who feel isolated in it, Sara's work is a reminder that language is one of the tools available. Whether that means writing, speaking, or simply finding the right words to use with a doctor, naming what is happening is not a small thing. It is often where advocacy, connection, and a sense of self begin to rebuild.
