On Friday I mentioned that two discussions occupied our time on the car trip down to the in-laws. First, a calm conversation about our current feelings on adoption. That one I’ve already reviewed. The bigger land-mine was when conversation changed (as it so often does) to a discussion of our sex life. If you know me and Mr. But IF in real life, this is your warning that you may not be able to look us in the eyes after this one. I give you full permission to look away.
First, as a bit of a preface, this is going to be a hard post to write. But, one of the many things infertility has taught me is that, in almost all cases, the things you find hardest to discuss are often those things that must be discussed. Sex is one of those things. Deep breath…
Once upon a time a precocious college lad met an inquisitive young lass. A few walks home from class, a hilariously failed phone call (remind me to tell you about that one some time!), and, ultimately, a first date. A date that turned into an all night conversation at a doughnut shop. That turned into an all morning snog-fest in the dorm room. That turned into a let’s skip class and stay in bed all day. I hear Mr. But IF now, shouting into the screen, “We didn’t go all the way that first night!”, and that’s true my dear readers. I think we waited, er, 48 hours?
I was a late-ish bloomer – at 18 Mr. But IF was only my third kiss – but it was opportunity not motivation that had held this overachiever back. Worlds of experience separated me from my man, and I wanted to make up for lost time! And make up we did.
Three years of daring college escapades, uncomfortable public over-sharing, and (barely) evading roommates later, the man I thought I’d learn a little from became the man I wanted to spend my life learning alongside. We started dating at 18 and 21, were engaged at 20 and 23, and married at 22 and 25. I never saw any of that coming, but, looking back, the results have been better than I could have dreamed. Since we largely grew into adulthood together, we’ve grown together through all those changes as well. I never expected to be married so young, but I’m happy. Well and truly happy.
Yet, somewhere in the months before our wedding something changed. We went from a couple that thrived on brassy exploits in physical intimacy, to a couple in which one partner (myself) lost all desire. I blamed grad school stress, I blamed the difficult process of learning to live with someone, I blamed my increasing weight and the seemingly unending process of grieving my mom, I blamed the wedding. Despite years of really good sex, I hatched a plan that now makes me look back and shudder. “You know what would make the wedding night special,” I coyly queried. “How ’bout we totally abstain until then?” I watched my future husband turn a shocking shade of bright white, and, bless the man, he consented. If I’m totally honest with myself, I, on the other hand, felt deeply relieved. I was tired of sex, and, though I couldn’t quite put a finger on it then and there, I now know why. I wasn’t crazy, getting older, or under stress (all things suggested to me by the medical community). I was in pain, physical and emotional. And, unfortunately, the worst had yet to come.
During our early years together I was on the birth control pill. In fact, I was on it before I needed to be on it for the usual reasons. It was prescribed to me to calm the extreme pain I had during my menstrual cycles (you know, that sign that I was just an overly sensitive weak woman) and I was given birth control as a curative to my ever absent cycles. While to many women (and men) it may sound awesome to only cycle once every year, it’s less awesome when your period crashes the party that one day you wore white pants in the past 10 months. And, it’s absolutely less awesome once you do, indeed, become sexually active. There’s nothing like taking a pregnancy test every day for 10 months while you wait for your cycle to return and endlessly Google “false pregnancy test, but still pregnant?”
Then, coincidental to our becoming engaged, moving, and planning our wedding, I was taken off of birth control by a horrid former doctor. She didn’t like that my blood pressure was “a little high” the one time the nurse took it. To this day it still stuns me that all medical practitioners think it is totally sensible to assess your BP first thing after the marathon-running “I don’t have time for this” nurse chases you back into the exam room and asks you to strip from the waist down. I personally think all pills for Viagra should be revoked if there’s even the mildest elevation in a man’s blood pressure as the glove is slapped on for his prostate exam. So, anyway, despite no history of elevated blood pressure, I was off the birth control. My cycles disappeared, and, on the rare occasions that they did reappear, I missed several days of classes vomiting and writhing in pain on the floor of my apartment. From February to November of 2004 I had no period, I saw my first (of now hundreds of) negative pregnancy tests, and I went to the doctor at our student health center. One more pregnancy test and he simply said, “You likely have PCOS. You’ll probably be infertile, but otherwise you are fine. Here’s a prescription for a drug to jump-start your cycle. Need some condoms?”
So, by the eve of our wedding I was fat, possibly infertile, stressed, and in pain. And I could never wear white pants. Oh, and one other lovely realization. Sex hurt. Sex hurt badly. It felt like my entire body was a walking, talking, aching muscle. Tell me that’s not a turn on? But, young, embarrassed, and ashamed I held it back from my future husband. It was, after-all, just the stress, just the worry, just getting older. It would be fine once we were married.
A month before our wedding I went to a new doctor to get a new prescription for birth control. She gladly consented and was actually a little taken aback when I told her why I’d been taken off of it in the first place. To be on the safe side I was prescribed a low-dose option, but I never again had a single questionable blood pressure reading (until, that is, it started bottoming out during the hey day of my undiagnosed Hashi’s). Fast forward to holy-moly-sex-is-awesome! See, it was the stress after-all! But, why am I so constipated?
I finished my graduate degree, I got a “real” job, and along with the job came a “real” doctor. We discussed my past, I complained of some issues (severe chronic constipation, emotional ups and downs, easy bruising), so she decided to change my birth control. Bad move, doc. Bring on the emotionally abusive, desire-less, wife from hell. But, laying it out like that, it makes it seem so obvious. Change in pill leads to change in health and happiness so just stop taking the pill, right? But, we didn’t know it was the pill. I mean, hell, it’s the birth control pill. It’s the pharmaceutical equivalent of a tic-tac. Pop one a day and all worries away, right? Surely it wasn’t the pill. It was depression, it was IBS, it was stress, it was poor diet… it was anything but the pill. I had X-rays, I had blood work, I went to counseling, I was referred for a colonoscopy three times (but thank God their scheduler always managed to forget to call me back). I accepted that this was my life now and there was nothing to be done about it.
Then, in 2010, we decided to start a family. I dumped the birth control and, at least in the beginning, it was wonderful. Pain-free sex, desire (now fueled by the “holy crap we’re making a baby” phenomenon!), emotional stability. Then, that first crippling period. Then, 50, 60, 70 days without another. Then the return of the pain. I sucked it up and rolled with the pain of sex. I can’t count the number of pep talks I had with myself in those early days. “You want children, you need to have sex, your husband doesn’t deserve to see you in pain. Smile, moan, say how much you want it!” Months rolled by, I had no periods, and I certainly had no positive pregnancy tests. Visit #1 to the PCP was the, “Give it time, you’re young” visit. Visit #2 was the “For some people it takes time to regulate after birth control” visit. Visit #3 was a pep talk from my OB and a reminder to keep taking prenatals (which I’d been taking already for 9 months). Visit #4 I was referred for a colonoscopy (which I again didn’t have). Visit #5 I was told my acne could be corrected after we were done having our family since most treatments weren’t pregnancy safe. Visit #6 I’ve recounted already. As the diagnoses rolled in I still had pain but I thought I had all my answers. Hashi’s and PCOS were the be-all, end-all of my health and happiness problems over the past few years. What couldn’t be explained away by that evil duo were most certainly the result of infertility-induced depression and self-loathing.
But, they weren’t. On November 18, 2011, we terminated our first pregnancy that my OB coolly told us was “almost certainly” in my tube. In January 2012 my first RE gave us the news that both my tubes were, in fact, blocked. And, in February 2012 I had an exploratory laparoscopy that uncovered Stage II endometriosis of the ovaries, tubes, and bowel. The day I woke up from surgery was the day I realized what life was supposed to be like all these years. Even while still in pain from incisions and CO2, I felt better than I had in years. Bowel movements weren’t a painful occurrence that happened once a week, they were a morning celebration of my new found health. (Turns out having your bowel adhered to your abdominal wall kinda messes with you.) My periods were a walk in the park. I mean, seriously, I could take a walk in the park while on my period. I could LEAVE MY HOUSE while on my period without fear of public vomiting and physical breakdown. Oh, and sex. It was AWESOME.
For a while. It’s now been just over a year since my surgery, and I fear the pain is returning. Endo is a stubborn little bitch. She’s always lingering there, just under the surface, waiting to pounce the next time your body goes through the normal hormonal changes associated with a complete menstrual cycle. Multiply this times 100 when (most) fertility medications are used. In 13 months I’ve had 3 cycles off of birth control and 1 pregnancy that lasted until 9 weeks. Yet, here I sit, back on birth control for fear endo is coming back to get me. But, again, that makes it sound so simple. Don’t forget the nagging head games. Is that constant bowel pressure endo, or should I not have had that piece of cake last night? Was that 1 painful session of intercourse from endo, or just a bad position? Is my drive gone because of fear of pain, or because WTF my body just killed my third baby?
So that brings us to Friday and Mr. But IF’s (very poorly timed), “When do you think we’ll ever have sex again?” “I don’t know!” I screamed. “It hurts so bad!” I admitted. “It’s not that simple!” I implored. Whether I like it or not, our sexual encounters are now intimately connected to my fears of my future (failing) health and memories of my past failures to both achieve and maintain a pregnancy. This, in turn, leads to a frustrated partner, at best, and a man that feels reduced to a sperm donor, at worst, since the only time I apparently am able to get “in the mood” is when I know I have to for the sake of making a baby. Add to this some long gone memories of my past precociousness, inflammatory statements on both sides, a bucketful of tears, and an unhealthy bantering about of differing connotations of the words “selfish,” “pig,” “ignorant,” “bitter,” and “asshole,” and it makes for a truly thrilling drive down the highway at 70mph.
I wish I could say that we solved our problems on that drive, but these problems aren’t solve-able. The best I can promise is to remain open about what I’m feeling, and the most I can rightfully hope for in return is understanding. And, it goes both ways. I know I often make myself out as the martyr. I hurt, I miscarry, I get ignored by doctors. In the heat of the moment I ridicule Mr. But IF for having the nerve to discuss his sexual wants while I’m wondering when/if the time will come when my endo gets so bad I’ll need a bowel resection, or how much that brand of birth control that leaves me with some drive will effect my thyroid levels, or whether or not the sex will “count” given my expected date of ovulation. It’s easy to minimize the importance of physical intimacy in a marriage when one partner is constantly waiting for the other shoe to drop. And, in that process, make out one partner’s needs as optional upgrades. Intimacy in marriage shouldn’t be an upgrade, though, it should be a foundation. One of many foundations, yes, but a foundation all the same.
Truth of the matter is, as this heart-breakingly accurate post from the blog “My Free Mind” details, not all battles with infertility have happy endings. And, that’s one of the shittiest aspects of infertility — you just don’t know where you will stand when the smoke finally clears. I do not know whether I will ever be a mother, but I do know I’m capable of being a wonderful partner. I’ve been madly in love with my husband since that afternoon standing under the trees outside my dorm room discussing barbers, pocket watches, and history class. Our marriage will not become a casualty of endometriosis, inept doctors, and infertility.