There are pains that announce themselves loudly, and there are pains that are carried quietly for decades — hidden under clothing, hidden under false smiles, hidden under the forcefully instilled belief that “this is simply how my body is now.” This is the story of one such pain. The details of the patient have been changed to protect her privacy, but her suffering — and her recovery — are real, and they deserve to be told.
A Wound That Never Fully Healed
She walked into our clinic fifteen days ago — a 33-year-old woman, mother of six, carrying herself with the quiet composure of a courageous someone who has spent years learning to function despite pain rather than because it was never addressed. As a child, she had undergone female genital cutting (female circumcision), a barbaric practice still performed on girls in parts of the world in the name of tradition. What was done to her that day was never meant to be spoken of again. But the body remembers what the mind tries to bury in silence.
For years, the scarred tissue sat quietly, exquisitely tender but tolerable. Then came marriage at the age of . Then came intimacy. And with every attempt at closeness with her husband, what should have been a source of pleasurable connection became a source of dread — a deep, tearing, burning pain radiating through the scarred region and all the tissues around it. Within a span of a brief ……years, six pregnancies and six deliveries later, stretched and repeatedly re-injured tissue compounded the original trauma many times over.
By the time she arrived at our clinic, the pain had crossed a threshold most of us can barely imagine. She could not wear underclothes — the friction of fabric against her skin was unbearable. Sitting for even a short while triggered a sensation she described simply as “on fire”. Every day had become an exercise in avoiding her own body.
She stoically stated in her history that her husband had sent her to India for treatment because it was difficult for him to remain aroused in the presence of her obvious flinching in distress
Why This Kind of Pain Is So Hard to Treat
Cases like hers sit at a painful intersection — part physical scar of a distorted normalcy, part nerve injury, part years of the body and mind dreading the pain but learning to brace against anticipated pain. The branches of pudendal nerve in the perineum ( part of the body that comes in contact with a cycle seat) and other sensory nerves of pelvis, having been damaged by the genital cutting and repeatedly irritated and sensitized over decades of pregnancy and deliveries, don’t just transmit pain — they amplify it by a process called peripheral and spinal sensitization whereby increased traffic in the pain pathway renders it unduly hypersensitive. Ordinary touch gets processed as a painful threat (allodynia) . Sitting becomes agony. Sexual Intimacy becomes impossible because of excruciating pain, devoid of any semblance of pleasure .
Currently treatment options for chronic pelvic and vaginal pain are genuinely limited, because the mainstream pain management doggedly pursues nerves for treatment more or less ignoring the muscles and few clinicians are trained to approach it comprehensively. As a result, most women in her position are simply never given a diagnosis at all but told to “manage” it with the prescribed painkillers and neuromodulator medications that dull the edges without touching the source. Many stop seeking help entirely — not because the pain has gone, but because they’ve been told, implicitly or explicitly, that this is just what their life looks like now.
At Ashirvad we refuse to accept that answer.
The Treatment: Precision Over Guesswork
After a detailed pain mapping and clinical assessment, we built a targeted, multimodal interventional plan:
Caudal epidural infusion of local anaesthetics – to calm the inflamed and hypersensitized nerve roots feeding the pelvic floor and perineal region, continuously interrupting the pain-amplification cycle at its source for a protracted period of 7 days.
Botulinum toxin (Botox) injection – to relax the chronically contracted pelvic floor and scar-adjacent musculature that had been in a protective but painful spasm for years, a spasm that was, by now, a major pain generator in its own right.
Ultrasonography-guided dry needling – to precisely target and desensitize the specific myofascial trigger points around the site of the original scarring as well as the rest of the perineal muscles that form the pelvic floor under real-time ultrasound visualization for accuracy and safety in such a delicate region.
Each step was deliberate. In a region this anatomically sensitive and emotionally charged, there is no room for approximation — every needle placement was image-guided, every intervention layered to address a different piece of a complex, compounded pain puzzle.
From “I Can’t Sit” to “I’m Ready to Go Home and Live”
The change did not happen overnight, and we did not expect it to. But across her follow-up sessions, over the past fortnight the transformation has been remarkable. The burning that once made sitting unbearable has quieted. She can now wear underwear without distress — something so ordinary to most of us, and something she had been denied for years. She is, in her own words, ready to go home and finally *enjoy life.*
She is not “pain-free” because the years of trauma disappeared. She is pain-free because, for the first time, someone treated her pain as a medical problem with medical solutions — not as an inevitable consequence of something that happened to her as a child.
The Bigger Picture
Female genital cutting affects millions of women and girls globally, and its consequences don’t end when the wound closes. Chronic vaginal and pelvic pain, painful intercourse, and nerve-related complications may persist for decades — often unspoken, undiagnosed, and untreated, simply because women don’t know that help exists, or because they’ve been made to feel this is a burden they must carry alone.The academic medical world also offers few articles to explain or understand the problem may be because it is “taboo” to emphasize the horrors of a barbaric custom that has been ingrained culturally in some parts of the world
BUT IT ISN’T.
This case was one of the most difficult we have managed — anatomically complex, emotionally layered, and with very few established treatment pathways to follow. But it is proof of something we want every woman reading this to know:
Chronic pain — even pain rooted in trauma decades old, even pain that feels unspeakable — is treatable. No one needs to live with it in silence.
*If you or someone you know is living with chronic pelvic, vaginal, or post-traumatic pain, know that specialized, compassionate, interventional pain care exists. You don’t have to accept pain as your normal.
