Vaginal infections TMS?

[Time2be]

Some might remember, I had bladder and urethral pain for a long time. I was not successful then in 2017 and 2018 with the TMS approach. I looked for medical treatment and found specialists who diagnosed me with chronic UTI. The treatment (antibiotics and Hiprex) helped, but since I still had periods of pain. Lately in spring this year they found two forms of infections (cytolytic vaginosis and aerobic vaginitis) in my vagina that cause much of the urethral burning I experience. Are these diagnoses real? I think so. These are diagnosis that are supported by evidence. And do they produce my symptoms? I think part of it is produced by these infections. However, I ask myself why I have them in the first place? It is often in periods of stress that the symptoms occur. And since a few years I have developed anxiety, I react with panic to the symptoms. And this makes it worse, of course. I guess I have a mixture of a structural health problem and TMS.

How to address this? I cannot tell myself/my brain, that nothing is wrong with me. I might need a test and see if I have to take medication (an antibiotic creme). This is counterproductive to the overall approach of TMS or Buglios perceived danger, because I tell my brain, yes, something might be there that has to be looked after. My reaction to my symptoms though is clearly formed by panic, anxiety, catastrophizing etc. I am seeing a psychologist, and I learned a lot. But right now I have again urethral and bladder pain, and I am asking myself, how to react properly? Latest research on neuropsychoimmunology show that there is a connection between your psyche and the immune system. Not so astonishing. I will continue to use the approach of Buglio, which seems to me the most straightforward one and I already had my share of journaling, psychotherapy etc. But there is doubt about what is infection and what is TMS. I also know that body and psyche are together in this. But this doesn't mean to not treat the infections?

Another thing: I am aware of the symptom imperative. I had this urethra bladder issue for a very long time (30 years), only interrupted by gastric discomfort. When I had these periods I had no pelvic pain. And the last three months I had dental work and issues, then the pelvic pain was most of the time gone. Now my dental issues seem to be solved for the time being and the pelvic pain starts again. It looks like my brain is perceiving danger and changing the site of symptoms.

 

[Adam Coloretti (coach)]

And this makes it worse, of course. I guess I have a mixture of a structural health problem and TMS.

Two things I'd consider that may mean this isn't necessarily true.

1. How many people have these findings with no symptoms? On a very brief search (and you'd know more about these than I do considering your research) it told me that especially with cytolytic vaginosis, having it with no symptoms is extremely common. This brings into question the idea that they are causing your symptoms.

2. To put it simply, most bacterial infections can and are cured by antibiotics (often with the exception of deep and internal infections, but you'd likely know if you had one of those). If the antibiotics don't seem to be working, then I'd be questioning the existence of the infection in the first place. Even the idea of a chronic UTI that's not responding to antibiotics makes me highly skeptical.

3. I'd also be considering other symptoms typically seen with these conditions. If you just have the pain, but no discharge (which often happens with both) or odour (which happens with aerobic vaginitis) - then yes whilst you will find it say that you can have it without those symptoms, I think not having it can be quite telling in terms of the TMS picture (because it lends itself to the idea that the pain in isolation isn't being caused by the infections).

Another thing: I am aware of the symptom imperative. I had this urethra bladder issue for a very long time (30 years), only interrupted by gastric discomfort. When I had these periods I had no pelvic pain. And the last three months I had dental work and issues, then the pelvic pain was most of the time gone. Now my dental issues seem to be solved for the time being and the pelvic pain starts again. It looks like my brain is perceiving danger and changing the site of symptoms.

This might be the best evidence of them all. For your theory that it's a mix of neuroplastic and also the infections causing it to hold, essentially the only way this makes sense with having basically no pain when having the dental work is that the infections magically resolved themselves within that period (that's the only way it makes sense if you're blaming the pain on them) only to magically return now that you have pain again. Why would your dental work resolve the infections? A better question is are you saying that the infections resolved and then came back in this periods? Doesn't make a lot of sense to me and that's a massive coincidence if so.

 

[Tooske]

Er zijn twee dingen die ik in overweging zou nemen, die erop kunnen wijzen dat dit niet per se waar is.

1. Hoeveel mensen hebben deze bevindingen zonder symptomen? Na een korte zoekopdracht (en u weet hier waarschijnlijk meer van dan ik, gezien uw onderzoek) bleek dat het, met name bij cytolytische vaginose, zeer vaak voorkomt dat er geen symptomen zijn. Dit zet vraagtekens bij de stelling dat deze bevindingen uw symptomen veroorzaken.

2. Simpel gezegd: de meeste bacteriële infecties kunnen en worden genezen met antibiotica (vaak met uitzondering van diepe en inwendige infecties, maar dat zou je waarschijnlijk wel merken als je die had). Als de antibiotica niet lijken te werken, zou ik me afvragen of er überhaupt wel een infectie is. Zelfs het idee van een chronische urineweginfectie die niet reageert op antibiotica maakt me erg sceptisch.

3. Ik zou ook andere symptomen overwegen die doorgaans bij deze aandoeningen voorkomen. Als je alleen pijn hebt, maar geen afscheiding (wat vaak bij beide voorkomt) of geur (wat bij aerobe vaginitis het geval is), dan is het inderdaad zo dat je het weliswaar kunt hebben zonder die symptomen, maar ik denk dat het ontbreken ervan veelzeggend kan zijn voor het TMS-beeld (omdat het de suggestie ondersteunt dat de pijn op zich niet door de infecties wordt veroorzaakt).



Dit is misschien wel het beste bewijs van allemaal. Wat betreft jouw theorie dat het een combinatie is van neuroplastische effecten en infecties die ervoor zorgen dat het aanhoudt, is de enige manier waarop dit logisch is, gezien het feit dat je tijdens de tandheelkundige ingreep vrijwel geen pijn had, dat de infecties zich in die periode op magische wijze hebben opgelost (dat is de enige manier waarop het logisch is als je de pijn daaraan toeschrijft) om vervolgens op magische wijze terug te keren nu je weer pijn hebt. Waarom zouden de infecties verdwijnen door de tandheelkundige ingreep? Een betere vraag is: bedoel je dat de infecties verdwenen en vervolgens in deze periode weer terugkwamen? Dat lijkt me niet erg logisch en het zou wel een enorm toeval zijn als dat zo is.

Same.. so hard to believe you’re do this to you… ugh. Worst thing ever in my life

 

[Time2be]

@Adam Coloretti (coach), thank you for your response, I did quite some research. You are right, there are women with no symptoms and CV and AV. However, many have symptoms. The case of chronic UTI is difficult. There is no medical consensus, but what is known is that bacteria invade the bladder walls and then are difficult to eradicate. There is so much new research all the time, I rely on what my specialists say, they are very cautious about misuse of antibiotics and know about central sensitization.

This said: the anxiety is the worst part of it. The pain is bad, surely. But the anxiety makes it so much worse. I still work, but I am not really effective. And waves of anxiety all the time. And it is not clear to me anymore why. Because I have this condition for 30 years and in the first 15 years I was shocked at first, and then accepted it as a psychosomatic disorder, so I was actually indifferent to the pain. Didn't help though. I am really struggling with anxiety now.

System imperative: yes, this is evidence. Right now the tooth is in pain again, together with the bladder. But I have this phenomenon that one pain subsides and the other rises. In the case of infections: they are an imbalance of the microbiome, one type of bacteria can take over in a period of stress when the immune system is low or altered. These are always bacteria you already have in your body, so not what we think an infection is, like a bad bacteria invading from outside. This fact doesn't rule out TMS, instead does it rule in TMS, because it has to do with our overall state of the mind and the body.

 

[Adam Coloretti (coach)]

thank you for your response, I did quite some research. You are right, there are women with no symptoms and CV and AV. However, many have symptoms. The case of chronic UTI is difficult. There is no medical consensus, but what is known is that bacteria invade the bladder walls and then are difficult to eradicate. There is so much new research all the time, I rely on what my specialists say, they are very cautious about misuse of antibiotics and know about central sensitization.

Welcome Do you have the other symptoms, or just pain?

and then accepted it as a psychosomatic disorder, so I was actually indifferent to the pain.

Are you still accepting of it? Because it seems as if you're not sure now.

In the case of infections: they are an imbalance of the microbiome, one type of bacteria can take over in a period of stress when the immune system is low or altered. These are always bacteria you already have in your body, so not what we think an infection is, like a bad bacteria invading from outside. This fact doesn't rule out TMS, instead does it rule in TMS, because it has to do with our overall state of the mind and the body.

You're saying though that the symptoms are in part caused by the infections - but if it is swapping like this how can that be? For this to be true, it just so happens that when you had dental work that was when the infection disappeared (which is even more unlikely because that was a time of stress, assuming you're correct and the microbiome is being impacted by stress, which makes sense), and when that pain died down the infection (or imbalance) just so happened to come back (that's the only way it makes sense if the infection/imbalance was causing the pain - because otherwise if the infection/imbalance was there the whole time it obviously wasn't the cause of the pain - if it was it wouldn't have largely vanished just because you had dental pain). That is a massive massive coincidence, and this being all caused by TMS and the infections being actually incidental and asymptomatic to me is a far more likely truth based on this swapping of symptoms.

 

[Time2be]

@Adam Coloretti (coach), this is going to be detailed: What happened was that in 2026 after four months with pain (and some discharge and odor) (treatment among others antibiotic creme and then only the hormonal stabilizer Intrarosa) I was out of pain. Everything was good in July and beginning of August. When then my tooth problem started I had the odd day with bladder pain, but it subsided again. Now, when the dental work is finished for now (but there is still pain sometimes) the urethral and vulvar pain started again like one and half week ago. Before it was there, but only occasionally.
My explanation is, in very simplified words: my brain is sensing danger all the time, this puts the nerve system in high alert and all sorts of sensations can then be highjacked and become chronic. The imbalance of the microbiome is then a result of what the brain is doing, but it still is a biological fact. If I could reverse the imbalance with the TMS approach that would be wonderful. I tried that for many years without knowing at that time that I had this imbalance of the microbiome. The pain periods would always be about 3 to 5 months and when it got better, this did not last. So, I found that taking some medication sometimes is helpful. But all this leaves me a bit in a grey zone between biology and mind. As I said, 15 years I treated this as purely psychosomatic, I did not go to urologists etc. Instead I tried to find out what was bothering me, emotions behind this. Maybe it diminished the periods of pain a bit, and I didn't have this kind of anxiety that I have now. That changed after 15 years when I wanted to have a more proper diagnosis, which was then the first 8 years a nightmare with different doctors, very different diagnosis. First with the specialists I am seeing since 2020 I made some progress, there were years with very little pain. This year is unfortunately different. I do not really know why, anxiety got worse again. Maybe my old parents that need care now, but I am living far away and have to travel every second month. I never had a good relationship with my parents and it is very hard to be the caring child for parents with dementia. My sister is helping a lot and we are waiting for two places in a nursery home. There are other things that stress me, my work, the situation at my work place, that I feel often lonely etc. Objectively my life looks good, subjectively it is like I am not really inhabiting my own life. And everytime I think I am out of the woods, like this July, something else hits me, or the urethral pain comes back.
I am open for the thought that another mind set would diminish my symptoms. That is a possibility. And maybe I didn't do it the right way the first 15 years. In another post you told me to have self compassion. I think that was missing then, I was always pulling through, but I was not kind to myself.

 

[Tooske]

@Adam Coloretti (coach), dit wordt in detail uitgelegd: Wat er gebeurde, was dat ik in 2026, na vier maanden met pijn (en wat afscheiding en geur) (behandeling onder andere met antibiotische crème en daarna alleen de hormoonstabilisator Intrarosa), pijnvrij was. Alles ging goed in juli en begin augustus. Toen mijn tandprobleem begon, had ik af en toe een dag met blaaspijn, maar dat verdween weer. Nu de tandheelkundige behandeling voorlopig is afgerond (maar er is soms nog steeds pijn), is de pijn in de urinebuis en de schaamlippen anderhalve week geleden weer begonnen. Daarvoor was het er wel, maar slechts af en toe.
Mijn uitleg is, heel simpel gezegd: mijn hersenen detecteren constant gevaar, waardoor het zenuwstelsel in opperste staat van paraatheid verkeert en allerlei sensaties kunnen worden gekaapt en chronisch worden. De disbalans in het microbioom is dan een gevolg van wat de hersenen doen, maar het blijft een biologisch feit. Als ik die disbalans met TMS zou kunnen herstellen, zou dat fantastisch zijn. Ik heb dat jarenlang geprobeerd zonder te weten dat ik een disbalans in mijn microbioom had. De pijnperiodes duurden altijd zo'n 3 tot 5 maanden en als het beter ging, was dat van korte duur. Ik merkte dus dat medicatie soms hielp. Maar dit alles plaatst me een beetje in een grijs gebied tussen biologie en geest. Zoals ik al zei, heb ik dit 15 jaar lang als puur psychosomatisch beschouwd, ik ben niet naar urologen gegaan, enzovoort. In plaats daarvan probeerde ik te achterhalen wat me dwarszat, de emoties die erachter zaten. Misschien verminderde dat de pijnperiodes een beetje en had ik niet de angst die ik nu heb. Dat veranderde na 15 jaar, toen ik een betere diagnose wilde. De eerste 8 jaar waren een nachtmerrie met verschillende artsen en uiteenlopende diagnoses. Met de specialisten die ik sinds 2020 bezoek, boekte ik eerst wat vooruitgang; er waren jaren met weinig pijn. Dit jaar is het helaas anders. Ik weet niet precies waarom, mijn angst is weer erger geworden. Misschien komt het door mijn bejaarde ouders die nu zorg nodig hebben, maar ik woon ver weg en moet elke twee maanden reizen. Ik heb nooit een goede relatie met mijn ouders gehad en het is erg moeilijk om de zorg voor ouders met dementie op me te nemen. Mijn zus helpt veel en we wachten op twee plekken in een verpleeghuis. Er zijn ook andere dingen die me stress bezorgen, zoals mijn werk, de situatie op mijn werk, het feit dat ik me vaak eenzaam voel, enzovoort. Objectief gezien ziet mijn leven er goed uit, maar subjectief gezien voelt het alsof ik niet echt leef. En elke keer als ik denk dat ik de ergste fase achter me heb, zoals in juli, slaat het weer toe, of komt de pijn in mijn plasbuis terug.
Ik sta open voor de gedachte dat een andere denkwijze mijn symptomen zou kunnen verminderen. Dat is een mogelijkheid. En misschien heb ik het de eerste 15 jaar niet op de juiste manier aangepakt. In een ander bericht zei je dat ik zelfcompassie moest hebben. Ik denk dat dat toen ontbrak; ik kwam er wel doorheen, maar ik was niet aardig voor mezelf.

I have the same: it’s so hard with the bladder stuff…

 

[Adam Coloretti (coach)]

Everything was good in July and beginning of August. When then my tooth problem started I had the odd day with bladder pain, but it subsided again. Now, when the dental work is finished for now (but there is still pain sometimes) the urethral and vulvar pain started again like one and half week ago.

That all makes sense and I agree with you about the biological fact, I'm probably jumping around a bit too much so my main point is getting lost.

The key question is: With this imbalance (which is a biological fact) is it causing (either fully or in part) your symptoms, or is it just a coincidence and asymptomatic (in much the same way as many bulging discs in the back are - and therefore the symptoms are TMS)?

I'm keen to understand how you understand what you just described (as in how it makes sense) - essentially the symptoms have been up and down and ramped up when the dental work and pain was largely over. To me. there's two possibilities:

1. You've had the imbalance the whole time. If that's the case, it's pretty difficult to say that the imbalance is causing the symptoms, because if it was (and you had the imbalance for the whole time) then these fluctuation of symptoms (they aren't minor fluctuations either) don't make much sense (and that's pointing towards TMS), or:

2. You're of the belief that the changes in symptoms coincide with the microbiome going in and out of balance. Whilst I appreciate this is possible, to me it's a massive coincidence that this just so happens to align well with the beginning and ending of the dental work and pain. I.e. Just as the dental pain began the microbiome went into balance, and then coincidentally again once the dental pain subsided that's when it went out of balance again. To me, that's a massive coincidence and TMS makes a lot more sense (as it is reflective of the symptom imperative). Additionally, you're saying that the microbiome goes in and out mainly due to stress, but then wouldn't it have gone out of balance (and therefore caused symptoms) at the time of the dental work itself given how stressful that was? That doesn't make sense based on that theory.

Either way, the evidence of TMS is strong.

 

[Time2be]

@Adam Coloretti (coach), I get your point and thank you that you clarify things. It would be much easier for me to see all my pain as TMS and the imbalance like a MRI that doesn’t mean much. Unfortunately, the different enterococcus species in my vagina caused really bad inflammation, which is visible and seen under the microscope. And the antibiotic creme helps.

No, I do not have this imbalance all the time. It was gone in July and August, but then came again now in November. I had last year long periods without pain and my tests were negative. And yes, I believe that part of my pain is correlated with this imbalance called CV and AV. But not all of my pain is due to this. I have of course learned pain also, like when I have a conference I sometimes have pain. That subsides immediately after the stressing event. This is pure TMS so to speak. I do not speculate about what was first, the imbalance and then chronic TMS pain. I cannot know this. But I can differentiate the kind of pain I have: pain from the imbalance that is best tackled with medical treatment, pain from TMS that I learn how to address, and a few times I had really bad bladder pain with many leukocytes in urine, that needs antibiotics.

I am not saying that mystically when the dental problem stopped the imbalance just starts like this. I am convinced that this imbalance is a reaction to my brain to perceive danger. Only, that this reaction causes changes in the biochemistry, that might be reversible on its own, but it takes time and is very painful. For years I tried to accept all pain as TMS or psychosomatic, but it always came back. It always ended also, but sometimes it was a constant up and down.

My point was only that sometimes you have a structural thing AND TMS.

 

[Adam Coloretti (coach)]

I am not saying that mystically when the dental problem stopped the imbalance just starts like this. I am convinced that this imbalance is a reaction to my brain to perceive danger.

It does seem like quite the coincidence though - like I said too, I would think the dental work would be the height of your brain perceiving danger, so why then wouldn't the biochemistry have changed for the worst then and then you would have had the bladder pain very intensely alongside the dental pain?

Also, why did you have no pelvic pain when you had gastric discomfort? Are you saying during that time that your microbiome was balanced, but then the whole other time (the rest of the 30 years) it wasn't which explains the pain (assuming that the imbalance is contributing to the pain, that would have to be the case)? It's up to you as to how you want to interpret that, but to me that doesn't make a lot of sense structurally.

My point was only that sometimes you have a structural thing AND TMS.

This is true but it is actually a rare occurrence. I'm not saying it's definitely not happening here, but you have to look at the evidence closely I feel to discern. All I'm saying is that to me there are pieces of evidence suggesting this is wholly TMS (which is a lot easier to treat from a TMS perspective - and allows you to embody the fact that nothing is wrong). Like I said above, I can't force you to believe anything, but if I can at least get you to question this (because you seem quite sure) based on the evidence then that's enough.

In saying that, assuming you're correct (and it makes a lot of sense) that the stress is causing the imbalance - technically I think you can tell yourself that there's nothing at least seriously wrong and not be lying to yourself. Whilst yes, it may still need treatment, as long as you're safe by taking that treatment, then there's nothing terribly wrong that can't be treated (at least treated enough so that it isn't a serious issue). It's like someone who gets bad TMS rashes. Assuming the rash is treated and doesn't get infected, the person is still technically ok and safe (despite the stress expressing itself in the body).

 

[Time2be]

@Adam Coloretti (coach), thank you again. I think my main concern is exactly this:

Whilst yes, it may still need treatment, as long as you're safe by taking that treatment, then there's nothing terribly wrong that can't be treated (at least treated enough so that it isn't a serious issue). It's like someone who gets bad TMS rashes. Assuming the rash is treated and doesn't get infected, the person is still technically ok and safe (despite the stress expressing itself in the body).

Right now I use the antibiotic creme my specialist recommend and the pain subsides very clearly. And it did that before. I do not think it is a placebo effect. I was torn between not using medication at all (because it wholly is TMS) and using medication (because part is structural). But maybe this is a unnecessary distinction. I think it is as you say for a person with a rash, that needs treatment, but is caused by TMS.

t does seem like quite the coincidence though - like I said too, I would think the dental work would be the height of your brain perceiving danger, so why then wouldn't the biochemistry have changed for the worst then and then you would have had the bladder pain very intensely alongside the dental pain?

Also, why did you have no pelvic pain when you had gastric discomfort? Are you saying during that time that your microbiome was balanced, but then the whole other time (the rest of the 30 years) it wasn't which explains the pain (assuming that the imbalance is contributing to the pain, that would have to be the case)? It's up to you as to how you want to interpret that, but to me that doesn't make a lot of sense structurally.

I understand your skepticism, but this is how it works for many: one pain disappears the other takes over. My brain was very much occupied with the dental problem, no time for attention to genital pain (although it was sometimes there). When the dental problem seems halfway solved, the genital pain gets attention again. There is a point where medical treatment seems reasonable, however, I know it is a crutch.

 

[Adam Coloretti (coach)]

Right now I use the antibiotic creme my specialist recommend and the pain subsides very clearly. And it did that before. I do not think it is a placebo effect.

Fair enough! That makes sense and you know best given your history

I understand your skepticism, but this is how it works for many: one pain disappears the other takes over. My brain was very much occupied with the dental problem, no time for attention to genital pain (although it was sometimes there). When the dental problem seems halfway solved, the genital pain gets attention again.

I'm well aware of it and see it all the time - it's the symptom imperative and it's a very strong TMS indicator. I'm not skeptical of it happening in the sense that I don't believe you, my point is that it is indicative of TMS - if it were structural (I appreciate the fact that you think it's a mix, that's fair enough) then it wouldn't care what was happening with your dental work - it would just hurt consistently (i.e. the attention you give it wouldn't have that large of an impact). To use an example, if someone had a herniated disc pressing on a nerve (something structural in nature) their agony wouldn't be lifted by the presence of a migraine (maybe very slightly), it would still very much hurt when the nerve compression is triggered (such as when walking) - both things would hurt at the same time (it's not largely going away to the point of sometimes not being there, such as what you've experienced). You're preaching to the choir here in terms of the phenomenon of the symptom imperative, I'm simply highlighting what it means.

no time for attention to genital pain (although it was sometimes there).

Exactly - so if something can be that impacted purely from your attention - how can it not be TMS? For it to be structural you'd essentially need to argue that your attention here is changing something structural within you (to explain the changes in pain - that's why I brought up the microbiome because to argue it's structural it would mean that the microbiome had changed here between when you had symptoms and didn't, but it likely didn't and as you highlighted the only thing that changed was your attention, if that is the only thing that changed then it's fully TMS) - makes far more sense as TMS from what you've shared.