Kooka on Fire

Issue 37 • Spring 2018 • Nonfiction

I move to New York in June 2016 after spending a year living in France. I’m excited to be back in the same country as my boyfriend, Will. My first week here, I walk to view an apartment with a broker. Between Sixth and Seventh Avenue, I feel a tremendous stabbing in my left side. I ask myself “Cramp?” and when it continues, “Hospital?” and when it subsides 10 minutes later, “Don’t be dramatic.” Later that week, Will and I try to have sex—try being the operative word, because about two minutes in, my teeth clench with pain and we stop. I’m not trying to brag, but Will and I used to have fabulous sex. 

I make an appointment on Zocdoc for my annual gynecological check up with a random doctor who accepts my insurance and whom I assume to be female. Dr. Durig turns out to be a no-nonsense man whose smile always remains in the horizontal axis. He tells me he’ll be doing a vaginal ultrasound, which I’ve never done before, but I am glad he does it, because as he’s taking a tour of my uterus, he points to a small blob on the screen. 

“That’s blood,” he says. “Did you experience any sharp pain in your side recently?” 

I tell him about the horrible cramp I had two weeks earlier on the way to meet the broker. “Yup, you had an ovarian cyst erupt, a pretty substantial one. Your left side. Come back in two months to check on it.” 

A few weeks pass and I can’t have sex at all. There is a searing, stabbing sensation at the base of my vagina that brings tears to my eyes and renders me inarticulate. I go to Dr. Durig again. “You must be stressed; try a lubrication gel,” he says, as though this is very novel thing to do. 

I go to a doctor in Midtown East who has a basement office and zero bedside manner. I go home to California and see my gynecologist there, who prescribes me an MRI, a blood test including blood count, a chemistry panel, tumor marker Ca125, sed rate, and 300 milligrams of gabapentin, which is used to treat nerve pain. “Try to have sex at least once a week,” she tells me. A prescription for intercourse. 

Will and I try. While the nerve pain subsides for about a month, I begin to feel as if I am being impaled, as if my boyfriend’s penis has a razor’s edge. I cry a lot. He hugs me a lot. We kiss, we sleep in the same bed, and yet when we watch movies together and the characters begin taking off their clothes, I watch Will watch the fornication, the thing we can’t do, the thing we used to do.

“Are you feeling, you know, in love?” my mom asks me as we walk the dog while I’m visiting home. 

“Maybe you’re frigid,” my father tells me over a gin and tonic, and I resist the urge to throttle him. 

“Try butt stuff,” my friends tell me as a joke. 

A year goes by. 

One day in mid-October 2017, I’m on the phone seething to my mother after being told a specialist at Stanford Medical can’t see me for another six months. When I hang up my roommate Dana says, “This shouldn’t be this hard.” Her father knows someone who knows someone, and I am swiftly emailed by the personal assistant to the Gynecology Chief at the foremost research hospital in New York—would I like to make an appointment, can the doctor assist me with anything else in the meantime? This is the world of medicine I both despise for its elitism and am grateful to, privilege rearing its head for the bodies it is asked—in even-keeled, well-educated voices—to listen to, while those it does not know continue to suffer. When I show up to the appointment, there are three people waiting ahead of me, but I’m herded in first. 

Something very interesting happens: I am listened to. For 40 minutes, I speak to a nurse practitioner named Andrea who asks me everything from my sexual history (pleasant but not noteworthy, no double digits) to my pubic hair removal preference (waxing when I find a good Groupon) to the amount I douche (never). She asks about my pain, my stress level, my exercise regimen. She doesn’t write things down because she’s too busy looking me in the eye. I want to thank this woman for the free therapy but I’m also questioning whether I’m going to have to do this whole routine again when the doctor enters, in which case I’m going to be stupendously late to work. When I’m done talking she says she’ll be right back in with the doctor, can I remove my clothing from the waist down and put this sheet over me? I can. I play Bubble Shooter pantsless for ten minutes. 

Andrea returns with a skinny man who greets me warmly: “Andrea told me about some of the issues you’ve been having; okay if we do a physical exam?” I’m confused, but deeply grateful: Andrea sat with me and asked me the nitty-gritty because she knows what a profoundly difficult thing it is to tell a stranger, let alone a male stranger, about your non-existent douching habits and sexual pain. I leave with two diagnosed conditions whose names are vague and whose courses of care are even more nebulous: vaginismus, pain of the vagina with penetration, and vulvodynia, pain at the opening of the vagina. I leave with a referral to see a pelvic muscular specialist, a prescription for gabapentin six times stronger than the one I had before, and a gnawing sense of hope. 

When I see the doctor’s bill in the mail a week later for $400—the portion insurance refused to pay—I cross out my name and put my parents’ address. In the envelope, I put a $20 bill with a post-it—“My contribution.” My mother calls me when she receives it: “At least you have a sense of humor.” 

I think it’s important to say I’m lucky. I’m lucky to have support, both emotional and intellectual. I’m lucky to have insurance. I’m lucky to have parents who, in spite of my purported adulthood, have paid for every compound medication and doctor’s appointment, in network, out of network, deductible met or still a stranger, without complaint. “You have a rich person’s condition,” as my friend Kristy puts it. She’s not wrong. 

I research: The University of Michigan Medical School did a study in 2011 which found that about eight percent of women surveyed suffered from symptoms of vulvodynia. Other studies have found this number to be even higher—around 16 percent of women globally will experience vulvodynia at some point in their lives. And yet, only half of the women who had vulvodynia in the study sought treatment for it, despite experiencing pain for an average of about 12.5 years. Dr. Barbara Reed, one of the study researchers, opines that “a lot of women think this is just [how] they are, and that it’s as to be expected and nothing can be done.” 

When the six o’clock position of your vagina burns or stings or aches, you need to suffer for at least three months to receive the diagnosis of vulvodynia, according to consensus made by the Committee of the International Society for the Study of Vulvovaginal Disease. From there, there’s a number of treatments you can try: antidepressants, SNRIs (serotonin-norepinephrine reuptake inhibitors), anticonvulsants, opioids, hormone creams, lidocaine gels, all with the disclaimer: “It may take time to find a treatment, or a combination of treatments, that works for you.”

When I Google “Vaginismus,” I get angry. The Google tool “People also ask” pops up, and beneath it is: “Why does it hurt after having intercourse?”, “Why did it hurt when I had intercourse?”, and then “What is the definition of frigidity?” I remember my father’s words and I click the down arrow for the response: “Frigidity: Failure of a female to respond to sexual stimulus; failure of a female to achieve an orgasm (anorgasmia) during sexual intercourse.” 

Failure of a female. It is a fault of mine, of my body’s, to not achieve arousal. By experiencing pain, I fail—but fail whom? Myself? My partner. A 1994 study by Jane Ogden and Elaine Ward states that “Vaginismus should not be regarded as a psychosexual problem but as a psychosocial experience in which defenses have been created to protect the self.” I do not feel protected. I feel annoyed.

On November 21st, I go to Regenerative Pelvic Medicine, which is on the 20th floor of an ugly building in Midtown. The waiting room is playing Zen music, and there is a water pitcher with cucumber and lemon. I sign a lot of consent forms. Yes, you can text me. Yes, you can email me. Here is my emergency contact, my mother, and yes, you can tell her what’s happening. Yes, to HIPAA. Yes, I know this is out-of-network. Yes, I acknowledge that the following procedures will likely be out-of-network. I see words like injection, trigger point, levator ani, the coccygeus muscle, the pudendal nerve. I pretend not to see them.

I’m shuttled into the exam room, which is playing ocean sounds. I don’t feel like a beacon of tranquility yet. My vitals are taken, and Dr. Sykora emerges. She’s a petite woman who is very pregnant, which gives her the look of a breadstick with a bowling ball attached to it. “You must have a strong pelvic floor,” I tell her. She is gracious enough to laugh before she begins to ask questions:

Are you in pain when you walk? Are you in pain when you urinate? Are you in pain when you sleep? Are you in pain when you sit? No, no, no, no. 

Are you in pain during intercourse? Yes. 

When did it start? A year and a half ago.

Describe the pain. Sharp, stabbing, throbbing.

On a scale of 1 to 10? 10.

Unbearable? Unbearable.

Describe your course of care. I tell her about this “care:” four different gynecologists, each with their own non-solution. The vaginal ultrasounds. The bloodwork. The MRI with contrast I got at NYU, where I didn’t realize what “with contrast” entailed until I saw four syringes of jelly lined up on the MRI table like soldiers on parade and was given a maxipad for when it all inevitably gushed out of me later. The MRI returned displaying all structures normal, no signs of endometriosis. Ditto the bloodwork. The ultrasound showed more cysts on my ovaries, but none that were a sign of concern. I tell her about the $500 vibrator my gynecologist in California suggested, one that could get you to climax in 20 seconds, so that at least my sex drive could potentially start creeping back. I didn’t buy it—the cost of climax should be free. I tell her about the bespoke $300 cream the gynecologist in Midtown prescribed that made me feel a burning so bad that one day, curiosity got the best of me and I took a mirror to those parts. It looked as burned as it felt, scorched, angry red skin, a welt. 

“That’s odd,” the gynecologist in her basement exam room said when she saw me the following week. 

“Sorry.” 

I never know when to add that I’ve had a boyfriend this whole time. It feels defensive; I’m not just complaining and want to get nailed. No, I’m in a caring, happy relationship with a man whose patience seems limitless, who has transformed over the past year into someone who doesn’t even reach for me, doesn’t even try because he knows I live in fear of those moments, knows I’ll try to perform and knows I won’t be able to, or on the off chance I am able to, I’ll be waiting for it to end. I ask him why he stays with me and each time he laughs and says, “For more reasons than sex.”

Dr. Sykora begins the exam. We start from the outside: pressing on different parts of my abdomen, then on my hips, then on the outside of the vagina, and then she puts a gloved finger inside me. She asks me to do a kegel, the thumbs up of womanhood, and then asks me to do two more. 

“Are you releasing?” she asks me. 

“I think so?” I say.

She removes her gloves. “Let’s talk.”

I’m hoping she’s going to say something to the effect of: “You have a hot Cheeto lodged firmly at the base of your cervix; I’ll take it out real quick and then you’ll feel better.” Instead, Dr. Sykora tells me about the pelvic floor and the pelvic saddle, showing me diagrams and 3-D models. Lots of scientific words, but what it comes down to is nerve pain—the vulvodynia—and my pelvic muscles, which are in shambles, tangled like ropes. “If you were pregnant and needed to deliver a baby right now, you would need a C-section, otherwise your pelvic floor would collapse. And if you don’t do anything to untangle these muscles, it still could collapse regardless of any pregnancy.” 

What this means, she tells me, is that if untreated, I could wind up on bedrest for six months with my legs at an incline and a mesh net slung in my vagina like a hammock holding in my intestines and bladder. I’m floored by the sophistication of modern medicine, and what it does for an organ that is vital to the perpetuation of humanity.

“But how did it get this way?” I ask. 

“Was there anything that could have triggered this for you, a UTI or a yeast infection or anything? Because a lot of the time, when something’s different in that area, the muscles clench to protect the inner structures, it’s called ‘guarding’—” 

Suddenly the cyst is all I can remember, the exploding cyst and the cramp and the dark blob on the screen. “Could an erupting cyst do it?”

“Yes. If that’s what happened, your muscles clenched to guard you, and then…”

“They never unclenched.”

“So you need to go to a pelvic floor physical therapist who can help you stretch these muscles. Obviously this is an incredibly niche practice. There’s only one place in the city I can recommend.”

I don’t know what she means by “stretch these muscles” but all I can envision are vaginal beads and huge, clownish dildos. I don’t tell Dr. Sykora this, and instead take her brochure for North Star Physical Therapy. She prescribes a lidocaine gel to be applied to the vestibule of the vagina, heat patches to be worn at night over underwear, meditation, and valium suppositories. I blanche at this last prescription. Which hole?

“Whichever you feel better about—either way, they’ll get to the right group of muscles. And,” she adds with a smile, “A lot of our patients like to try having sex after they’ve popped one in. Gets them all loose.” I decide right then I like Dr. Sykora.

I call the compound pharmacy in upstate New York later that day for the lidocaine gel and the valium suppositories. Neither of these medicines are covered by insurance, and they’re $185 each. When the medications arrive, Will and I marvel at how the suppositories are shaped like missiles, and how the pharmacy graciously included finger condoms in the baggie with them. 

I’m told via email that physical therapy will be $298 for the initial session, and $228 for every session thereafter. The physical therapy office emails me a sheet of questions I can ask my insurance carrier, because pelvic physical therapy, I’m told, isn’t covered by insurance. I call Anthem Blue Cross and stay on the phone for two hours, mostly on hold, periodically being notified by a monotone automated voice that my call is very important to them. I’m then told by the agent that I can file a claim and that Anthem will review the claim and send me back the amount they decide is fair. “But what’s the amount?” I ask the agent. “And what’s fair?” She tells me that’s all she has on the screen in front of her. She tells me to have a good rest of my day.

On December 2nd I take the LSAT. Afterwards, Will and I go to a bar we’ve always talked about but have never been to on Greenwich Ave and 12th Street and have two cocktails each. A few hours later we are going to bed and I pop in my valium suppository. I’m tired and happy and prepared for deep REM when I remember that valium and alcohol are not meant to mix. Will researches drug interactions while I run to the bathroom, pajama pants at my ankles, attempting to kegel the suppository out of me. 

“What does it say?” I call to Will from the bathroom. 

“Um, well, uh…” 

“Hello?” 

“… It’s not great.”

Pantsless I go to the bedroom and snatch his phone out of his hand. He’s on some blog called Bluelight where I read that not only can “benzos and booze” make me high, they can be fatal. One user writes: “My sister took 10 mg of diazapam and had two glasses of wine and was dead by morning. Stay safe fellas.” I look at the valium dosage on the package. 10 milligrams. Will is staring at me tenderly, in a way that tells me he’s certain my passing is imminent. 

“Urgent care or emergency room?” I ask.

“Okay, hang on, my insurance has a 24/7 nurse hotline,” Will says, fishing out the card and dialing. I’m grateful it’s a female nurse who takes the call. I laugh when I can tell she’s trying not to laugh when I say the words ‘valium suppository.’ 

“Okay, well I think you’re going to be fine since the drinks should have metabolized by now, but I have to tell you something you’re not going to like,” she tells me.

“Uh oh.”

“I need you to call poison control.”

Will and I look at each other. 

“Is my vagina going to kill me?” 

“Honey, you’re doing great,” says the nurse.

We call poison control. This time I speak to a man, and I try to make a bit out of it: “Okay, so I took these things whose names I don’t like to say, but they’re the reason I’m calling you, valium suppositories.” The poison control man doesn’t appreciate this highbrow piece of comedy. 

“Stay awake for another hour and if you don’t feel nauseous or signs of a headache or have a seizure or diarrhea, then it’s okay,” he says, deadpan. 

When we hang up, Will assures me I was probably his least interesting call. He then puts himself to the task of keeping me awake for the hour, which means he lists dog breeds I like and I say what I would name them.

“Great Dane?”

“Theodosia.” 

“English Bulldog?”

“Rambaldi.”

A few days later, I go to my first physical therapy appointment, which is on the 8th floor of a nondescript building. When I walk in, I’m overwhelmed by the smell of essential oils. There’s a fake orchid and a stock painting that says: “The happiness of your life depends on the quality of your thoughts.” I’m wondering if my vagina smells like a swamp and whether or not this physical therapist will mind, which doesn’t feel like a particularly high quality thought. The receptionist, a woman with a perma-scowl named Cora, checks me in and tells me Sophie will be with me momentarily. A blonde woman emerges from around the corner and shakes my hand. We walk to a room with pale gray walls and yet another stock painting: “Life is beautiful,” it says, amidst red flowers. 

“We’re just going to talk for the majority of this appointment. You can tell me what’s going on, and maybe for the last twenty minutes we’ll do some stretching.”

We, stretching? Does this mean we do lunges side by side? I give Sophie the rundown, she listens, she asks questions. 40 minutes pass. 

“Okay, so now I’ll step out for a second and you can put this sheet on you and we’ll stretch.” I oblige and lay down on the pillow. She comes back in and puts on a pair of pink gloves. If my vagina does indeed smell like a marsh, she is kind enough to pretend not to notice. 

“So what I’m gonna do is start pulling and pinching those muscles to get some blood flow going, so that they can hopefully start to unravel,” she says. And that is what she does. 

“So what’s going on in there?” I ask her as her hand roams inside me.

“It’s kind of like…you know cat’s cradle, with the strings all jumbled in someone’s hands?”

“Yeah.”

“Like that.”

At the end of the appointment, Sophie opens a cabinet. “I want to give you some at-home exercises to do, which means you’re going to start using a dilator every night. It’s a silicone tool that you can use on your muscles the same way I do, just to get them to start untwisting.” She then pulls out eight different candy-colored phalluses, ranging from the size of a tampon (orange) to a $5 Footlong (purple). Sophie sees my eyes bulge at the largest one. 

“Don’t worry about that guy,” she says. “But do you see something in here that resembles your boyfriend’s size?” I’m no longer surprised that an almost-stranger is inquiring about the magnitude of Will’s penis, at how picking out my boyfriend’s dick in a lineup of cheerfully-dyed appendages has become quotidian. 

“Probably somewhere between the blue and the green?” I say. When I explain this to Will later, he will demand to know exactly what the sizes were, how many colors there were to choose from, and the dimensions of the blue and green. “Toxic masculinity in action,” I will say, to which he will respond: “But how big was the big one?”

“We’ll start you off with this one, and then we’ll work up to the blue or the green,” Sophie says, handing me the second to smallest size, bright pink, which is the length of a mozzarella stick and the width of a grape, and thoroughly, deeply unappetizing. I put it in my coat pocket, and when I walk home from work that night, I rub it between my index finger and thumb, thinking of that colossal purple dilator, and how I’ve never seen anything like that on neither man nor statue in my life.

The next day I attempt to use the dilator. Will sets a timer and reads aloud the instructions Sophie printed out for me. 

“Put lubrication gel on dilator. Put dilator into base of vagina. If vagina clenches, remove dilator. If vagina does not clench, proceed.”

I proceed.

“Does it hurt?” he asks. 

It feels nearly impossible to describe pain that cannot be seen. A bone is disjointed. A bruise is purple. There’s athlete’s foot flaking between two toes, red and angry. This is the pain people take seriously. “It’s like there’s something there that I wish wasn’t,” is the only way I can describe it.

“I’m sorry,” he says.

A week later, Sophie and I are easing into a routine together, starting to chat like people getting to know each other over coffee and not like my leg is perched chicken-drumstick style on a pillow while her hand pulls and stretches the muscles inside the left and right sides of my vagina for 20 minutes each. Her daughter Ava is two and already expressing curiosity about potty training. But her husband incenses her. 

“He’s trying to teach Ava to call that part of her body her ‘kooka,’” she says. “Is that not the stupidest thing? And I’m like, no, it’s your vagina. What if someone does something terrible to her and she’s in court like, ‘and then he touched my kooka.’”

“Vagina is a pretty hard word to say.” 

“Yeah, right now it’s still ‘gina.’ We’re working on it,” she says. “Some of Ava’s friends are jealous, I think, that she gets to go to the potty and they don’t. They sing that song, you know, liar liar, pants on fire–”

“Or kooka on fire, in this case,” I say.

$228 later, I pull up my pants and walk back to work.

On my way to the airport a few weeks later, my best friend Elsa texts me. She’s on Canadian health insurance and getting birth control. The doctor is pushing her to get an IUD, to avoid the hoopla of snail-mailing birth control to LA. Elsa is scared. “Also, I’m crying ‘cause it’s expensive,” she texts me. “I’m just pissed how hard it is to be a girl.” I cry for her in that moment, wishing I could be there in that exam room in Vancouver. I cry for me—for the love that cannot heal me, for the pain that throbs invisibly. We cry for our bodies, our bodies that fail us. Our bodies that can create and grow people, be loved and lusted after, our bodies that withstand waxing, shaving, plucking and picking at, verbal and literal. How do we learn to mourn ourselves well?

Over the Christmas holiday, I share a hotel room with my sister, Allie. When we go to breakfast in the morning, we laugh at what the hotel cleaning people must think of the pink erection on the nightstand. We hope they have a vision of us as cool lesbians with a not-so-sizeable toy, instead of sisters, one of whom uses a medical dildo. By the end of the trip, the dilator no longer hurts or even bothers me when I insert it. 

On January 3rd Sophie passes me the yellow one with a smile: “You’ve graduated.” That night, I go get a wax. It’s leftover from a cheap Groupon and about to expire, and I’m determined not to let those eight dollars go to waste. I go to a small and very crusty hole in the wall on Seventh Ave and strip by the strip, the waxer rips off the hair. I’m struck by how painless it feels, this ritual that once brought tears to my eyes. The first time I got a wax, I was 19 years old, and all I wondered the whole time was what the beautician thought of my vagina. Now I feel like everyone’s seen it, and nobody’s thoughts really matter. At the end of it, the waxer gives me a hand-held mirror to inspect her handiwork. She leaves the room for me to get changed and instead of putting on my pants, I keep the mirror in that position, studying this structure I never really thought twice about until it made my eyes well and my throat clench a year and a half ago. 

This is days before I will go back to Dr. Sykora, who will tell me that the physical therapy and the medications aren’t doing enough, and would I be open to trying trigger point injections, which are $8,000 per shot and so painful they can cause me to pass out. This is days before I need to call my new insurance and go through the physical therapy worksheet for the out-of-network and non-deductible game. This is days before I will call my mother and tell her, facetiously but furious, that I am ready for a hysterectomy. For now, it’s just my vagina and me in the mirror, this cantankerous hoof of a body part: a wound, a scab, a blossom. 

Issue 53 • Spring 2026

Fiction

Poetry

Fiction

Poetry