Medical histories aren’t the easiest to read (or to write, for that matter). But I’m subjecting you to mine because Planned Parenthood, which provides women across the country with high-quality, low-cost care, is at risk of being defunded. The fact is, my vulva is in danger of fusing shut. I didn’t know this until two months ago, when Planned Parenthood diagnosed my condition after my gynecologists couldn’t, and it helped me when my health insurance wouldn’t. I’ve had a condition with embarrassing but unremarkable symptoms for a couple of decades now: intense itching in the vulva during flare-ups and excruciating pain whenever anything is inserted. It sometimes feels OK, but when it’s bad, it’s really bad. The pain started early. When I was 13, I went to the emergency room with intense pain in the lower right abdomen. The doctor couldn’t tell whether it was an ovarian cyst or appendicitis, so he called in a couple of colleagues. The result was that I — a physically small 13-year-old — was subjected to three pelvic exams. Most ovarian cyst ruptures aren’t dangerous, but the pain is severe. You double over and break out in a cold sweat. What I remember from that long-ago ER visit isn’t the pain from the cyst, though; it’s the indescribable agony of those pelvic exams. No one batted an eye at my vaginal pain at that particular moment. Given the risk of appendicitis, there were more important fish to fry. But the incident shaped my expectations. When I started going to a gynecologist, I assumed that that pain level on insertion of a speculum or other medical device was normal. My gynecologists likely assumed that I was prone to dramatics or hypochondria when I gasped and gritted my teeth and apologized as a tear or two leaked out of the corner of an eye when they inserted a tiny speculum. Some of them thought I was lying when I said I hadn’t had sex. But I couldn’t imagine having sex; tampons were barely tolerable. The thought of giving birth made me collapse in a swooning salute to my gender. The condition lasted years. I came to call it the Thing. Doctors reassured me that everything was fine. They diagnosed yeast infections or chalked it up to allergies or changed my birth control or ordered herpes tests that kept coming back negative. Boyfriends, of course, didn’t know what to do. So I got on with it, convinced I was defective, crazy or both. Sex, when it finally happened, felt like being impaled. My vulva felt as if it were covered in carpet burns. I pretended everything was great, but it was agony — and, given the contrast with my partner’s pleasure, lonely too. “What kind of Darwinian failure am I?” I mused, mired in the shameful solitude of an animal trying to mask its defect.

I now have Planned Parenthood to thank for the discovery that my vulva is in danger of losing its architecture.

Things got worse with stress. Right before my wedding nine years ago, the area was so horrifically angry — white bumps, ulcerations, fissures — that I ended up consulting a doctor the day before the ceremony. He suggested herpes and sent me on my way. I suspected a misdiagnosis, as usual. Still, I wondered. Had I gotten herpes since my last test? Had my fiancé cheated on me? (He hadn’t.) I got married with my nethers in agony. The marriage did not last, for many reasons, including my sexual dysfunction. Loneliness of the sexual kind only seems to expand. Some years later, a kind family friend who happened to be an OB/GYN alerted me to the possibility that I might have vestibulitis. Female genital pain, like female sexual dysfunction, is woefully underresearched. The literature on vestibulitis was limited, but he knew of it. One test consisted of holding a wet cotton swab up to the vestibule of the vagina and touching it very gently to see if hurt. It did. The doctor did all he could. I was given dilators and topical analgesics. (Numbness before sex was the best outcome I could hope for.) It all helped a little. Sometimes sex felt almost normal — even good. But not always. Fast-forward a decade: I was traveling, and the Thing flared up. I couldn’t walk without intense discomfort. I couldn’t sleep. Underwear was out of the question. I had recently gotten an activity tracker, and my average of 11,000 steps a day went down to 1,300. Worst of all, my health insurance didn’t cover where I was. There would be a $7,500 deductible for out-of-network visits unless it was an emergency — and female pain is seldom considered an emergency. After five days it showed no sign of improvement, so I started looking for alternatives and came up with Planned Parenthood. I had never considered Planned Parenthood before, and I didn’t want to then. The last thing I needed en route to yet another doctor was a horde of protesters brandishing photographs of aborted fetuses and screaming at me. But I gathered my wits and called. I was seen the same day. The facility was clean and welcoming. The receptionist gave me an estimate and checked in with me at every stage to tell me how much everything would cost. My nurse practitioner took her time. She listened to my concerns and symptoms with a level of attention I had never received before. She examined me and called in a colleague to consult on my case. They conferred, and she explained what she thought was going on: a rare condition called lichen sclerosus, in which the skin thins and starts to form white plaques, papules, ulcerations and fissures. She urged that I get a biopsy and helped me get in touch with a hospital that could perform it. I got the biopsy. Her diagnosis was correct. I now have Planned Parenthood to thank for the discovery that my vulva is in danger of losing its architecture. If lichen sclerosus — a mutilating disease of mysterious origin — goes untreated, according to Susanna Fistarol and Peter Itin in a paper published in The American Journal of Clinical Dermatology, the “labia minora may become reabsorbed and fused and the clitoris entrapped under scar tissue. The vaginal introitus may become stenotic and narrowed.” The skin thins in some places and thickens in others; there’s a small chance of developing squamous cell carcinoma, a kind of cancer. The condition is incurable and progressive unless you aggressively manage the symptoms. At the moment, standard treatment is an ultrapotent topical steroid.

We ought, as a society, to take stock of how our Puritan habits make it easy for us to blindly accept the punitive logic of Eve’s curse.