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Finding Relief From Vulva Pain

At least 200,000 American women suffer from chronic vulva pain, a condition that perplexes doctors and can destroy a woman's sex life.

Why Is There no Cure?

"Vulvodynia hasn't been studied well enough to know the cause, and you can't find a cure without knowing the cause," says Stewart, director of the Stewart-Forbes Vulvovaginal Specialty Service at Harvard Vanguard Medical Associates in Boston. "There's only been interest in the last few years. Recently the National Institutes of Health (NIH) have taken an interest." Stewart is co-author of an NIH-funded study of 5,000 women at Brigham and Women's Hospital. In the study, reported in the April 2003 issue of the Journal of the American Women's Medical Association, 16% of the women screened reported histories of unexplained vulvar pain lasting least three months or more.

"Those are pretty striking numbers because we'd assumed the numbers of people were small, perhaps fractions of 1%," says Glazer. He and Stewart, who are both members of the International Society for the Study of Vulvovaginal Diseases, are hopeful that the new numbers will lead to more studies and a cure.

No "One-Size-Fits-All" Treatment

The experts tell WebMD that among the many theories about what causes vulvodynia, the most likely is a response to tissue abnormality, possibly caused by infection, irritation, or trauma long after it's been resolved. "I think most people believe this is chronic regional pain syndrome, or CRPS," says Glazer. "It was first noted in the Civil War as a consequence of buckshot wounds." He explains that when soft tissue gets irritated or damaged, the body activates a number of defenses. The tissue becomes inflamed and puffs up like a protective pillow to prevent further contact. New nerve endings grow and become hypersensitive so they can detect further contact and withdraw. Blood vessels in the area shut down to prevent possible infection from traveling to the rest of the body. Finally, muscles go on the defensive, producing spasms in the pelvic floor which reduce blood flow and produce further inflammation.

Glazer says treatments reflect the components of the self-protective mechanisms, so anti-inflammatory drugs, such as high-potency steroids, antihistamines, or Cox-2 inhibitors are often used. Tricyclics, which are mainly antidepressants, as well as anticonvulsant drugs, often work to relieve pain. Topical nitroglycerine may be used to open blood vessels.

A key component of Glazer's treatment is teaching women to do daily, specific exercises along with biofeedback to modify the pelvic floor muscles. The patient uses a tampon-like sensing device which attaches to a monitor where it displays a squiggly line that reflects muscle tension. "About 50% of the people we treat get completely better," he says.

Before a diagnosis of vulvodynia can be made, Stewart says other causes of vulvar pain or painful intercourse must be ruled out. These might include infections, such as yeast or herpes; trauma, such as sexual assault; systemic disease, such as Behcet or Crohn's disease; precancerous conditions; irritants, such as soaps or douches; and skin disorders, such as dermatitis or psoriasis.

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