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Health & Sex

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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.

No "One-Size-Fits-All" Treatment continued...

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.

She advises patients to eliminate sources of irritation, such as tight jeans or horseback riding, and to soothe the vulva with an ice pack or fan and possibly a topical anesthetic such as Xylocaine. Any condition that might be causing vulvodynia is treated. She uses tricyclic antidepressants and anticonvulsants to control pain.

She also sends patients to a physical therapist who understands vulvodynia and can detect old injuries or poorly aligned muscles and treat muscle spasms. "My experience is we can help most people, especially if we see them early enough," says Stewart. "I do have patients whose pain I haven't been able to improve, and I've sent some to pain clinics."

Vestibulectomy is a surgical option that removes sensitive nerve endings but should be considered only as a last resort, says Stewart. Conservative medical therapy is the initial treatment of choice. "Get another opinion. It's very helpful for properly selected women, but usually we try medical things first."

Don't Give Up Sex

Pain destroys sexual desire and can also lead to the fear of sex because of the chronic pain.Many women give up sex altogether, depriving themselves of pleasure and putting relationships at risk. The pain from vulvodynia can also lead to spasm of the muscles around the vagina making sex penetration harder for a woman's partner. "Many husbands and partners are very understanding, but sometimes you see marriages break up," says Stewart. "Vulvodynia really can wreck your life."

She and Stewart encourage women to engage in nonpenetrative sex. "For most patients, the clitoris doesn't hurt," says Glazer, who prefers to see patients accompanied by their partners. "They can still remain quite intimate by doing oral sex."

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