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    Does Sex Hurt?

    A little-known condition may be the cause of your pain.
    By
    WebMD Feature
    Reviewed by Gary D. Vogin, MD

    Lucy was dating the man who would become her husband and enjoying every moment. Soon after, without warning, she began to feel discomfort and then pain in the genital area. It got so bad she couldn't even insert a tampon.

    The pain made having sex impossible, too. At first, she thought she had a yeast infection. Eventually, her doctor diagnosed her with vulvar vestibulitis, an inflammation of the tissues surrounding the entrance to the vagina. Putting pressure on the inflamed area can result in severe pain. In Lucy's case, the pressure occurred during intercourse.

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    The condition is usually accompanied by burning, stinging, and irritation or rawness of the affected area. Laser surgery to remove some of the painful tissue improved the problem only temporarily, and Lucy went on to suffer for four more years.

    Lucy says her husband has been very understanding. ''My husband and I learned to have a sexual relationship that didn't involve intercourse, but it really put a damper on things."

    A Newly Recognized Condition

    Few people have heard of vulvar vestibulitis (one form of a broader category of problems called vulvodynia), although it affects at least 200,000 women in the United States, according to the International Pelvic Pain Society. Says C. Paul Perry, MD, the president of the society, ''We think the numbers are [even] higher because it is often misdiagnosed or women are not willing to talk about it.''

    The condition wasn't recognized by medical science until the 1980s. Before that time, doctors passed off vulvar pain as psychosomatic and frequently sent their patients to a mental health professional.

    A Ray of Hope

    Recently, however, researchers may have found a cause for this painful condition. A study published in the American Journal of Obstetrics and Gynecology in February 2000 showed that a genetic disorder could be to blame. More than half of the 68 women in the study with diagnosed vulvar vestibulitis were found to have this genetic abnormality.

    "In vulvar vestibulitis, something triggers inflammation, but then it doesn't go away," says Steve Witkin, PhD, a co-author of the study and a researcher at Cornell University. The gene the researchers looked at is involved in ending the inflammatory response in most women. But a lot of the women with vulvar vestibulitis have a rare form of the gene that makes them less able to stop the inflammation, Witkin says. These women also often suffer from other inflammatory problems such as nasal congestion.

    The study could be the first step to finding a treatment that works, says William Ledger, MD, another co-author of the study and a Cornell University gynecologist who studies infectious diseases. Since anti-inflammatory drugs haven't helped, the hope is to develop a drug to do what the defective gene cannot. But research funds are not plentiful, Ledger says, partly because the disorder takes a back seat to more life-threatening conditions.

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