Jan. 13, 2004 -- Fans of popular show Sex and the City know it as having a "depressed vagina," thanks to an episode in which character Charlotte York is prescribed antidepressants to treat her genital pain.
The medical term for the condition, characterized by persistent pain or burning outside the vaginal area, is vulvodynia, and new research shows that it is far more common than previously thought.
Instead of a couple hundred thousand cases, an Internet survey indicates that millions of American women may suffer from vulvar pain. The implication, says survey author Barbara Reed, MD, is that most are suffering silently.
"Women who seek treatment for this are usually in pretty severe pain, but those with less severe pain may not even interpret anything as being abnormal," Reed tells WebMD. "They may think that they are supposed to feel this way."
For those who need an anatomy refresher course, the term vulva refers to the outer area of a woman's genital organs. It includes the labia majora, or large lips; the labia minora, or small lips; the clitoris; and the openings to the urethra and vagina.
Women with vulvodynia may feel sharp stabbing pain, especially at the opening of the vagina, or they may feel generalized burning throughout the area. Pain is typically most intense during intercourse, so it is no surprise that many sufferers experience a decrease in sexual desire.
In the University of Michigan study, 28% of the 995 women who responded to the web-based survey reported having had vulvar pain. With 8% of these saying they have experienced vulvar pain within the last six months. A total of 3% reported that their pain was chronic lasting three or more months.
"From this data we extrapolated that roughly 2.4 million American women have this pain, but the number may be as high as 5 million," Reed says.
About one-third of the survey respondents were African American. Although previous reports show the condition is rare among black women, the responses indicated that this is not the case. Black women had similar rates of vulvar pain as women of other races. The survey is reported in the January issue of the Journal of Lower Genital Tract Disease,
Reed says she hopes the realization that vulvodynia is common may convince more women to seek treatment. The antidepressant Elavil is often prescribed, not because women with the pain are depressed, but because the condition seems to be associated with hypersensitive nerves in the genital area. Low doses of antidepressants like Elavil have been shown to reduce nerve sensitivity.
Boston ob-gyn Patricia DeGroot, MD, says a wide range of conditions, from yeast infections to lower back problems, can cause vulvar pain. For this reason, a one-size-fits-all approach to treatment does not work. DeGroot says approximately 10% of her practice involves treating women with vulvar pain syndrome.
"You can get a good idea about what is going on with a patient just by listening to her story, and I am always amazed at the number of healthcare providers who don't take the time to do this," she tells WebMD. "If a patient doesn't feel like she is getting the right help, she should find a professional who knows about vulvar pain."
She recommends the National Vulvodynia Association's web site that lists physicians who treat vulvar pain.
"Almost every metropolitan area has at least one person who specializes in this area, but it doesn't really take a specialist," she says. "The most important thing is finding a physician who takes the time to listen and takes symptoms seriously."