Post articles about vulvodynia

05/27/2009 at 7:31 pm | Posted in Uncategorized, vulvodynia | 3 Comments
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Hey guys, you want to see a recent article on vulvodynia? It’s full text & it’s free!

A practical approach to vestibulitis & vulvodynia

Careful, it’s not work-safe (but then, I suppose few things about vaginas are…) It’s even got pictures.

I don’t want to copy & paste the entire article so instead, let’s have a bulleted point list. Chances are, if you’re reading this blog you may already be familiar with some of what is being rehashed here anyway.

But if you’re not familiar with this topic, then well here’s your chance.

Couple of noteworthy points –

Article breaks out V into 3 kinds: cyclical vaginal infections (recurrent yeast in particular.) Vestibulitis (pain with penetration) and essential Vulvodynia (more generalized pain.)

I still tend to use “Vulvodynia” as a blanket term which includes vestibulitis.
However, technically speaking we’re supposed to start moving away from the “-Itis” suffix in “Vulvar Vestibulitis,” since, that ending implies inflammation. Inflammation was present for me, but it’s not present for every patient. Instead some doctors are moving towards using the phrase “Vulvar Vestibulodynia.” I’m probably going to continue with the -itis though, since I’m more used to that phrase.

This article cites a 16% rate of some type chronic vulvar pain in female patients in Boston. That’s around the same numbers I’ve seen before. That’s not necessarily a 16% rate of diagnosed vulvodynia, just those reporting chronic pain.

I disagree with the headline that says “Medical treatment is ineffective” re: vestibulitis. It’s kind of a weird headline anyway since I always thought that the vestibulectomy was a medical treatment. The only thing I can think of is that the authors consider surgery to be a category of treatment unto itself, separate from “Medical.” Maybe the authors mean “Medical” as in, oral medications?
But then why not mention the oral tricyclic antidepressant approach for vestibulitis? It’s mentioned further down re: treatment of vulvodynia – maybe the authors of this article have concluded that tricyclics work better on vulvodynia rather than vulvar vestibulitis?
Also, the article mentions that steroids don’t usually play out too well as a topical treatment… but why didn’t it mention topical hormones? It’s mentioned as a treatment for older & post-menopausal women, but, I’m a young lady & I used topical estrogen gel for awhile.
I also disagree with this headline because ouch, what a kick in the teeth to women with vestibulitis who would very well benefit from some medical intervention. Surgery or bust just isn’t fair.

The authors note that vulvodynia is more likely to happen among older women, although in practice I’ve seen it among women the same age as I & younger. In practice I’ve also seen resolution take much longer than just a few months for vulvodynia. The authors sound pretty optimistic.

For some reason Physical Therapy is not mentioned as a treatment in this article at all. I find that to be a glaring omission. “Where’s the beef Biofeedback?!”
Dietary changes & avoiding irritants are likewise not mentioned. Alternative treatments like acupuncture & chiropractic is not mentioned.
Sex therapy is missing. Maaaybe this article isn’t really the best place to bring up sex therapy since, the article focuses on typical medical treatments. I don’t think that sex therapy be a good option for myself but the authors could have mentioned it as an option to expand a patient’s sexual horizions. Intercourse does not necessarily have to be the end goal of treatment, which is kind of implied with the patient used as an example at the beginning & end of the text.

The authors do not examine possible causes much.

Some of the sources cited in the footnotes are on the older side. I’m familiar with several studies though; I’ve printed out & read several of these. The Goetsch study in particular comes to mind. I’ve seen statistics in other subsequent studies hover around the same incidence rate numbers that Goetsch came up with so I guess the repeatability makes it a fairly strong research paper. Still, I’d prefer to see a stronger emphasis on more recent work.

So it’s not perfect, it’s missing some things, but it’s still an article on a website so maybe somebody with a medical degree will actually pay attention. Or even a layperson who never heard of such things before.

Maybe…

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3 Comments »

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  1. I don’t understand the insistence that vulvodynia is an old woman’s disease. It’s just not. Almost all of the people I’ve seen talking about it online are young or older and had it start when they were young (usually 20’s). Now, that could be a bias since younger people (probably?) are more likely to write about that stuff online, but c’mon.

    It also really scares me that it’s so common in young women. WHY? And why haven’t we figured out the cause(s) yet?!

  2. I find it really strange that biofeedback/physiotherapy was left out of the article. When my gyno diagnosed me, he didn’t even mention oral medications, antidepressants, topical creams, steroids. He said it was either surgery, which he didn’t recommend — not yet anyway; or physiotherapy and psychotherapy combined, each of which have 40-something% success rate separately.

    Loving my gyno more and more. I guess it helps that he’s leading a huge study right now on vvd, and that he’s the top vvd guy in this city.

    • Hi–stumbled across this blog–it’s great. I can’t wait to spend some time with it.

      May I ask what city? I see Dr. Glazer in NYC, or maybe saw is a better word because it’s been awhile and I’ve fallen off the biofeedback wagon. I’d love to find a plain old gyno who is on top of this issue. Glazer is a psych and my gyno doesn’t know much about. If you are in NYC and feel comfortable sharing his name, I’ll get you my email.


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