There are some over-the-counter anti-inflammatories that can help:. Note: not all the different types of vitamin E oil being marketed seem to work equally effectively, and some women may be sensitive to the oil -- do a patch test before applying it to a wide area.
The two sources mentioned above are ones that have been used to good effect. A note on isoprenosine: this is a drug mentioned in an bibliography on Howard Glazer's website as something that can be used to treat vulvar pain symptoms. None of us have been able to find a doctor knowledgeable about it, and it is unlikely that the drug has FDA approval in the United States.
The reference in which the drug is mentioned is: Sand Petersen C. Isoprenosine improves symptoms in young females with chronic vulvodynia. Acta Dermato-Venereologica. These are both drugs that are in advanced clinical trials and do not yet have FDA approval. They selectively target and inhibit prostaglandins COX-2 that are implicated in the inflammatory response.
Initial tests have shown them to be powerful and without serious side effects. They will initially be approved only for arthritis, so your doctor probably will not have heard about them. You can monitor their FDA journey on the internet by periodically reading the pharmaceutical company press releases in this case, the manufacturers are Montesano and Merck. If your pain is due to herpes, acycolvir may help.
It is not clear whether this drug is otherwise beneficial to vulvar pain sufferers. Interferon is an injectable anti-viral drug that is sometimes given to women who appear to have HPV.
Typically, the drug is injected around the vestibule -- into the wart or sore, if any are present -- three times a week for three or four weeks. Interferon is extremely expensive, and the frequent office visits required for its use make it even more so. Ask your doctor about the possibility of self-injecting the drug in your upper thigh -- it is not clear whether vaginal or intramuscular injection is superior, although larger doses may be required for the latter.
If done by your doctor, lidocaine can be mixed into the preparation to ease the pain of the shot. Many women report flu-like symptoms with the use of interferon, but these can range from very mild and only shortly after the shot to chronic. Many journal articles report that when interferon is used at the same time as other techniques, such as surgery, the recurrence rate of pain is lower than with the use of either technique alone.
Benefits from interferon may not be apparent until some time after the treatment is completed. One of the new antiviral medications being used for HPV is Aldara cream. Aldara's active ingredient, imiquimod, is a substance that is believed to stimulate the body's own interferon response. It is used for up to 16 weeks, and it may take longer than that for results to be seen. Some doctors -- dermatologists, in particular -- may be interested in killing off wart viruses through less conventional means.
Surface viral material may be destroyed by repeated applications of heat which may, however, cause other problems -- see section 6. Others may recommend the use of a high-dose antihistamine like cimetidine for several months. You may find that this slows your metabolism or disturbs your sleep, and it may not be especially effective for your pain.
For strep or for bacterial overgrowth, the antibiotic Augmentin may be effective. For those wishing to avoid antibiotics, a douche consisting of 1 part water to 1 part hydrogen peroxide might be effective. Use every other day for five days. For cytolic vaginosis, or other bacterial overgrowth, betadine douches may help. You can purchase one at the drugstore -- it'll probably be labeled "medicated douche"; just check the ingredients.
Or, more cheaply, you can buy a bottle of betadine and add it to an ordinary and re-usable douche. Note that if you have a yeast infection rather than a bacterial one, these treatments can make you worse by making the vagina less acidic and hence more hospitable to yeast. If you do not currently have a bacterial or viral infection, it is possible that the Bartholin glands located in the vulvar vestibule, as well as other vulvar glands, may have been blocked or otherwise damaged from past infection.
Treatment would involve draining the glands lancing or aspirating them. Anti-inflammatories may also help for milder forms of irritation. Removal of the Bartholin's glands is sometimes discussed for vulvodynia that doesn't respond to anything else see "surgery".
Before going that far, it may be useful to have the doctor merely open and drain the glands. This can be done at the doctor's office and without the use of general anesthesia. Treatment of chronic irritation of Skene's glands is more controversial. Skene's glands surround the urethra, near the bladder, and are the homologue of the male prostate gland.
Removal of these glands may lead to incontinence, as well as making vaginal orgasm impossible. If the glands seem to be inflamed, lancing, rather than removal, is strongly recommended. The rationale for biofeedback can be found in Glazer's paper on the vulvodynia. The goal is not to strengthen the pelvic muscles which can be quite strong in vulvodynia sufferers , but to RELAX them by learning to work them to the fatigue point.
One of the biggest problems in pursuing this treatment is locating a physical therapist or other practitioner who can help you assess what the current resting levels of your pelvic muscles are, and thus whether biofeedback would be appropriate for you.
Check the professional registry on the vulvodynia. Successful biofeedback requires access to purchase or rental of a home trainer, which is expensive, and many insurance companies simply won't pay for "biofeedback. Glazer's published study results, and copies of articles from both the national vulvodynia organizations, which supply additional data from other sources.
A letter from a sympathetic doctor stating your muscular problems have led to "loss of functioning" may be helpful. Identify the home trainer you wish to buy or rent, and which features it has that will enhance your recovery. THEN, present your plan's definition of durable medical equipment and how the home trainer meets that definition. Also investigate whether your insurance covers biofeedback for migraines -- many do -- and you might be able to build a case on the similarity of the need for tension reduction.
If your insurance comes back with a denial, don't fade away. The golden rule, for dealing with both insurance companies and doctors: Don't be afraid to be a bitch! Features to look for are portability, programmability, memory, ability to hook up to PC for printing out hard copy reports, type of sensor used, light bar and audio feedback, and cost.
One list member has favorably mentioned the "Regain" machine. Howard Glazer recommends the U-Control machine, citing that it's compact, easy to use, reliable, and possibly the least expensive on the market. John Perry, however, feels this to be a false economy. The idea behind biofeedback is not to strengthen the pelvic muscles, but to get them to relax. If your physical therapist uses biofeedback primarily to treat incontinence or interstitial cystitis, he or she might recommend that your resting levels of pelvic tension be below 1 microvolt.
Glazer and Perry recommend that, for the treatment of vulvar pain, you learn to bring -- and keep -- muscular tension below 0. The idea behind Kegel exercises is to strengthen the muscles of the pelvic floor.
This is often recommended for older women or for women after childbirth to reduce the occurrence of incontinence and restore the tone of the vaginal muscles, and is sometimes recommended for all women, to improve the strength of contractions felt during orgasm.
You can practice contracting the muscles on your own, or you can buy often very expensive "Kegel weights" to assist you. If you practice on your own, you might want to meet at least once with a physical therapist first so that you can ensure that you're doing the exercises correctly -- done incorrectly, they can be harmful.
Since the goal of biofeedback isn't strengthening but relaxation, it is a very different process than Kegel exercises. Theoretically, if one were to use Kegels to exercise the muscles to fatigue, relaxation would result.
It is difficult, however, without the feedback the machine provides, to isolate the correct muscles and have an accurate sense of the level of work the muscle is experiencing. If you simply strengthen the muscles without learning how to relax them, you may make your vulvodynia worse by making the chronic pelvic tension BETTER at cutting off blood flow to the vulvar tissue.
TENS machines are sometimes recommended for nerve or muscular pain of all types. These machines work by electrically stimulating the muscles. There are no published reports of success at using TENS units to reduce vulvar pain, and we are not aware of anecdotal reports.
This does not mean they aren't potentially useful, however. This product has not been available very long, and we do not have information about its effectiveness.
If your skin irritation allows it, it might not be a bad idea to acquaint yourself with your pelvic muscles. A URL to help you learn can be found in the Resources section. If nothing else, you can get a better understanding of where your pain seems to be coming from, and you can try to practice isolating particular muscles and contracting and relaxing them. This can help make you aware of the times during the day in which you unthinkingly tense up.
You may find it helpful to try pushing the muscles out as if you were going to the bathroom ; to try pushing against NOT clamping down on an inserted finger; or to imagine that your vagina is sucking on a straw. Remember to breathe deeply while doing this. Vigorous exercise releases endorphins and can thus break the pain cycle in a way similar to acupuncture.
For women with hormone problems, especially those related to insulin resistance, exercise can help by increasing insulin uptake in the muscles. Gentle exercise is particularly recommended for women with fibromyalgia. A consistent program of exercise also boosts mood, helps the immune system, and improves sleep. Some women find that sweat is too irritating to the vulva to pursue strenuous exercise.
Try doing an aerobics video at home naked from the waist down. Your partner may be especially encouraging on this one! Even if this still generates too much sweat, there are other forms of exercise available, like T'ai Chi or yoga, or -- if the chlorine isn't irritating -- swimming.
There are several possible ways hormone problems might cause vulvar pain, so there are several possible hormonal treatments. This is NOT used to increase systemic estrogen levels, but is used to vascularize increase blood flow to the vulva, as well as to thicken it.
You will almost certainly have to educate your doctor about this. Estrace is normally used by postmenopausal women, who insert an applicatorful, and doctors are reluctant to prescribe it for premenopausal women. Instead, you will be using an amount about the size of a jellybean and will be applying it only to the external vulva. Willems claims that, used in this way, Estrace is only minimally absorbed.
Blood levels of estrogen do not change, and patients do not exhibit symptoms of hyperestrogenism, such as increase in breast size. However, be aware that long-term studies on the use of low-level estrogen creams do not exist, and the effects on the risks of breast- or endometrial cancer are unknown.
Furthermore, it is not clear whether discontinuing Estrace causes a rebound effect: increasing the amount of hormone in the vulva causes the estrogen receptors there to "down-regulate" -- become less sensitive to -- the hormone. Thus, ceasing the cream can cause what little estrogen is naturally there to be even less effective. It will probably take about six weeks to notice any benefits. Your doctor can call in a prescription for Estrace to the Women's International Pharmacy, which offers estrogen preparations in more soothing bases than are normally used, and which may be considerably cheaper than your local pharmacy.
If you have a local compounding pharmacy, they may be able to make an estrogen cream in a vitamin E base, which gives you the benefit of an agent many have found helpful. There is an insertable device, called Estring, which is left in the vagina and which time-releases estrogen. The benefits of Estring are that it has very little systemic absorption, doctors may more readily prescribe it, and it is relatively inexpensive.
Unfortunately, the device itself is rather large and may cause discomfort for smaller women or women prone to pelvic muscle spasms; the material the device is made of can itself be irritating to the walls of the vagina; it also can uncomfortably block menstrual blood flow. Premarin cream has been anecdotally suggested by women on the list to not be as effective as Estrace, although no research has been conducted on this question.
Willems suggests that the amount of estrogen you will be absorbing should be too small to require additional progesterone, as long as you cycle regularly. If you or your doctor feel you should be taking progesterone -- or if you don't cycle regularly -- be aware that "natural" progesterone can have far fewer side effects than the synthetics usually prescribed.
In Canada, an oral natural progesterone called Prometrium is available. In the US, you can either get your doctor to prescribe Prometrium and contact a foreign pharmacy to fill it, or a compounding pharmacy can make an oral natural progesterone for you that's similar to Prometrium. Testosterone cream has been useful for some women with lichen sclerosis and also for others with unspecified vulvar pain. Some women using testosterone cream at higher doses or for long periods of time have complained about permanent virilizing side effects.
This is also probably not a good option for women with irregular periods or "polycystic ovarian syndrome", as androgen levels are already high. Some doctors have suggested that it is not the hormone content of the cream that matters; what really provides relief is the physical barrier between your vulva and urine and outside irritants. This does not seem to be wholly the case for most women.
While physical barriers DO offer some degree of relief, the same woman will generally find that some creams are helpful and others do nothing. Many who use Estrace can see the difference in visible irritation and thickening of the skin.
The content of the cream does seem to matter. There are some clinical studies suggesting that a variety of herbs may be useful in regulating hormone cycles. These include licorice root, black cohosh, and dong quai. John's Wort interact in a way that may be dangerous.
Remember that none of these treatments are regulated, and that finding a product that is as pure and potent as its labeling suggests may be difficult. It is probably best not to try these treatments at the same time, both so that you know what's working for you if you experience improvement, and also to avoid unknown effects of interactions.
If you have irregular periods along with hypo- or hyperglycemic symptoms, a family history of diabetes, and some signs of too-high androgen levels facial hair, adult acne , you may have the so-called polycystic ovarian syndrome, which is actually a form of insulin resistance.
A low-carbohydrate and low-sugar diet may help you cycle, and the resulting rise in estrogen levels may help the vulvar skin. Two drugs are currently on the market which re-sensitize insulin receptors: troglitazone Rezulin and glucophage Metformin. Like the diet, these drugs may make you resume having ovulatory cycles, which can help normalize your hormones as well as relieve your hypoglycemic symptoms. A low-oxalate cookbook is available from the Vulvar Pain Foundation address in "Resources" , and there are websites also in "Resources" that list the oxalate content of many foods.
Some women use calcium citrate -- mg, three times a day -- to help bind the oxalates and prevent crystal formation. If you can't tolerate or can't find calcium citrate, calcium carbonate such as is found in TUMS seems to also work, albeit for fewer people.
Some controversy exists as to when the calcium should be taken. Clive Solomons argues that the calcium should be timed to one's oxalate peaks; others argue it should be taken 20 minutes before eating for maximum absorption ; still others feel it makes no difference.
Please note that many women have achieved success with the diet regardless of whether they have had urinary oxalate levels tested and without taking the citrate at specific times. Length of time until pain reduction on the diet varies greatly, with some women reporting improvement after a week or two, and others requiring six months or more to see progress. Reducing your oxalate intake may not curb your pain, even if your problem is oxalate sensitivity. The amount of uric oxalate is determined not only by dietary intake of oxalate but also by the ability of your intestines to break down the oxalate.
There's been some discussion of a "good" bacterium, "oxalobacter formagenis", which is being studied at the University of Iowa as something that helps break down oxalates. As many women report that their pain was triggered by antibiotic use, some have wondered whether the destruction of oxalobacter formagenis through this kind of treatment is the source of their problems.
Some women following the low-oxalate diet also make use of some of the nutritional supplements listed in the next section. For all of the following, please bear in mind the usual warnings that the FDA does NOT regulate the "nutrition supplement" industry, except in ensuring that they can't make specific claims of beneficial results. Independent consumer rights groups who have tested these products frequently find that the potency and purity is NOT as high as what's claimed on the label.
If you find a specific brand that seems to work well, please share that information with the list. Also, taking a vitamin or, for that matter, an antidepressant is not like popping an aspirin. It will take time on the order of weeks for the substance to build up before you notice an effect.
These are generally used for vulvodynia and constant pain rather than for pain with penetration. Research has shown that those who use narcotic pain relievers out of necessity as opposed to for recreation do not seem to develop addiction.
You will have more success obtaining these drugs if you go to a pain clinic, rather than going through a GYN or your GP. Be aware that you can develop tolerance to any pain medication. Do not increase your dosage without your doctor's approval. You may also want to switch medications rather than increase your dosage. Whether your problem is CAUSED by contact dermatitis, or your skin has become easily irritated due to other causes, the following may help:.
It is a myth that the vulva needs anything more than water to keep clean. Soap can wreak havoc on the balance of vaginal flora and exacerbate pain. If you feel you must use soap, oatmeal soap or a bath with Aveeno Oatmeal Powder seems to clean without causing irritation. This is probably the single most controversial issue on the list. The facts we all agree on: surgery should be a last resort, not a first resort. Surgery can make you worse.
There are two types of surgery available: scalpel and laser. With scalpel surgery, the "Woodruff procedure" is used; the sensitive areas around the vestibule are excised, and the healthy skin is pulled over them.
Recovery can take weeks. Many different types of lasers are used for laser surgery. The worst results seem to be from doctors who laser too aggressively, damaging healthy tissue. The skin CAN be pulled over the lasered area, but generally is not. Recovery time can take longer and be more painful than with scalpel surgery. It seems that most of the cases of worsening after surgery come from the use of laser surgery, but it's not clear whether that's because more laser than scalpel surgeries are performed.
If you are considering surgery, it is absolutely imperative that your doctor be able to provide you with the phone numbers of past patients.
Talk to them. There are horror stories out there. Do not allow yourself to be talked into a vestibulectomy if all you need is a minor resection. Despite the pain and expense and recovery time, it is better to get a second operation if you need one than to have healthy tissue removed or damaged.
This first number is lessened, however, by the chance of pain recurrence, which tends to be high. If you do have surgery, make sure your doctor is aware of the literature suggesting recurrence rates are lower if a course of interferon shots is undertaken at the same time as the surgery.
For any "success rate" your doctor quotes you, make sure you ask whether he or she has followed up with the patients a year or two later. Yeast problems seem to come in two varieties: vaginal yeast infections frequent or resistant , and so-called "systemic" or intestinal, at least yeast infections, which may make the vaginal ones more likely.
Most women agree that antifungal creams the "-azole" creams do NOT work and may make the pain worse. Many people get yeast overgrowth while taking antibiotics because the drugs kill the "good" bacteria, which allows the yeast to gain purchase in the intestines, and prevents the bacteria from recolonizing.
In an intestinal yeast infection, then, you really need to take both steps -- both getting rid of the yeast while also supplying the kind of bacteri that should be there. Some women have recently become aware of an exciting body of research on yeast allergies and vaginal yeast infections see "Marjorie Crandall, PhD" in the "Resources" section in which the yeast burrows into the submucosal deeper layers of skin and hence neither shows up in cultures nor is responsive to topical antifungals.
If you suspect you may have these conditions, you can be tested for the presence of elevated anti-candida IgE antibodies in your vaginal discharge.
Yeast allergies can be helped by hyposensitization injection with tiny amounts of the allergen , just like other allergies. Allergies and submucosal infections can also be treated by a long course of oral antifungals. Be aware that if your problems ARE yeast-related, your treatment may initially make you feel much worse, because the dying yeast release toxins into your body.
But there are options available to get relief from this condition. Read on to find out more. When it comes to digestive and sexual health, few muscles in the body are more important than your pelvic floor muscles.
Problems with these muscles can create unpleasant complications you should look out for. Millions of women deal with some type of pain during intercourse, and it happens for many reasons. Whether you experience pain occasionally or all the time, here are some ways to alleviate the discomfort.
Many vaginal conditions can be irritating but harmless. Other conditions can be dangerous, like vulvar intraepithelial neoplasia, or VIN. Read on to learn more about what signs to look for and how VIN is treated. You can experience chronic pelvic pain for many reasons, like menstrual cramps, ovulation, and other issues during your period.
Most just brushed her off. Another doctor, before he even examined the area, told me he could cut out the part that hurt or put me on an antidepressant. I never went back to either of them, obviously. Furious, frustrated and in agony, Langdale-Schmidt, who was 28 at the time, decided to do research herself. The American College of Obstetrics and Gynecology defines vulvodynia as vulva pain that lasts three months or longer and is not caused by an infection, skin disorder or other medical issue; the condition can come on suddenly or slowly progress with time.
There are two types. Generalised vulvodynia can be found in different areas of the vulva at different times. The pain may be constant or can come and go. Localised vulvodynia is described as pain found in one specific area of the vulva. Often associated with a burning sensation, this type of the condition is usually provoked by touch or pressure, such as sexual intercourse, inserting a tampon, or prolonged sitting.
The pain, burning, irritation, or rawness can make a woman so uncomfortable that having sex, or even sitting for long periods of time, becomes unthinkable. But due to a variety of factors — including the difficulty of studying such a sensitive subject, variations in definitions and diagnostic criteria and a historic lack of research on health conditions that primarily affect women — it has gone under-researched.
In , more than 80 researchers came together for a conference on the state of vulvodynia research at the National Institute of Child Health and Human Development in the US. If you have a biopsy, your doctor first numbs your genital area with a painkiller, then takes a small piece of tissue that will be examined under a microscope.
Some types of vulvar pain get better with creams or pills made to treat yeast infections. Sometimes the pain goes away if you use creams that contain estrogen or cortisone.
Some antidepressant medicines can help nerve pain and irritation. Other treatments that may help include interferon injections, laser therapy, or surgery.
Muscle spasms in your pelvic area can also make vulvar pain worse. Physical therapy or biofeedback treatments treatments that help you strengthen and relax your pelvic muscles may help ease the spasms. With practice, you can learn to relax your pelvic muscles with exercises you do at home. Some of the following steps may help ease your vulvodynia symptoms. If they help, keep doing them. Doing so can cause an excess of bacteria and yeast in the genital area. This article was contributed by: familydoctor.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Pelvic inflammatory disease is an infection of female reproductive organs. It can make it hard to get pregnant and….
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