What Is Causing My Pain ‘Down There’?

>> Wednesday, December 5, 2012

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Imagine vaginal burning and pain so severe you can’t sit comfortably, wear tight clothing or have sex. That’s the reality women with vulvodynia face, and although many of us would like to have a push-button answer to the problem, the human body does not function this way.

Why so many women suffer from pelvic pain during their cycles, during sex and some almost every day has puzzled many researchers and clinicians for years. There are a wide variety of reasons women can experience pain and problems.

Vulvodynia is a debilitating, difficult to treat, often incurable problem that causes extreme sensitivity of the vulva and vaginal labia. Possible contributors include injury to nerves in the vulva, hypersensitivity to candida (yeast) or other fungal and bacterial infections At times, the pelvic floor muscles spasm, causing throbbing and sensitivity to the slightest touch or pressure.

Some partially successful treatments have included the use of tricyclic antidepressants (to block pain receptors in the vulva), topical estrogen or lidocaine gel, and even surgery. Surgery is an extremely radical approach and requires removal of vulvar tissue in hopes the grafted tissue will cure the pain Capsaicin cream is a newer treatment that has to be specially compounded (and which contains the active ingredient in chili peppers), but has been shown to dramatically reduce symptoms.

If a woman’s condition is flared by a candida (yeast) hypersensitivity -- to which even a slight imbalance can cause itching and burning -- weekly doses of an oral antifungal medication over several weeks or months can help alleviate symptoms.

Some treatments for painful sex in women do not require medical intervention and can be treated safely at home - by using personal lubricants with intercourse, allowing injuries & surgical incisions to heal completely after surgery or childbirth, and simple patience and rest. Sometimes with vaginal pain due to menopause, excessive dryness after childbirth, or infections like yeast or bacteria, it may require a prescription from your physician. And, there are actually physical therapists that specialize in pelvic floor muscles that can help to alleviate the pain of pelvic organ prolapse.

Another condition, vaginitis, is caused from a disruption in the natural balance of bacteria that live in every healthy vagina. Vaginitis usually refers to bacterial vaginosis and yeast infections that can cause unbearable itching, burning, pain and/or odor for many women. It can re-occur several times per year.

There is no single cause for vaginitis, and it is not considered sexually transmitted. Common causes may include hormonal changes due to birth control, menopause or pregnancy, as well as chronic medical conditions, such as HIV and diabetes, which weaken the immune system. Frequent sex can also be a big cause of recurrent vaginitis, due to the sugary, alkaline solution surrounding the sperm which disrupts the acidic environment of the vagina. This creates a perfect environment for bacteria and yeast to flourish. Recurrent infections can cause chronic pain in women. Treatment is painless and easy - most women simply insert a prescribed cream at night or take a prescription oral antifungal or antibacterial.

Atrophic vaginitis is thought to be a problem of menopause. The term describes the dryness, vaginal wall thinning and shrinkage, and paleness of tissue due to lack of estrogen. Urinary incontinence can go hand in hand with this. Many of you have experienced this with childbirth and breastfeeding, due to the hormone changes which are similar to menopause. This condition can feel like an infection, with burning, itching, and pain, but no active fungus or bacteria is found. Treatments such as estrogen creams or oral estrogen therapy can help.

Some women suffer from another condition called lichen dermatoses, which is a condition that can lighten and stiffen the tissue in the vulva and can cause severe itching and scar formation. A mix of topical steroids with a tiny dab of estrogen can help heal the damage to the vulvar tissue and decrease symptoms.

Vaginismus is a rare condition (affecting fewer than 2% of women in the United States) in which the muscles surrounding the vagina involuntarily spasm so tightly that you can’t have sexual intercourse or even insert a tampon. The specific cause of vaginismus is unknown, but, as with vulvodynia, physical therapy can be a successful treatment.

Physical therapists who specialize in pelvic floor disorders can correct structural abnormalities and design a manual therapy and exercise program that will retrain pelvic muscles that are too tight or too weak, depending on the condition. Their efforts can dramatically reduce symptoms without the side effects of medication. They also teach women the proper way to perform techniques at home, with dilators and their own fingers, to gently stretch and massage the muscles. If a woman’s symptoms persist despite physical therapy, a doctor can inject Botox to paralyze muscles and prevent the spasms for up to six months. Other (older) treatments that have been successful for vaginismus include sex therapy medications such as Valium and hypnotherapy.

Fibroids affect about 77% of women, but most don’t realize they have them. In some cases, there are no symptoms, but some women can develop cramping, excessive bleeding during menstruation, and painful intercourse. The growth and development of these uterine tumors are rarely cancerous, in fact less than 0.01% of the time. Fibroids may shrink naturally after menopause. Treatment options vary and usually have a lot to do with a woman's age and desire for future childbearing.

Hysterectomy is one option, but if you have a desire for future fertility, it is possible to have only the fibroids removed, leaving the uterus and ovaries intact. There is also a procedure called uterine artery embolization, which cuts off the blood supply and forces the fibroid to shrink, however this may compromise future ability to have children, as it compromises blood flow to the uterus.

Genital Herpes is a disease caused by the herpes simplex virus (HSV), of which there are two types. Type 1 (HSV-1) usually causes oral herpes, an infection of the lips and mouth. Symptoms are commonly known as cold sores or fever blisters. In the past, HSV-1 was not known to cause genital lesions, but that is changing, and we now know oral herpes can be passed to the genital area via oral sex. Genital herpes is caused by the second type of herpes virus (HSV-2) and reoccurs more often - causing more distress to the person who has it. Chronic herpes infections can be a cause of persistent pelvic pain and painful intercourse.

I hope this has helped many of you with questions and concerns. I hope you all had a happy and safe holiday.

Sincerely,

Dr. Susan Boyd, MD

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