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New Hope for Chronic Vaginal Burning and Pain As many as one woman in thirty may suffer with chronic, undiagnosed burning, rawness, stinging, itching, or stabbing pain around the vaginal opening. She will, most likely, suffer for many years, see many doctors, and be told the problem is "all in her head" before being correctly diagnosed with vulvodynia (AKA vulvar dysesthesia), a descriptive, rather than diagnostic term that literally means pain in the vulva, (the external, visible part of female genitalia, consisting of the clitoris and two pairs of the skin folds called labia). Also known as vestibulodynia or vulvar vestibulitis syndrome, the condition is poorly understood, widely underdiagnosed, or unknown to most gynecologists. Yet the impact on the quality of a woman's life can be profound. The pain can interfere with daily functioning, the ability to work and participate in a social life, engage in physical and, often, sexual activity. Ultimately, the condition can negatively impact on self-image, leading to depression. Vulvodynia symptoms can vary in persistence and location, ranging from mildly irritating to completely disabling. The pain, itself, is highly individualized and may be constant to intermittent, localized or diffuse. In many cases, pain will occur spontaneously or be provoked when vaginal penetration is attempted, as when inserting a tampon or during sexual intercourse. Sometimes a sore or redness can be seen, but often no infection or abnormalities are noted on gynecological and/or dermatological evaluation. The complex vulvar condition that covers a wide range of disorders was officially identified by a small group of doctors in 1983 and thought to result from multiple factors, such as injury or irritation involving the nerves that innervate the vulva, a local hypersensitivity to candida, allergies to environmental irritants, high levels of oxalate crystals in the urine, or spasms of the muscles that support the pelvic organs. No evidence points to infection or sexually transmitted disease and vulvodynia is diagnosed only when other causes of vulvar pain, such as active yeast infection, herpes, skin disorders, and other bacterial infections are ruled out. And while no cure was recognized, types, symptoms, their possible causes, and treatments are defined as follows:
Vulvar vestibulitis Symptoms: Inflamed, tender red spots near the entrance of the vagina (the vestibule). Pain when pressure is applied to the vestibule. The defining characteristic of vestibulitis is pain upon entry during sexual penetration; some women are unable to insert a tampon. Possible Causes: An allergic response to chemical irritants (soaps, deodorants, antifungal creams). High urine levels of calcium oxalate crystals. Pelvic muscle spasms. And/or trauma to the external genitalia from surgery, accident or rough sexual activity. Treatments: Removal of irritants. Reduction of oxalate-rich foods (including chocolate, peanuts, celery, teas and spinach) and the addition of calcium citrate supplements. Electronic-based biofeedback or physical therapy to rehabilitate the pelvic floor. Dermatological Diseases Symptoms: Vulvar burning or itching. Visible pimples or other lesions on the vulva that can vary depending on the underlying skin condition. Possible Causes: Genetic predisposition. Autoimmune dysfunction. Contact with irritant, commonly, lichen planus, lichensclerosis or lichen simplex chronicus. Treatments: Topical steroids. Antihistamines to reduce swelling. Other Causes Symptoms: Constant or intermittent vulvar burning along the pudendal nerve in the pelvic area; pain anywhere from the clitoris to upper thighs (called pudendal neuralgia). Pain only in the vestibule and vulva proper (called essential or dysesthetic vulvodynia). Possible Causes: Trauma to the pudendal nerve due to an accident of childbirth. Tumors of the spinal cord. Herpes virus infection. Pelvic muscle spasms. Treatments: Tricyclic antidepressants such as amitriptyline or desipramine (to help block pain). Anticonvulsants or anesthetic derivatives. Nerve blocks. Electronic-based biofeedback or physical therapy to rehabilitate the pelvic floor. Additionally, vulvar injections and surgical intervention have always been options when more conservative treatments did not produce acceptable relief. But now new hope is offered through the work of Howard I. Glazer Ph.D, clinical professor of psychology and obstetrics and gynecology at Cornell University Medical College in York, who has developed the first non-invasive, non-drug treatment with scientifically demonstrated effectiveness in the treatment of this condition. Dr. Glazer has discovered that the muscles of the pelvic floor in vulvodynia patients are unstable. This can cause the vulvar area to become hypersensitive, inflamed and painful. He is able to measure abnormalities with highly sophisticated muscle measurement technology known as surface electromyography (sEMG). And once a patient's exact dysfunction is known, it can corrected by an individualized program of muscle rehabilitation. Continued monitoring assures that the correct changes occur in the muscle. When muscle abnormalities are corrected, pain is relieved. Says former sufferer Anne Kahn: "A year ago, the pain in my vagina finally went away. After years of being misdiagnosed, unsuccessfully treated, told was nothing wrong with me, and that I was crazy, I finally found a cure. A small box of electronics gave me back my life." How I Used a Simple Exercise (and Biofeedback) to Ease My Vaginal Pain by Anne Kahn (Self Magazine) Glazer's method involves a tampon-like sensor that is inserted into the vagina. The sensor is attached to a biofeedback instrument that signals the patient when to vaginally squeeze and release the sensor, providing feedback about the strength of each contraction and the amount of tension in the muscle when it is relaxed. Performed daily, this exercise stabilizes pelvic floor muscles and diminishes pain. "For the first few weeks, I felt no improvement and almost gave up," Kahn confesses. "But after eight weeks things improved slightly; after 12 weeks, I had no pain except during sex. After 24 weeks, I could make love without pain...Now, a year later, I still do a modified regimen of biofeedback, but my pain is just an unpleasant memory." Overall, women undergoing this treatment report an average reduction in pain of 80%. Moreover, research reports that 50% of patients become completely pain free by the end of the treatment. But before beginning biofeedback, a complete diagnostic work up must be done and appropriate treatment for acute problems and medical symptoms addressed. This includes vaginal infections (fungal, yeast, or bacterial), peri- and post menopausal hormone related thinning of vulvar tissue with consequent irritation, dermatological sources of vulvar discomfort (including lichen simplex chronicus, lichen planus and lichen sclerosis) that causes thickening of the vulvar skin to cause localized irritative symptoms, venereological sources (diseases such as herpes simplex virus (HSV), vulvar warts, such as those found in human pappillomavirus (HPV), precancerous and cancerous vulvar diseases known to cause vulvar discomfort, transient vulvar irritation from contact with irritants (including soaps, detergents, topical vulvar preparations used to treat some of the above conditions), prolonged or inadequately lubricated penile vaginal intercourse and vulvar trauma. After resolving and/or discounting all the above, one must be certain to select a biofeedback practitioner who is a specialist with specific training in sEMG biofeedback for the pelvic floor. Ideally this will include training in the treatment of vulvovaginal pain conditions. Be sure to ask the practitioner if the office equipment and protocols include readings of muscle fibers, as well as muscle stability and that the sensor is the insertable type. Only sEMG biofeedback can measure the stability of the pelvic floor muscle at rest and specify which muscle fibers are used during contraction. Keep in mind that the treatment of vulvovaginal pain with electromyography biofeedback is new. Insufficient practitioner training, or inadequate equipment and protocols, are likely to affect the quality of the biofeedback results. Unsuccessful experiences with biofeedback are those in which sEMG biofeedback equipment has not been used or those in which the practitioner has not had appropriate training and equipment. To learn more, contact Howard I. Glazer Ph.D, 340 East 63rd Street, Suite 1A, New York, NY, 10021; Email Address howardg@idt.net; website http//www.vulvodynia.com, or The National Vulvodynia, Association (NVA), Box 4491, Silver Spring, MD 20914. Phone: 301-299-0775. Fax: -299-3999. Website http://www.nva.org End. Copyright Julia Busch, 2000.
Julia Busch is president of Anti-Aging Press, Inc., editor of So YoungTM anti-aging holistic newsletter, contributing editor to "The New Mexico Light," the "Arizona Networking News," and Living Alaska. She is also an anti-aging product researcher and CEO of the So Young anti-aging mail order company, a Subtle Energy Consultant, and the author of 10 books, including Facelift Naturally (acupressure facelift program for Men and Women), Treat Your Face Like a Salad, Power Color, Positively Young, Powerful Prayer Secrets, Youth and Skin Secrets Revealed, and My Secret Life with an Angel. For more information on cal 1 800 SO YOUNG. For a catalog of cutting-edge anti-aging products and information on the So Young newsletter, email julia@gate.net or call (800) SO YOUNG. For press or radio interviews see: The Yearbook of Experts, Authorities, and Spokespersons http://www.YearbookNews.com. |
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