Dr. Goldstein recalls the symptoms associated with vulvodynia and describes the numerous ways this condition is treated that include oral and topical medications, pelvic floor therapy, hormonal therapy, psychological therapies, and even surgical options.
It’s best tried by woman who has it, but I’ll do my best – it’s burning, tearing, ripping, raw like paper cuts, can’t wear tight clothing, can’t wear jeans, can’t wear even underwear in some situations, intercourse is extremely painful. Women who are in relationships do it out of duty and hope that it’s over with soon. It’s a disaster. It really is a disaster.
We have all kind of strategies – psychological strategies, pelvic floor therapy strategies, oral pill strategies, topical agent strategies, hormonal strategies and what is really interesting is the multidisciplinary approach has recognized now surgical strategies where we actually remove the vestibule surgically in women who have gone on and on.
I just did a case on Tuesday on a woman who at age 11 was starting to have vestibular pain. She is 33. 22 years now of just misery and we finally removed her vestibules surgically. So there are congenital reasons for abnormalities in the vestibule. There’s acquired reasons for abnormalities. We have done basic research to understand genetic predilections of women who are going to have this condition.
So a woman who has sexual pain should see a specialist, ostensibly a sexual medicine specialist, but at least a gynecologist who is familiar with this diagnosis. After the regular physical examination there can be provoke testing with a Q-tip, just a simple Q-tip or cotton swab to be placed around the tissue around the hymen, which is the vestibule, and simple touching of that area will provoke in women who have this condition an unusual response like very, far more pain considering the application is just a Q-tip.
So there is erythema or redness around the area and there’s no obvious explanation for this and what we are finding is that there is a growth of nerves in this tissue. So there’s 40 times the number of nerve endings in this crazy part of the anatomy called the vestibule, and the vestibule is just an extension of the urinary system.
It’s very funny that the male needs a urethra in its reproduction because that’s how semen comes through, but because men and women all come from the same sort of beginning the women get stuck with this urethral tissue that they don’t need and that ends up becoming their vestibule and in the vestibule it can be congenital growth of nerves or acquired growth of nerves from various allergens or trauma or injuries, and then women are stuck with tissue just around the opening to the vagina where just simple touching with a Q-tip provokes this unbelievable response.
And we try multiple therapies – we try physical therapy, psychologic therapies, oral pill therapies, topical agents, dilator therapies, but at the end of the day, continuing of the pain leads to the possibility of surgery and the vestibule can be easily removed in a woman – that’s what’s really exciting, and the results of surgery are so amazing. We have approaching 80-90% success rate. Just think of this – women who have this condition for ten or more years, 20 years, can actually have this removed.
It’s interesting that the vestibule is a middle embryology. If you think of your mouth, you have your buccal mucosa and skin. If you think of the anus, it’s anal mucosa and skin. If you think of the vagina, it doesn’t open to skin. It opens to the vestibule and then to skin. So you can actually create surgically, the vagina open to skin by removing the vestibule. It’s like an hour operation.
About Dr. Irwin Goldstein, M.D.:
Dr. Irwin Goldstein is Director of San Diego Sexual Medicine at Alvarado Hospital, the Secretary of the International Society for the Study of Women’s Sexual Health, a former President of the Sexual Medicine Society of North America and a Clinical Professor of Surgery at University of California at San Diego.
Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. His specialties include penile microvascular bypass surgery, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women.