Guest Author - Heather C. Guidone

Vulvodynia is a painful disease affecting millions of women, yet the disorder continues to be treated with a lack of significance by
medical and lay societies alike.

Characterized by the International Society for the Study of Vulvovaginal Disease as "chronic vulvar discomfort or pain," symptoms of
Vulvodynia include burning, stinging, irritation or rawness of female genitalia. In many cases, the pain occurs spontaneously. With
Vulvar Vestibulitis, a form of Vulvodynia, pain is experienced only when pressure is applied to the vestibule (the area surrounding the
entrance to the vagina). According to the National Vulvodynia Society, Vulvodynia is also sometimes referred to as pudendal
neuralgia.

As with most chronic pain states, Vulvodynia can have a profound, negative impact on a woman´s quality of life, interfering with her
ability to function on a daily basis. Women with the disease are often unable to engage in sexual activity due to extreme pain, and
find themselves unable to work, care for themselves or their family, or participate in a social life. These effects are far-reaching and
can ultimately lead to a negative self-image and depression.

A survey by the National Vulvodynia Association found the average age of women with Vulvodynia to be 43, but age ranges have
been reported from 11-75 years.(1) While the definitive cause of Vulvodynia remains unknown, experts on the disease speculate that
it may be caused by an injury to or irritation of the nerves surrounding the vulva, hypersensitivity to Candida, an allergic response to
environmental toxins, high levels of oxalate crystals in the urine, or spasms in those muscles that support the pelvic organs.
Vulvodynia is not caused by infections or sexually transmitted diseases.

Vulvodynia is diagnosed when other causes of pain, such as bacterial or viral infections or skin disorders, are ruled out. Upon
physical examination, vulvar tissue may also appear inflamed and swollen. Frequently misdiagnosed with a sexually transmitted
disease, yeast infection or other ailment, it is not unusual for a woman to consult seven or more physicians before obtaining an
accurate diagnosis.(2)

There is no cure for Vulvodynia. Treatments are aimed at symptom relief, and include drug therapies such as tricyclic
antidepressants or anticonvulsants, nerve blocks, interferon, biofeedback and diet modification. Surgical intervention is an option for
some when other treatments do not provide relief.

Though millions of women suffer from this painful disease, it is still portrayed inaccurately by the media and regarded with
insignificance by the medical community. One recent, unjust depiction includes Home Box Office´s "Sex and the City" series, in
which a main character on the show received a diagnosis of Vulvodynia from her gynecologist after reporting symptoms of vaginal
burning, itching and stinging. When asked if the condition is serious, her female gynecologist brushes off her concerns and provides
the character with a prescription for anti-depressants. The character, Charlotte, tells her doctor, "but I´m not depressed!" Her
gynecologist counters, "they are not for you - they are for your vagina." In a press release(3) following the airing of the episode,
Phyllis Mate, Executive Director of the National Vulvodynia Association, criticized the show, stating "Sex and the City failed
miserably at portraying the serious and complicated nature of this condition, particularly when the show´s gynecologist indicated that
it´s easy to treat."

The good news is, the National Institutes of Health has awarded federal funding to three Vulvodynia research studies for the first time,
in order to find out what causes Vulvodynia and to develop more effective treatments for the disease. Bernard Harlow, Ph.D.,
Associate Professor of Obstetrics, Gynecology & Reproductive Epidemiology at Harvard Medical School will be investigating the
prevalence of Vulvodynia in his proposed five-year study. The study aims to assess demographic, environmental, and various other
risk factors for the disease. The second study, conducted by Barbara Reed, M.D., Associate Professor of Family Medicine at the
University of Michigan School of Medicine, will examine possible neuroimmunologic causes of Vulvodynia. A third study, conducted
by Gloria Bachman, M.D., Professor of Obstetrics, Gynecology & Medicine at the University of Medicine & Dentistry of New Jersey,
seeks to determine whether Vulvodynia is more common in certain age groups and whether there are similarities among women who
develop the disease. In addition, Dr. Bachman and her colleagues will also assess the benefit of both traditional and new
pharmacologic and dietary interventions in diagnosed women.(4)

Women with the disease need to know they are not alone. For validation, education and support, patients with Vulvodynia are
encouraged to contact the National Vulvodynia Association. The NVA is a non-profit organization established in 1994 to improve the
lives of women suffering from chronic vulvar pain. For more information, contact the NVA by mail at PO Box 4491, Silver Spring, MD,
20914; by phone at 410/686-7011 or on the internet at www.nva.org.

References:
1) "Vulvodynia: Causes, Diagnosis and Modern Therapy," Summer 1999 NVA News (Volume V, Issue III), by Jessica Thomason, MD, FACOG, Clinical Professor of
Obstetrics and Gynecology, University of Wisconsin Medical School, Madison, Wisconsin, and Director of Women Now Health Care, Milwaukee, Wisconsin.
2) NVA, PO Box 4491, Silver Spring, MD, 20914; by phone at 410/686-7011 or on the internet at www.nva.org.
3) http://www.nva.org/press3.htm
4) http://www.nva.org/press2.htm

© Heather C. Guidone. All Rights Reserved.