Vaginal pain often misdiagnosed

DEAR DR. DONOHUE: My mother-in-law has a lot of trouble with vulvodynia. You had an article about it, but I didn't keep a copy of it. Will you repeat it? I'll hang on to it this time. -- L.B.

ANSWER: The vulva are the external female genitals: the labia, clitoris and vaginal opening. "Dynia" is a Greek word for "pain." Vulvodynia, therefore, is pain in this part of the female anatomy. The tissues might be red. Touching them and tight undergarments intensify the pain. Intercourse can be extraordinarily painful. To qualify as vulvodynia, pain in these structures has to be present for three or more months. Other causes for such pain -- infections and conditions like lichen simplex and lichen planus -- have to be considered and ruled out.

Most women who suffer from vulvodynia have been shuffled from one doctor to the next and given repeated prescriptions for antibiotics or antifungals but have not gotten any relief. Too often, the pain is dismissed as a psychological problem. It's the lucky woman who finds a doctor who finally makes the diagnosis.

The cause is disputed. Estrogen cream has brought relief to some women. Lidocaine gel, a numbing agent, can also quiet the pain, as can cool compresses. Loose-fitting underwear and the avoidance of harsh soaps also are helpful.

Quite by accident, it has been found that a percentage of affected women are sensitive to oxalate foods. Oxalate crystals in the urine irritate these tissues. Oxalate foods include beans, greens, green peppers, berry fruits, nuts, chocolate, tea, soy, beer, beets, spinach, sweet potatoes and purple grapes.

Have you heard of the National Vulvodynia Association? It's an advocate for all women with this distressing condition. It can give detailed information on the condition and keep you apprised of the latest treatments. You can contact the association at www.nva.org.

DEAR DR. DONOHUE: I was married one year ago at the age of 24. I started taking birthcontrol pills a couple of months prior to our wedding. I have terrible pain every time we have intercourse. I have been to the doctor, and she diagnosed vestibulitis. I have used numbing creams, antidepressants, times without sex and going off the birth control pill, but the awful pain continues. Can you help? -- Anon.

ANSWER: The vestibule is that part of the female genitals where the vagina and the urethra (the tube that drains urine from the bladder) open to the outside world. Vestibulitis is vulvodynia confined only to the vestibule. The symptoms are otherwise the same. It's understandable how this is upsetting to you and your husband.

Treatment is the same as treatment for vulvodynia.

You should also contact the National Vulvodynia Association for support and information.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com. 2006 North America Syndicate Inc. All Rights Reserved