Research Outlines Effective Diagnosis and Treatment of Puzzling Gynecological Disorder
Treatment Gives New Life to Women's Sex Lives
A lack of awareness of vulvar vestibulitis—a condition associated with excruciating pain and burning of the vulva where sexual intercourse is virtually impossible—has, in the past, left many women and physicians frustrated. However, doctors in the Department of Obstetrics and Gynecology and the Division of Infection and Immunology at The New York Hospital-Cornell Medical Center have found that an accurate diagnosis and effective medical or surgical treatment of the disease can be achieved in the majority of cases.
In a clinical study cited in the journal of Infectious Diseases in Obstetrics and Gynecology (1996), Dr. William Ledger, Chairman of the Department of Obstetrics and Gynecology at New York-Cornell and a leading expert on gynecological infections, led a team of physicians in evaluating 220 women with vulvar vestibulitis over a period of about eight years.
Every patient had vulvar pain when she attempted intercourse, 36.4% had constant or recurring vulvar burning, and 10.9% had symptoms suggestive of bladder inflammation. Seventy-five percent had excessive vaginal discharge. In this instance, Dr. Ledger warns that physicians should take care not to attribute vulvar vestibulitis to candida vaginitis as some physicians are wont to do in cases of excessive vaginal discharge. Diagnostic evaluations, which included either a vaginal fluid test or a culture for yeast and bacteria, yielded only a 14.5% occurrence of candida vaginitis.
It was also found that 36.8% of the women studied showed no clear, recognizable cause for their vulvar vestibulitis. In 24.1% of the cases, the evaluations showed the women either had a history of, or were presently infected with, human papilloma virus (HPV). Allergic vaginitis was diagnosed in 19.5%.
A variety of medical and operative techniques were used to treat these women. Symptoms were relieved in 65.9% of the women. Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate supplement, 16% with anti-Candida treatment, 48.1% with antihistamines, and 77% with vulvar injection of interferon. The use of creams and suppositories containing propylene glycol was avoided as many women proved allergic to this compound.
Of the women who showed no improvement after medical treatment, 83% were cured after an operation which removed the inflamed vulvar tissue and was followed up by reconstructive surgery to the vulva. However, Dr. Ledger points out that this approach should not be the first treatment option, but should be utilized only after other therapies have been proven ineffective.
"Vulvar vestibulitis is a very painful, socially debilitating illness. Women with this disease need emotional support and appropriate medical care. Unfortunately, because of lack of awareness of this condition, positive interventions are often not offered," says Dr. Ledger. "My colleagues and I hope that our experience with vulvar vestibulitis will make more physicians aware of this condition."
Dr. Alan Kessler and Dr. Garrick H. Leonard, Department of Obstetrics and Gynecology; and Dr. Steven S. Witkin, Department of Obstetrics and Gynecology and the Division of Infection and Immunology also contributed to this study.
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