Health Notes, June 29th 2008, by Sarah Stacey

An integrated approach to vulvodynia

A reader wrote recently asking about vulvodynia: ‘my 23 year old daughter suffers from this distressing and little talked about condition, which causes much pain, makes sexual relationships difficult if not impossible, and also causes urgency to urinate’. Vulvodynia means pain in the vulva (the labia, clitoris and vaginal opening), which may be raw, stinging, itching and burning.  The pain can be continuous (known as ‘unprovoked’ vulvodynia) or ‘provoked’ when anything presses, even lightly, on the tissues (this may be called vestibulodynia).  It’s been compared by sufferers to having acid poured on to an open wound.   

According to recent Aermican research, this chronic pain condition affects up to one in six women, and may last for months or years. Sadly, many doctors do not correctly diagnose the condition, partly because the symptoms are similar to those of common vulvovaginal infections such as candida or cystitis.

The problem involves inflammation of the nerve endings in the vulva, but what causes that is unclear.  However, American research has revealed that sufferers may have a genetic tendency to chronic inflammation, whereby an inflammatory response to an infection doesn’t go away.  They may be genetically more vulnerable to chronic infection.  It’s been shown that sufferers have more nerve fibres in the vulva, so more pain signals are sent to the brain.  This may be a genetic tendency, due to inflammation, or to hormonal changes triggered by the contraceptive pill.

Currently, a diagnosis is made on the basis of eliminating other problems, such as infection or dermatitis.  The notion that the cause was primarily psychological has been disproved and experts here and in America are campaigning for quicker diagnosis and better treatment.  A range of options is available but so far no cure, according to consultant gynaecologist Michael Dooley of the Poundbury Clinic, London:‘It’s a bit like psoriasis: you can’t actually cure the underlying condition but you can help the patient through that bout, and then manage it as well as possible.’

If the vulva is itchy, Mr Dooley uses topical steroids such as Dermovate ointment: ‘unlike the skin of your finger, say, the vulva won’t get increasingly thinner.  But you must apply it with a cotton wool bud, not your finger.’ He also gives patients short term tricyclic anti-depressants such as amitryptiline, to break the cycle of pain (these are also used for endometriosis).  Gabapentin, a drug originally developed for epilepsy, gives effective relief if there is continuous pain.  Some patients need referral to a local pain clinic.

In terms of natural remedies, he recommends acupuncture (which has an impressive research record for pain), hypnotherapy and the use of biofeedback devices (however the effectiveness of biofeedback training is dependent on the practitioner involved).  If sex is a problem, he advises talking to a psycho-sexual counsellor.

Lifestyle measures are vital: wear loose, pure cotton/silk underclothes and no tight jeans; don’t use harsh chemicals in bath and cleaning products (bubble bath, bath cleaners, washing powders etc); cleanse the vulval area with water only, pat dry with a clean soft towel or tissue and complete with a hair drier; if inserting tampons is a problem switch to pads (chemical and additive free ones such as Natracare may help).  There are even special soft bicycle seats, according to the Vulval Pain Society, an independent charity, www.vulvalpainsociety.org  (this is an entirely volunteer organisation so responses may not be quick).  The American-based National Vulvodynia Association has lots of helpful information and research.

Vulvodynia is an individual condition and the treatment that suits one patient may not work with another. ‘Patients mustn’t give up: there will be something that helps,’ says Mr Dooley.

All that blisters…

Limping up New Oxford Street in London recently with a huge and painful blister on one heel, I was infinitely grateful to the resourceful assistant at Boots who found me a Compeed blister plaster, sat me on a chair and even unpeeled the backing for me.  These virtually invisible oval plasters, which were developed for hospital use,  are amazingly and instantly effective: I practically skipped on my way. Pop a packet in your bag, brilliant for hiking too.  £5.95 for 5, from Boots…

OTC spray for Swimmers Ear

Swimmers ear is a common complaint caused by getting unclean water in your ear.  It can be painful and itchy.  As well as keeping the ears dry, pharmacist Shabir Daya recommends EarCalm spray, which contains acetic acid and is the only OTC product for mild outer ear infections.  For 12 years of age on, £6.38 for 4ml from chemists nationwide.

Website of the week: www.managinghairloss.com

While I am wary of sponsored sites (this one is supported by Viviscal, a natural supplement for hair loss containing a marine protein complex, silica and vitamin C, with some scientific evidence to back it up), this is a good source of information on a very distressing condition from an independent GP and naturopath Dr Deborah Manners and trichologist Vetta Thompson.