His and Her Health

At onset of menopause 3 yrs.ago,quickly developed horrible burning and redness of complete vulva area. After several diagnoses,and 3 years of estrogen treatments in every form available,my latest research seems to confirm what one gyn.told me- that estrogen does not have much effect on vulvar tissue..and that testosterone is the only treatment which works in that area outside the hymenal ring. Response?

This is a great question for our experts. I will forward it along and let you know their response.

Have you had the condition diagnosed? Could it be a condition called lichen sclerosis? If so, topical testosterone can be applied to the skin once a day to treat it. Maybe this is why your gyn was suggesting this?

Hi-don't think it's lichen sclerosis..gyn's who've examined me see very little there...now just a little redness. Ultrasounds have shown almost no thinning inside, but quite dramatic thinning in the vulvar area. (Perhaps hereditary?)
Have seen some improvement last 6 months,with the usage of compounded estrogen in glaxal base,used nightly only in vestibule area. I do grow tired of constantly "fussing" with myself..and have concluded that only I have the interest to seek a solution for this, because I truly believe there is one. Unfortunately, when gyn's see your birthdate and determine you are menopausal or post, you are automatically "slotted" in their minds. It's up to YOU to persevere. After 3 years of estrogen treatment and still experiencing this symptom, it does make a lot of sense that perhaps estrogen doesn't build tissue in this area...the French gyn I saw said that this is because there are no "estrogen receptors" in the vulvar area for the estrogen to stick to. Just wanted to seek feedback (because women KNOW what's going on and what's worked for them) before making the pitch to my gyn. for testosterone creme. It's lovely to have this forum,and I'm very grateful for your response.Thank You!!

It just sounds like that area is really irritated, that's why I thought it might be lichen sclerosis. Maybe you need to treat the irritation first, and then the sex problems. Maybe it's becoming irritated from the estrogen you've been applying?

Sounds like it's really, really annoying.

Topical testosterone can increase clitoral sensitivity, increase vaginal lubrication and heighten arousal but it's definitely not the "cure for all". Why don't you ask your gyn more about it? Why do you have to "pitch" it to him/her? Can't you just inquire about it?

Red Hot Mamas expert Dr. Machelle Seibel has some advice for you:

You might want to get another opinion on your problem. It is possible that you have a vulvar problem called vulvar dystrophy. That is a skin condition that causes burning and itching. It might need a biopsy to diagnose but it isn’t as bad as it sounds.

A small amount of local anesthetic is injected a special small circular knife if used that only cuts the outer cells of the skin about 1/8th of an inch in diameter. That is looked at under the microscope to make the diagnosis.

There are other types of treatment for that. Estrogen does have an effect on the vulva and if rubbing estrogen cream on the outside isn’t helping, it is likely the vulvar dystrophy.

Prology, you may get some useful information from the articles on our other site.
http://www.ourgyn.com/

Prology, did you ever get a second opinion? Did you decide on a course of action? We're curious over here!

Hmmmm-vulvar dystrophy eh? I am still caught in the warp of Moscow, but will be home in Canada July 1st, and have an appointment booked with a vulvo-vaginal specialist Yea!The possibility of V.dystrophy seems to make a LOT of sense to me, although the common signs-white lesions, etc.are not apparant to the naked eye. For the past year I have been chasing the burning away with a tiny drop of cortizone (usually once or twice a week) but strangely, had a TWELVE WEEK period this winter where all felt very normal,and did not need to use the cortizone.Even had a return of sexual desire!!! Then Boom!! the old burning started again. It drives me crazy,because I have been compelled to "self-diagnose" and have explored possibilities such as oxalates/stress/allergies/irritant dermatitis(because a)my mother had horrendous exzema on her hands for years and b)I've always been super sensitive vaginally-have never been able to use bubblebath,bathsalts,etc).
The French gyn.I saw here in Russia was the worst experience of my life-he asked my age and put up his hand to say "Stop talking" and proceeded to tell me that he knew exactly what my problem was. He said "You have vaginal atrophy and there is no treatment for this condition". He said that the only treatment is testosterone and that he wasn't permitted to prescribe it in Russia. He then examined me,with some sort of probe (I think ultrasound)smiled and pronounced: "A beautiful atrophy! Go home my dear and be thankful you don't have cancer..you are not going to die". It was only that I lacked the courage, because on that day, after 2 years of constant burning,and that terrible,terrible man,I very much wanted to end the pain.
I AM improved. The estrogen in the compounded base DOES help,if I am vigilant,and use every night.But my gut reaction is that there is a problem that has yet to be diagnosed, and I DEEPLY appreciate your heads-up on V.Dystrophy...I had never heard of it, and from all my research, vaginal atrophy takes time to develop after years without estrogen. This symptom came out of nowhere..and became very intense, at which time, I began estrogen replacement with vagifem, and when this didn't improve symptoms long-term, I added Premarin in the vestibule...and after 3 years of this,one can't really say things are "normal" because I have to use the estrogen creme every night to obtain a semi-comfortable state. Sorry to be such a long-boring-story,but know each of you reading this, understand. Thank you.

Your experience with the French gynecologist sounds really frustrating! What an utterly disheartening comment to hear from a doctor. I'm glad you could see right through him/her to realize there is probably an answer to these issues! There are a lot of women out there who wouldn't stand up like you did to take charge of their own health care. They would just accept the fact that there is no hope. Hats off to you for having the courage to rise above that totally disastrous experience. As you said, "it's up to you to persevere"... that's so very true.

I hope you can get tested for vulvar dystrophy when you get back to Canada (as our expert suggested). I'm sure your specialist will give you more insight into the condition and hopefully find a remedy once and for all. Please keep us posted on the diagnosis! In the meantime, hang in there and try to make yourself as comfortable as possible. Can you go back on the cortisone? If that was helping, maybe there is a stronger dose you can get? Have you found a doctor there you can trust?

Thanks-kind words always much appreciated. I use cortizone when absolutely necessary. I'm afraid to lean too heavily on it, until I'm diagnosed, and know that this is what I should be using. My gyn in Canada was VERY reluctant to give it to me, cautioning that it can "thin tissues" so I use it when the burning gets too bad to handle. As mentioned I went 12 weeks this winter not needing it at all, and it seems I need it less than before, as long as I keep the compounded estrogen creme applied each and every night. I feel VERY confident that a diagnosis is imminent!
I'll let you know how it goes! Thanks again.

I had a lot of your same symptoms. For 8 months I unsuccessfully tried numerous treatments from numerous Drs. Finally, I saw Dr. Goldstein (his forum is at the bottom of this site).

He found that my low hormones had caused vulvar dystrophy. He had me apply a testosterone & estradiol gel every day and it helped.

We just posted a great article by Dr. Goldstein on our site about vestibular pain, redness and pain during intercourse (i.e., vestibulodynia). You may be interested in it: http://www.redhotmamas.org/content/index.php?option=com_content&task=view&id=128&Itemid=103