His and Her Health

Hi Dr. Goldstein,<BR>I have suffered from VVS since I started becoming sexually active. (I'm 44 now) When I was young, I noticed that I could have pain-free sex about the time I ovulated and the pain became much worse just before and during my period. I tried taking Orthocept about 10 years ago and my VVS turned into unrelenting burning pain. Discontinuing the drug allowed me to return to pain on contact only, but I never found sex to be tolerable again, even during ovulation. About 2years ago, I developed IC as well. I had always thought my VVS had something to do with my hormones, but I could never get a doctor to measure them. Finally, a few months ago, I found a doctor that would and lo and behold I had unmeasurable estrogen on Day 1, 50% normal levels the rest of the time, except I zoom up to normal on Day 14, when I ovulate. I am now using estrogen cream on the vestibule and wearing a 1.0 Climara patch. My IC disappeared and my night sweats and heart palpitations stopped, but my VVS remains unchanged.<BR>Is it possible that my nerve endings are too proliferate to be healed by the estrogen? How long does it take for the estrogen to have an effect, or is it your experience in these long-standing cases, that surgery is the only answer?<P>Thanks!<BR>Toby<BR>P.S. In the yahoo discussion group, you mentioned that you were going to discuss the causes and treatments for VVS & DS, but never had a chance to complete that task. I'm sure the members here would like for you to continue that discussion.

Toby:<P>It is my belief that primary vulvar vestibulitis (pain since the first attempt at intercourse or tampon insertion) is a congenital problem (birth defect). Woman with primary VVS are born with too many nerve endings in the vestibule. As with most congenital problems, surgery is usually the most effective treatment.<P>There is no evidence in the literature that shows that estrogen can cause these "extra" nerve endings to regress.However, estrogen can cause the mucosa to thicken which can act as "a cushion" and it can also increase vaginal lubrication which can also help minimize the pain during intercourse.<P>Dr. Goldstein <P><BR> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by Toby:<BR><B>Hi Dr. Goldstein,<BR>I have suffered from VVS since I started becoming sexually active. (I'm 44 now) When I was young, I noticed that I could have pain-free sex about the time I ovulated and the pain became much worse just before and during my period. I tried taking Orthocept about 10 years ago and my VVS turned into unrelenting burning pain. Discontinuing the drug allowed me to return to pain on contact only, but I never found sex to be tolerable again, even during ovulation. About 2years ago, I developed IC as well. I had always thought my VVS had something to do with my hormones, but I could never get a doctor to measure them. Finally, a few months ago, I found a doctor that would and lo and behold I had unmeasurable estrogen on Day 1, 50% normal levels the rest of the time, except I zoom up to normal on Day 14, when I ovulate. I am now using estrogen cream on the vestibule and wearing a 1.0 Climara patch. My IC disappeared and my night sweats and heart palpitations stopped, but my VVS remains unchanged.<BR>Is it possible that my nerve endings are too proliferate to be healed by the estrogen? How long does it take for the estrogen to have an effect, or is it your experience in these long-standing cases, that surgery is the only answer?<P>Thanks!<BR>Toby<BR>P.S. In the yahoo discussion group, you mentioned that you were going to discuss the causes and treatments for VVS & DS, but never had a chance to complete that task. I'm sure the members here would like for you to continue that discussion.</B></font><HR></BLOCKQUOTE><P><P>------------------<BR>Andrew T. Goldstein<BR>Director, The Center For Vulvovaginal Disorders

Toby, Dr. Elizabeth Vliet, whose books discuss the very problem you have (and apparently I do as well), told me during an appt that for some reason systemic estradiol doesn't always help with VVS -- you need topical estradiol (in the form of Estrace cream and/or Estring or Vagifem) as well... Hope that helps!<P>By the way, how long after you started the Climara patch did the night sweats, etc. disappear?<P>Did you titrate up to the 1.0 strength or just start with 1.0? Any negative side effects?

Hi!<BR>I have also been using Estradiol topically for a couple months now as well and it hasn't helped. I noticed improvements in my night sweats, etc within about 3 days of using the patch. I started with 0.5 and then increased to 1.0. Incidentally, I am now taking oral BiEst instead because I eventually became allergic to the adhesive on the patch. I am working on titrating the amount:<BR>If I take too little, I get heart palpitations and urethral discomfort.<BR>If I take too much, I get very sore breasts and my VVS symptoms actually worsen to burning even without contact! (darn) My doctor wants me to start taking some progesterone (natural) on my next cycle. I will be retested after a couple of months on the hormones. I may also need some testosterone because that is also a bit low, but they want to wait until I've balanced out the other two hormones.<BR>I've also read Dr. Vliet's book... felt like she was talking about me throughout! <BR><BR>Toby