His and Her Health

Is anyone familiar with one possible cause of vulvar vestibulitis being a vitamin D deficiency? Has anyone had any relief by treating the deficiency? Also, on another note - has anyone heard of or had any success with flexeril, hydroxyzine, or Nasalcrom as a VV treatment? Dr. Goldstein, do you have any thoughts or cautions on the above? Thank you.

Vitamin D deficiency as a cause of vulvar vestibulitis has been proposed by Dr. Monica Peacock in New York City. Unfortunatly, there are no studies or data supporting this theory and Dr. Peacock has not presented this theory at any sexual dysfunction, sexual pain, or vulvar disease conferences. Therefore, I cannot comment because there is a complete lack of evidence.

Thank you very much for the info. Any thoughts or cautions on flexeril, hydroxyzine, or Nasalcrom as a vv treatment?

Dr. Goldstein-- What mechanism of action does Dr. Peocock think Vitamin D plays in vulvar vestibulitis? Does it have anything to do with calcium metabolism? Would Miacalcin Nasal spray have any affect?

AC73,

I have been seeing Dr. Peacock for two years for VV and she has been treating me for a vitamin D deficiency. Based on family medical history she decided to have my D level tested and sure enough it came up quite deficient. The progress has been slow, but I have had great success. 95% of my pain is gone after about one year of taking Prescription vitamin D twice a week. She said with more time I should be 100% better. The theory is that vitamin D is necessary not only for bones, but for maintaining healthy soft tissue. Her theory is unproven, although someone else is currently testing it. I don't care though. I was in really poor shape when I first started to see her and now I have my life back.

Pili,

Thanks so much for sharing your experience. It's wonderful to hear that 95% of your pain is gone!Is Rx Vitamin D your only treatment, or has it been in conjunction with anything else? I'd love to talk with you further offline, but I didn't see an e-mail address included in your profile. So, if you update your profile to include that, I'll be sure to write you!

Fascinating thread. Thank you all for posting.

Pili -
I would love to discuss with you more about the Vitamin D theory w/ Peacocke offline if possible. Let me know.My symptoms started after use of antibiotics.
Thanks Puja

why i think vit D deficiency could be connected...
it would work by the same mechanism as Alpha Lipoic acid (an antioxidant)and doxycycline...
they work as MMP-9 inhibitors.
the level of vit d is inversely related to circulating MMP9. matrix metalloproteinases (MMPs) have been implicated in several pathological and physiological processes such as, periodontal tissue destruction, and are responsible for tissue damage in chronic inflammatory conditions, including keratoconjunctivitis sicca, recurrent corneal erosions, diabetes.
for specifics on vit d and MMP-9 you can check out "Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? " Source: QJM: An International Journal of Medicine, Volume 95, Number 12, December 2002, pp. 787-796(10)

Robin,
Interesting explanation, but true vulvar vestibulitis is not an inflammatory condition like the ones mentioned above. Instead it is caused by a neuronal proliferation (as shown by Bohm-starke, Bornstein, etc). While one of the proposed mechanisms of this neuronal overgrowth is an allergic response to topical chemicals, once there are too many nerve ending in the mucosa of the vestibule to just inhibit the inflammatory response does not help. An analogy would be this: You see a deer in the road and you swerve to get out its way and you crash your car. Does moving the deer fix your car?

I have published a report of 212 women treated with alpha interferon- A much, much, much stronger anti-inflammatory drug as compared to Vit D and it only has about a 40% success rate.

Lastly, Dr Peacock has never put her "research" to the a "litmus tests." She has never submitted it for peer-review, nor (to my knowledge) is she a member of any vulvar disorders or sexual dysfunction medical societies. She is practicing outside the bounds of standard medical practice and is doing her "research" without particpating in an ethical informed consent process.

Lastly, I can say only this "let the buyer beware."

<small>[ 04-10-2008, 10:30 PM: Message edited by: Moderator ]</small>

I have been a patient of Dr. Peacock for a number of years. I was at the point where it was too painful for me to have intercourse. Since she started the vitamin D therapy w/me along w/vagifem 2x/week, I'm 80% better. It didn't happen over night, but I'm doing much better.
I cannot have intercourse for an extended period of time, but i am SO MUCH better than before.
She currently has a paper published in CUTIS. I am only a layperson, but my understanding is that the vaginal walls thin & the vitamin d promote growth of these walls, mucosal linings, etc.

The paper is a case report of one person. In terms of evidenced based medical literauture it is useless.

Just as there have been testimonials to the success of Dr. Peacocke's treatment, I have seen DOZENS of patients who have not been helped by her.

<small>[ 11-27-2008, 09:58 AM: Message edited by: Moderator ]</small>

I have been treated by Dr. Peacocke and while she hasn't resolved all my problems, I have to say that she has pursued them as aggressively as any doctor I've ever visited.

When she initially treated me with vitamin D, I became symptom free for the first time in five years. Since my symptoms returned she has questioned me about every aspect of my medical history. I'm now on a gluten-free diet because celiac disease has very bad effects on mucosal tissues throughout the body and I've been going on and off gluten for years now (which, I understand, is very bad for you if you can't tolerate gluten). It was when I had been back on gluten for a few months that my symptoms returned--no other gynecologist has ever asked me if I suffer from celiac disease.

When the best conventional medicine can offer is, "We have no idea why you have so much pain, let's put you on anti-depressants to blunt your symptoms," I don't mind someone being a little kooky and taking a risk. When we're talking about vitamin supplements and healthier diets (I have a pretty classic celiac profile and have been in denial about it for a long time), I don't see how her practice poses any threat to patients who keep hearing about steroid creams and nothing about root causes.

There are plenty of systemic problems that can have local manifestations and I'm frustrated that more gynecologists aren't more curious and knowledgeable. My body was ravaged by endless--and pointless--topical treatments that did nothing but further irritate the tissue until I met Dr. Peacocke. I was not treated by bad doctors. They followed all the rules. It was just shocking to me how easily they gave up--in part because that's what the rules said to do.

No one else I've seen or talked to even has a theory (and I mean a cause, not a shoulder-shrug diagnosis like "Vulvodynia" with no cure). No one has been through more specialists than me and she's the only one I have remote faith in, because she's the only one who ever had me symptom-free, even temporarily.

Even Dr. Peacocke's detractors should concede graciously that she helps a lot of women.

-Anise

If Dr. Peacock believes that low vitamin D levels are the cause of DIV then she should do a study comparing serum vitamin D levels in women with DIV vs age matched controls without vulvar complaints. Without this data, she is practicing outside the normal standards of care and is therefore violating the ethical principle of Primum No Nocere "FIRST DO NO HARM."

<small>[ 12-27-2008, 10:19 AM: Message edited by: Moderator ]</small>