His and Her Health

About a year and half ago, I had about 4 months of awful irritation/pain around my clitoris, accompanied by some white discharge from the area. It became very uncomfortable to wear pants. I saw a number of OBGYNs who had no answers for me. They tested me for many STDs, told me I was experiencing a latex allergy or seasonal allergies or a variety of other things that were not at all useful. Then, after 4 months, the problem miraculously cleared up by itself (not due to any sort of treatment). I thought I was problem free until the problem resurfaced about 6 months ago--the symptoms were exactly the same. I saw one OBGYN who diagnosed the problem as being lichens schlerosis because the skin around the vulva was so thin. However, she made this diagnosis without taking a biopsy. I then saw Dr. Monica Peacocke who told me that there was no way I had lichens schlerosis because my tissue was pink and healthy (not white as it would be with lichens schlerosus). She explained to me that long term use of Nuva Ring (which I had been using for about 2 years), coupled with low vitamin b12 levels had messed up the hormone levels in my body and caused me to experience symptoms of menopause (despite the fact that I am only 22 years old). She said that the lack of estrogen in my body had thinned the skin around vagina and altered the pH of the area causing me pain and irritation. She said that if I stopped using the Nuva Ring and started taking vitamin B12 and vitamin D supplements, I would totally recover within 3 months. I have now been following these instructions for nearly 3 months and have seen no improvement.
Does anyone have any advice for me about where to go from here? Dr. Goldstein, do you think that I may have another problem that no other doctor has thought of yet? Has anyone else heard of the NuvaRing causing so many problems? If so, do you think I simply need to wait a few months longer for my body to recover.
Basically, any advice or insight that anyone can offer will be greatly appreciated.
RC

Here is a link to a description of some clitoral pain.See if this is like what you are experiencing.
http://www.hisandherhealth.com/ubb/ultimatebb.php?/topic/2/1293/2.html

Thank you for your reply. The link you supplied talks about clitoral adhesions. I have read about them online before and asked some of my doctors if they thought that I was experiencing clitoral adhesions. None of the OBGYNs I saw thought that this was the case. When I saw another doctor about my situation, she did not raise this as a possibility. Are clitoral adhesions very difficult to identify--is it likely that the 6-7 doctors I have seen so far could have overlooked the adhesions? When I have a particularly bad day, rinsing the area with water does provide some relief, but gently cleansing the area routinely has not caused my problem to go away. Next time I see a doctor, I will ask about adhesions again, but does anyone have any other ideas about what I could be experiencing or how to treat it?
RC

If you are in severe pain on a daily basis (not just intermittent when having intercourse) then I can tell you that you are not just suffering from a Vitamin D deficiency. The majority of the American population is Vitamin D deficient and they are not walking around in this kind of pain . I made the mistake of sticking with her for 9 months, in constant pain. The doctor got my Vitamin D level up to 120 (toxic level) and told me to up my dose even more b/c 'my body just requires a higher Vitamin D level to function pain-free'. This clearly is hog-wash. The doctor had no idea what was causing my pain, but insisted that she could get me better with higher Vitamin D doses. Also, as another side-note, I used to have heavy yellow discharge, but after using estrogen cream, the discharge is gone. So I would be inclined to say that DIV may entirely related to a hormone inbalance and not to a Vitamin D deficiency.

The nuvaring is a form of hormonal contraceptive which dramatically alters the normal levels of estrogen, progesterone, and testosterone in a heallthy reproductive age women. My regimen for these types of patients, and I have many, is to stop the contraceptive, allow your body to requibrilate and then resume a form of topical bio-identical estrogen as well as testosterone, which is the gold standard for lichen sclerosis. I would be happy to speak to you about alternative methods of birth control in the interim as well as the future. The good news is, you are not alone, I have many women with similar complaints and there are treatments available. Feel free to contact me directlly if you would like more information.

Jennifer R. Berman, MD