Jan. 13, 2004 — Fans of popular show Sex and the City
know it as having a “depressed vagina,” thanks to an episode in which
character Charlotte York is prescribed antidepressants to treat her genital
pain.
The medical term for the condition, characterized by persistent
pain or burning outside the vaginal area, is vulvodynia, and new research shows
that it is far more common than previously thought.
Instead of a couple hundred thousand cases, an Internet survey
indicates that millions of American women may suffer from vulvar pain. The
implication, says survey author Barbara Reed, MD, is that most are suffering
silently.
“Women who seek treatment for this are usually in pretty
severe pain, but those with less severe pain may not even interpret anything as
being abnormal,” Reed tells WebMD. “They may think that they are
supposed to feel this way.”
Burning Love
For those who need an anatomy refresher course, the term vulva
refers to the outer area of a woman’s genital organs. It includes the labia
majora, or large lips; the labia minora, or small lips; the clitoris; and the
openings to the urethra and vagina.
Women with vulvodynia may feel sharp stabbing pain, especially
at the opening of the vagina, or they may feel generalized burning throughout
the area. Pain is typically most intense during intercourse, so it is no
surprise that many sufferers experience a decrease in sexual desire.
In the University of Michigan study, 28% of the 995 women who
responded to the web-based survey reported having had vulvar pain. With 8% of
these saying they have experienced vulvar pain within the last six months. A
total of 3% reported that their pain was chronic lasting three or more
months.
“From this data we extrapolated that roughly 2.4 million
American women have this pain, but the number may be as high as 5 million,”
Reed says.
About one-third of the survey respondents were African
American. Although previous reports show the condition is rare among black
women, the responses indicated that this is not the case. Black women had
similar rates of vulvar pain as women of other races. The survey is reported in
the January issue of the Journal of Lower Genital Tract Disease,
Treatment
Reed says she hopes the realization that vulvodynia is common
may convince more women to seek treatment. The antidepressant Elavil is often
prescribed, not because women with the pain are depressed, but because the
condition seems to be associated with hypersensitive nerves in the genital
area. Low doses of antidepressants like Elavil have been shown to reduce nerve
sensitivity.
Boston ob-gyn Patricia DeGroot, MD, says a wide range of
conditions, from yeast infections to lower back problems, can cause vulvar
pain. For this reason, a one-size-fits-all approach to treatment does not work.
DeGroot says approximately 10% of her practice involves treating women with
vulvar pain syndrome.
“You can get a good idea about what is going on with a
patient just by listening to her story, and I am always amazed at the number of
healthcare providers who don’t take the time to do this,” she tells WebMD.
“If a patient doesn’t feel like she is getting the right help, she should
find a professional who knows about vulvar pain.”
She recommends the National Vulvodynia Association’s web site
that lists physicians who treat vulvar pain.
“Almost every metropolitan area has at least one person who
specializes in this area, but it doesn’t really take a specialist,” she
says. “The most important thing is finding a physician who takes the time
to listen and takes symptoms seriously.”

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