Hitting the Big Time: Vulvodynia in the NYT

The NYT has a really good article about vulvodynia today. Sometimes articles like this tell me things I already know, but this one, in addition to providing a good overview, is in depth and provides new information.

One part about a new study regarding the cause of the condition was extremely interesting:

Dr. William Ledger, professor emeritus of obstetrics and gynecology at the Weill Medical College of Cornell University and an expert on vulvodynia, said, “It is clear that there are subdivisions of this condition — one diagnosis doesn’t fit everyone.”

Working with Steven S. Witkin, Dr. Ledger has found two genetically based predisposing factors. In one, the women produce inadequate amounts of a substance that blocks an inflammatory response. “They get an inflammatory response to an infection,” Dr. Ledger said, “but it doesn’t go away.”

Another genetic aberration results in unstable production of a substance that normally responds to an invasion by yeast or bacteria, placing them at increased risk of chronic infections.

Using a dermatological instrument that reveals two cell layers beneath the skin, Dr. Ledger said, “we’re seeing much more widespread inflammation in these patients than appears to the naked eye.” He added that he had treated patients who had vulvar inflammation with local estrogen or steroids; while they looked 80 percent better on the surface, their symptoms were only about 20 percent better, because the inflammation remained beneath the surface.

In addition, Dr. Ledger said, “there’s good evidence that with vulvodynia as a whole, the women have more nerve fibers in the vulva and they are firing more pain signals to the brain.” He continued: “It’s a kind of vulvar fibromyalgia. Most patients with vulvodynia have very tender glands at the entrance to the vagina.”

In fact, several recent studies have shown up to a tenfold increase in the density of nerve endings in what is called the vulvar vestibule. In some cases the women appear to have been born with this overabundance of nerve endings. But as Dr. Andrew T. Goldstein, a gynecologist at Johns Hopkins School of Medicine, and colleagues reported in 2006 in The Journal of Sexual Medicine, excessive nerve endings may also be caused by nerve growth factors after an inflammatory response or from hormonal changes like those induced by oral contraceptives

Very interesting, indeed. It plays into my whole inflammation theory--that all of the things I have are caused by a degree of inflammation which is greater than the normal human or a reaction to inflammation that is abnormal.

The treatment section of the article is a bit light, offering only surgery and drugs as an option, when we all know there is more than just that. But all in all it's a great article that's not only informative, but for those of us with it, provides reassurance.