Excess sensitivity in women's genital area may by eased by acupuncture

BY KATHERINE DEDYNA, VICTORIA TIMES COLONIST

When most women think of their vestibule, they think of the entry to their homes, not the most private part of their bodies. But the vestibule -- where the vulva and vagina meet -- can be a source of serious sensitivity, burning and pain upon contact for reasons not yet known.

"It's hugely common," says Victoria gynecologist Dr. Trevor Cohen, who sees as many as 10 cases a week. Cohen is part of a University of B.C. study of the condition, whose principal investigator puts the prevalence of vestibulodynia at 15 per cent of women, according to random probability studies.

"We don't know what the main cause is," he says. But provoked vestibulodynia, or pain upon contact, sometimes develops spontaneously and leaves the same way. In between, even the touch of a Q-Tip is painful.

One woman in her early 20s believes a "mishap" with her IUD could have brought on her PVD and sought help when the pain began affecting her sexuality and relationship. Sex used to be "fun and exciting and never a worry" but now she has a team of doctors trying to help her.

She puts her pain after intercourse at five on a 10-point scale and it lasts for several hours -- it was several days before treatment. In talking to her friends, she has found she's not the only young woman to experience it.

Many women are reluctant to broach the subject with their physicians and even when they do, "on average, these women see approximately six doctors before they get their diagnosis," says Victoria psychiatrist Dr. Gail Knudson. The condition has been treated only for the last 10 or 15 years, she adds.

Both Knudson and Cohen are co-investigators for a study of acupuncture and PVD planned by the University of B.C.'s Sexual Health Laboratory. A pilot study of eight Victoria women is nearly complete at Elements of Health Centre, where acupuncturists await news of $24,000 in funding for a study of 32 local women underwritten by the U.S. National Vulvodynia Society. (Generalized pain in the area is called vulvodynia.)

The ACTIV Study -- Acupuncture Treatment Intervention for Vestibulodynia -- will examine the impact of acupuncture versus sham acupuncture for pain and other reference points of PVD. "It is very unfortunate that women are told that the pain is 'all in their heads' as this implies that they are making it up," principal investigator and psychologist Lori Brotto says in an e-mail. Part of the problem is that very often there is no redness or inflammation, yet women report "excruciating pain with attempted penetration."

"They are embarrassed, frustrated, anxious, as well as many other emotions associated with their pain. Because it is provoked when being sexual, and because most people still do not talk to their GPs about sexuality, they may experience the pain for many weeks [or] months before raising it," Brotto adds. "The real issue, however, is that many physicians are unaware of this condition, how to diagnose it, and treat it properly. Women tend to be prescribed a long list of anti-yeast medications which only exacerbates the problem. By the time they receive the correct diagnosis and start on an appropriate treatment plan, many of them have endured the pain for years."

In an article just published in the Journal of Sexual Medicine, the UBC team cites one study in which 11 of 13 PVD patients improved with acupuncture.

Victoria research participants receive 10 acupuncture treatments along meridians on their limbs and spine, says Stephanie Curran, a Chinese traditional medicine practitioner specializing in reproductive health who is also a study co-investigator.

Even when women report the same symptoms, she uses different acupuncture points for each -- none of them near the genitals.

Typical PVD treatments are trial and error -- including medication, biofeedback, be-havioural therapy, de-stressing, vaginal dilators and physiotherapy. A recent study in the British Medical Journal found TENS (transcutaneous electrical nerve stimulation) with a vaginal probe to be "effective and safe" in the short term.

Some women resort to surgery to remove redundant tissue, although it's not something Cohen favours. When tissue has been tested, no link with allergy or infection has been found.

If the ACTIV study is approved, local research participants will be sought. They must be over 19, literate in English, able to give informed consent and diagnosed with PVD by a medical doctor. Participation involves a traditional Chinese medicine diagnosis and 10 free acupuncture treatments over five weeks along with three measures of pain and sexual function.

For more information, contact Elements of Health at 250-383-2626 or www.elementscentre.ca or www.mvprogram.org

or e-mail UBCwomenshealth@ vch.ca

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