Hormone 'Receptors' & V pain *JESS* 3 articles here (long) but informative.*smile*

[Guest guest]

HI Jess and all,

Dee here, It sounds like you have a good doctor hon to me anyway.

If it were vestibulitis, that typically is thought to be when one has an excessive amt. of nerve endings that keep refiring and the steroid cream you used wouldn't have helped that I wouldn't think. So if it did help hon it seems to be more of a skin condition to me. The steroids help to reduce the symptoms, such as the pain, swelling, inflammation, itch etc....which apparently it has done for you at least short term and then what "I" would do would be to strengthen that tissue with the use of a topical estrogen cream like Estrace..... and even possibly a topical testosterone cream.

They both truly are like food and nourishment for that genital skin to give it back it's tone, color, strength and 'stretchiness' or 'give', and using a small peasize amt. gently massaged in (you don't want to let any of those meds just lay on top of the skin or it might open you to a yeast infection) and generally isn't systemic but it sure can help that V. tissue get good & healthy and hopefully prevent flare ups in the future. (although you may need a maintenance dosage now & then to keep it that way once you are well)

Here are a couple of articles (please forgive the length but you'll see how they all tie in together when you're done *if you make it that far* Smile*) that show how women with Vulvar problems may be lacking in both Estrogen and Testosterone 'receptors' that either aren't working efficiently whether 'reduced' with age or it may be even genetic & have less, or the use of certain drugs can 'block' those receptors such as with the birth control pills w. progestins etc. or even eating too much Soy.

Even after a pregnancy our Estrogen is low but esp. if one breastfeeds, so there are a myriad of possibilities. But note that it's the E & T. 'receptors' and not necessarily that the blood levels of those hormones are low, but the 'receptors' that may not be working correctly. I hope these articles help explain some things.

Here's one on Estrogen and it's ''receptors'':

(just a note but think of 'receptors' as a lock & key and they need the correct 'key' to open them and to make them active or work... but other 'keys' like progestins in birth control or soy or even yeast get in there to 'block' them or 'bind' them instead, so they aren't activated and we're depleted of the benefits of those hormones. *Hope that helps a bit*....)

August 2003 • Volume 189 • Number 2

Original article

Lois J. Eva, MRCOG Allan B. MacLean, MD, FRCOG M.N. Reid, FRCOG Kerstin J. Rolfe, MPhil W. Perrett, PhD

Estrogen 'receptor' expression in vulvar vestibulitis syndrome

OBJECTIVE: A pilot study was performed to investigate the relationship between vulvar vestibulitis syndrome and estrogen receptor expression.STUDY DESIGN: Women with a diagnosis of vulvar vestibulitis syndrome had tissue samples taken for vulvar estrogen receptor- expression and this was compared with a control group.RESULTS: The study group showed a 'significant' decrease in estrogen 'receptor' expression, and 50% of the samples did 'not' exhibit 'any' receptor expression.CONCLUSION: There appears to be a subgroup of women with vulvar vestibulitis syndrome who exhibit abnormal estrogen receptor- expression. This may be helpful in explaining why some women are resistant to medical treatment and may allow treatment to be prescribed more effectively." ... Am J Obstet Gynecol. 2003;189:458-61. END

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I don't think I'd call 50% a SUBGROUP, let alone they showed some with a 'significant' decrease in E. expression plus 50% had "NO" E receptor expression. DUH!

AND...... here's one on the Testosterone Receptors.....

Androgen Insufficiency May Lead to Vulvar Vestibulitis and Genital Pain

Yael Waknine

Oct. 26, 2004 — Androgen insufficiency may result in diminished structure and function of the vestibular glands, including decreased androgen receptor expression, leading to vestibular adenitis and dyspareunia, according to the results of a preliminary study presented last week at the 11th World Congress of the International Society for Sexual and Impotence Research in Buenos Aires, Argentina.

"Vestibulitis is a very common cause of genital pain among women, and there's a subgroup of women [in whom] it's probably related to the use of hormonal 'birth control pills' or hormonal manipulation,"

*comment by Dee.... A Recent study Jan '06 just showed that connection with birth control pills blocking testosterone, (and Estrogen I might add) & I may put that below too, DT)

Munarriz, MD, assistant professor of urology at Boston University School of Medicine in Massachusetts, told Medscape. "That small group of women responds to androgen replacement therapy."

Of 3,000 women with female sexual dysfunction (FSD) evaluated by Dr. Munarriz and colleagues, 13% had dyspareunia, 66% had physical findings of vulvar vestibulitis syndrome (VVS), and 83% had concomitant androgen deficiency.

To evaluate the possibility of a link between 'androgen deficiency' and vestibulitis, the investigators compared vestibular gland tissue excised from patients with VVS (n = 22; mean age, 36 years; 32 sections) with vestibular tissues excised from female cadavers having had no history of vestibulitis (control subjects, n = 5; 9 sections). Patients with VVS had significant dyspareunia as evaluated using the pain domain of the Female Sexual Function Index (mean score, 0.9 ± 0.06; maximal score = 5).

Hematoxylin-eosin staining showed significant inflammation (P = .00009) and squamous metaplasia in the vestibular specimens of patients with VVS compared with control subjects.

Immunohistochemical staining with antibody anti-estrogen, progesterone, and anti-androgen showed significant decreases in androgen (P = .014) and progesterone (P = .00042) ''receptor'' expression in vestibular tissue of patients with VVS compared with controls.

"What we found is that the specimens from women who had vestibulitis had significant inflammation, squamous metaplasia, and were completely depleted of androgen 'receptors' — while the controls had no inflammation, and normal staining for androgens," noted Dr. Munarriz.

"This makes us believe that there is a link between genital pain due to vestibulitis and androgens.

"We believe that there's a subgroup of women, particularly young women, who as a consequence of being on the birth control pill have very low androgen or testosterone levels," said Dr. Munarriz, noting that these women also tend to have a higher incidence of genital pain. "This may be one of the pathophysiologic mechanisms [explaining] why women on the pill get pain — because they lose their ability to express androgen receptors in the genital tissue," he said.

"On the basis of this premise, it may be that in this subgroup of women genital pain can be effectively treated with hormones," concluded Dr. Munarriz, adding that future studies may evaluate the benefits of testosterone therapy in this population.

The investigators report no pertinent financial conflicts of interest.ISSIR 11th World Congress: Abstract O74. Presented Oct. 20, 2004. Reviewed by D. Vogin, MD

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One last one and again I apologize for the length, but you'll see how Birth Control methods also blocks those 'receptors' (by creating more SHBG 'explained below) By the way the shot Depo-Provera is absolutely one of the worse. *sigh*

BIRTH CONTROL AND TESTOSTERONE PROBLEMS.

New research indicates birth control pill could cause long-term problems with testosterone

In the January '06 issue of The Journal of Sexual Medicine, researchers have published a new investigation measuring sex hormone binding globulin (SHBG) before and after discontinuation of the oral contraceptive pill. The research concluded that women who used the oral contraceptive pill may be exposed to long-term problems from low values of "unbound" testosterone potentially leading to continuing sexual, metabolic, and mental health consequences.

Sex hormone binding globulin (SHBG) is the protein that binds testosterone, rendering it unavailable for a woman's physiologic needs. The study showed that in women with sexual dysfunction, elevated SHBG in "Oral Contraceptive Discontinued-Users" did not decrease to values consistent with those of "Never-Users of Oral Contraceptive". Thus, as a consequence of the chronic elevation in sex hormone binding globulin levels, pill users may be at risk for long-standing health problems, including sexual dysfunction.

Oral contraceptives have been the preferred method of birth control because of their ease of use and high rate of effectiveness. However, in some women oral contraceptives have ironically been associated with women's sexual health problems and testosterone hormonal problems. Now there are data that oral contraceptive pills may have ''lasting'' adverse effects on the hormone testosterone.

The research, in an article entitled: "Impact of Oral Contraceptives on Sex Hormone Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction" published in The Journal of Sexual Medicine, involved 124 premenopausal women with sexual health complaints for more than 6 months. Three groups of women were defined: i) 62 "Oral Contraceptive Continued-Users" had been on oral contraceptives for more than 6 months and continued taking them, ii) 39 "Oral Contraceptive Discontinued-Users" had been on oral contraceptives for more than 6 months and discontinued them, and iii) 23 "Never-Users of Oral Contraceptives" had never taken oral contraceptives.

SHBG values were compared at baseline (groups i, ii and iii), while on the oral contraceptive (groups i and ii), and well beyond the 7 day half-life of sex hormone binding globulin at 49-120 (mean 80) days and more than 120 (mean 196) days after discontinuation of oral contraceptives (group ii).

The researchers concluded that SHBG values in the "Oral Contraceptive Continued-Users" were 4 times higher than those in the "Never-Users of Oral Contraceptives". Despite a decrease in SHBG values after discontinuation of oral contraceptive pill use, SHBG levels in "Oral Contraceptive Discontinued-Users" remained elevated when compared to "Never-Users of Oral Contraceptives".

This led to the question of whether prolonged exposure to the synthetic estrogens of oral contraceptives induces gene imprinting and increased gene expression of SHBG in the liver in some women who have used the oral contraceptives.

Dr. Panzer, an endocrinologist in Denver, CO and lead author of the study, noted that "it is important for physicians prescribing oral contraceptives to point out to their patients potential sexual side effects, such as decreased desire, arousal, decreased lubrication and increased sexual pain. Also if women present with these complaints, it is crucial to recognize the link between sexual dysfunction and the oral contraceptive and not to attribute these complaints solely to psychological causes."

"An interesting observation was that the use of oral contraceptives led to changes in the synthesis of SHBG which were not completely reversible in our time frame of observation. This can lead to lower levels of 'unbound' testosterone, (note* the unbound portion is the active and beneficial portion Dee T) which is thought to play a major role in female sexual health. It would be important to conduct long-term studies to see if these increased SHBG changes are permanent," added Dr. Panzer.

Dr. Andre Guay, study co-author and Director of the Center for Sexual Function/Endocrinology in Peabody, MA affirmed that this study is a revelation and that the results have been remarkable.

"For years we have known that a subset of women using oral contraceptive agents suffer from decreased sex drive," states Dr. Guay.

"We know that the birth control pill suppresses both ovulation and also the male hormones that the ovaries make in larger amounts during the middle third of the menstrual cycle. SHBG 'binds' up the testosterone, therefore, these pills decrease a woman's male hormone availability by two separate mechanisms. No wonder so many women have had symptoms."

"This work is the culmination of 7 years of observational research in which we noted in our practice many women with sexual dysfunction who had used the oral contraceptive but whose sexual and hormonal problems persisted despite stopping the birth control pill," said Dr. Irwin Goldstein, a urologist and senior author of the research.

"There are approximately 100 million women worldwide who currently use oral contraceptives, so it is obvious that more extensive research investigations are needed. The oral contraceptive has been around for over 40 years, but no one had previously looked at the long-term effects of SHBG in these women. The larger problem is that there have been limited research efforts in women's sexual health problems in contrast to investigatory efforts in other areas of women's health or even in male sexual dysfunction."

To better appreciate the scope of the problem, oral contraceptives were introduced in the USA in 1960 and are currently used for reversible pharmacologic birth control by over 10 million women in the US, including 80% of all American women born since 1945 and, more specifically, 27% of women ages 15-44 and 53% of women age 20-24 years. By providing a potent synthetic estrogen (ethinyl estradiol) and a potent synthetic progesterone (for example – norethindrone), highly effective contraception is achieved by diminishing the levels of FSH and LH, thereby reducing metabolic activity of the ovary including the suppression of ovulation.

Several studies over the last 30 years reported negative effects of oral contraceptives on sexual function, including diminished sexual interest and arousal, suppression of female initiated sexual activity, decreased frequency of sexual intercourse and sexual enjoyment. Androgens such as testosterone are important modulators of sexual function. Oral contraceptives decrease circulating levels of androgens by direct inhibition of androgen production in the ovaries and by a marked increase in the hepatic synthesis of sex-hormone binding globulin, the major binding protein for gonadal steroids in the circulation. The combination of these two mechanisms leads to 'low' circulating levels of "unbound" or "free" testosterone.

Thanks for reading it to the end..*grin* whoever made it, you must be a saint, but I do hope it helps a bit to explain why adding a topical natural bio-identical hormone like the E & T can be so beneficial for that V. tissue. I can tell you it definitely was 'my' answer after suffering thru 10 years of hell. *smile*

Hugs

Dee~