Androgen Insufficiency May Lead To Vulvar Vestibulitis and Genital Pain (birthc)

[Guest guest]

I definitely believe my VV started after I went on the birth control pill after not being on it for 11 years. I have tested low testosterone and low DHEA. I believe I have a hormone imbalance and the receptors have been depleted. I can find docs to give me the Testosterone creams, but I want to be balanced and have a doctor that really understands this. SO I called Dr. Sutherlands office. She participated in this study. I have an appointment with her on Dec. 11. Hopefully, finally a doctor that may know the connection between my hormones and vv. I think that is the reason I keep having yeast problems, allegies to foods and other substances. I am keeping my fingers crossed!susanSee what's new at AOL.com and Make AOL Your Homepage.

Female Sexual Dysfunction Update

Printed in Medscape Medical News

Androgen Insufficiency May Lead to Vulvar Vestibulitis and Genital Pain

Androgen insufficiency may result in diminished structure and function of the vestibular glands, including decreased androgen receptor expression, leading to vestibular adenitis and dyspareunia (genital pain), according to the results of a preliminary study presented at the International Society for the Study of Women's Sexual Health in Atlanta, Georgia and at the 11th World Congress of the International Society for Sexual and Impotence Research in Buenos Aires, Argentina in October 2004.

Vestibulitis is a very common cause of genital pain among women, and there is a subgroup of women in whom it's probably related to the use of hormonal birth control pills or hormonal manipulation, Munarriz, MD, assistant professor of urology at Boston University School of Medicine, told Medscape. That small group of women responds to androgen replacement therapy.

Of 3,000 women with female sexual dysfunction (FSD) evaluated at the Institute for Sexual Medicine in Boston by Dr. Munarriz and his colleague, Irwin Goldstein, 13% had dyspareunia. Of those with dyspareunia, 2/3rds had physical findings of vulvar vestibulitis syndrome (VVS), and 2/3rds had concomitant androgen insufficiency.

To evaluate the possibility of a link between androgen insufficiency and vestibulitis, Suzette Sutherland, MD, a urologist with Metropolitan Urologic Specialists Center for Female Urology and Continence Care in Minneapolis/St. , along with the other investigators at the Institute for Sexual Medicine, compared vestibular gland tissue excised from patients with VVS (n=22; mean age=36 years; 32 sections) with normal appearing vestibular tissues excised from radical vulvectomy specimens (control n=5; 9 sections). Patients with VVS had significant dyspareunia as evaluated by using the pain domain scores from the Female Sexual Function Index (mean score=0.9 +/- 0.06; consistent with severe pain; maximal score=5). Androgen insufficiency was present in 83% of these VVS patients.

Hematoxylin-eosin staining showed significant inflammation (p=0.00009) and squamous metaplasia (associated with chronic inflammation) in the vestibular specimens of patients with VVS compared with control specimens.

Immunohistochemical staining with antibody anti-estrogen, -progesterone, and -androgen showed significant decreases in androgen (p=0.014) and progesterone )p=0.00042) receptor expression in vestibular tissue of patients with VVS compared with control specimens.

What we found is that the specimens from women who had vestibulitis had significant inflammation, squamous metaplasia, were completely depleted of androgen receptors while 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 is 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.

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.See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

I agree that hormones are likely a factor, but I have

the opposite problem. I always test low on estrogen,

but borderline high on testosterone and THREE TIMES

the normal level of DHEAS for a woman my age. I also

have horrible cholesterol (280) and borderline

diabetes, despite no risk factors as far as diet,

heredity or weight problems.

My endocrinologist doesn't think it's PCOS, because

DHEA is produced by the adrenals. He doubled my ERT

patch (to 1 mg), which only gave me sore breasts and a

discharge that greatly worsened my vulvar pain. I

guess his theory is that, if two hormones are too

high, raise the deficient one until it's too high,

too.

I've come to the conclusion that there are no easy

answers for most of us.

Zig

__________________________________________________

[Guest guest]

Where is Dr. Sutherland's office?

-------------- Original message -------------- From: blueeberri@...

I definitely believe my VV started after I went on the birth control pill after not being on it for 11 years. I have tested low testosterone and low DHEA. I believe I have a hormone imbalance and the receptors have been depleted. I can find docs to give me the Testosterone creams, but I want to be balanced and have a doctor that really understands this. SO I called Dr. Sutherlands office. She participated in this study. I have an appointment with her on Dec. 11. Hopefully, finally a doctor that may know the connection between my hormones and vv. I think that is the reason I keep having yeast problems, allegies to foods and other substances. I am keeping my fingers crossed!susan

See what's new at AOL.com and Make AOL Your Homepage.

Female Sexual Dysfunction Update

Printed in Medscape Medical News

Androgen Insufficiency May Lead to Vulvar Vestibulitis and Genital Pain

Androgen insufficiency may result in diminished structure and function of the vestibular glands, including decreased androgen receptor expression, leading to vestibular adenitis and dyspareunia (genital pain), according to the results of a preliminary study presented at the International Society for the Study of Women's Sexual Health in Atlanta, Georgia and at the 11th World Congress of the International Society for Sexual and Impotence Research in Buenos Aires, Argentina in October 2004.

Vestibulitis is a very common cause of genital pain among women, and there is a subgroup of women in whom it's probably related to the use of hormonal birth control pills or hormonal manipulation, Munarriz, MD, assistant professor of urology at Boston University School of Medicine, told Medscape. That small group of women responds to androgen replacement therapy.

Of 3,000 women with female sexual dysfunction (FSD) evaluated at the Institute for Sexual Medicine in Boston by Dr. Munarriz and his colleague, Irwin Goldstein, 13% had dyspareunia. Of those with dyspareunia, 2/3rds had physical findings of vulvar vestibulitis syndrome (VVS), and 2/3rds had concomitant androgen insufficiency.

To evaluate the possibility of a link between androgen insufficiency and vestibulitis, Suzette Sutherland, MD, a urologist with Metropolitan Urologic Specialists Center for Female Urology and Continence Care in Minneapolis/St. , along with the other investigators at the Institute for Sexual Medicine, compared vestibular gland tissue excised from patients with VVS (n=22; mean age=36 years; 32 sections) with normal appearing vestibular tissues excised from radical vulvectomy specimens (control n=5; 9 sections). Patients with VVS had significant dyspareunia as evaluated by using the pain domain scores from the Female Sexual Function Index (mean score=0.9 +/- 0.06; consistent with severe pain; maximal score=5). Androgen insufficiency was present in 83% of these VVS patients.

Hematoxylin-eosin staining showed significant inflammation (p=0.00009) and squamous metaplasia (associated with chronic inflammation) in the vestibular specimens of patients with VVS compared with control specimens.

Immunohistochemical staining with antibody anti-estrogen, -progesterone, and -androgen showed significant decreases in androgen (p=0.014) and progesterone )p=0.00042) receptor expression in vestibular tissue of patients with VVS compared with control specimens.

What we found is that the specimens from women who had vestibulitis had significant inflammation, squamous metaplasia, were completely depleted of androgen receptors while 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 is 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.

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.See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

These things, high cholesterol, diabetes and hormonal imbalances are highly indicative of a malfunctioning thyroid. Keep getting a full panel on your thyroid as frequently as possible as you could be suffering hypo T right now, but it may be subclinical.DustyZigmissus wrote: I agree that hormones are likely a factor, but I havethe opposite problem. I always test low on estrogen,but borderline high on testosterone and THREE TIMESthe normal level of DHEAS for a woman my age. I alsohave horrible cholesterol (280) and borderlinediabetes, despite no risk factors as far as diet,heredity or weight problems. My endocrinologist doesn't think it's PCOS, becauseDHEA is produced by the adrenals. He doubled my ERTpatch (to 1 mg), which only gave me sore breasts and

adischarge that greatly worsened my vulvar pain. Iguess his theory is that, if two hormones are toohigh, raise the deficient one until it's too high,too. I've come to the conclusion that there are no easyanswers for most of us.Zig __________________________________________________