DR. WILLEMS ON USING ESTRACE (for Vulvar Pain)

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DeeTroll wrote These are just a few comments by Dr. Willems. Topical Estrogen Treatment JOHN J. WILLEMS, M.D. Vulvar disease was brought to my attention in 1976 during fellowship training at the Medical College of Wisconsin. Subsequently, I incorporated what was recommended at the time - primarily surgical excision - into a general ob/gyn practice at Scripps Clinic and Research Foundation. In 1988, five women were referred to me after having CO2 laser surgery to vaporize red dots in their vulvar skin, which their physicians thought had some relation to HPV. Again, I had been taught that removing the

area surgically was the accepted solution to the problem. Toughening the Tissue; It is 'common' gynecologic practice to prepare vaginal tissues for surgery with topical estrogen cream. Estrogen tends to thicken or toughen up the skin, and provide it with a greater blood supply. Thus, the surgeon not only has better tissue to work with, but post-surgery healing potential is increased. Since vestibular tissue is thin after it has been lasered, I thought it reasonable to prepare it for surgery with a course of topical estrogen. (NOTE: He did use the trade name of ESTRACE in a seminar, I'm sure it's politics and likely why he used the generic term 'estrogen' here ) DT. Prior to surgery, several of the women told me they were feeling much better after using estrogen cream, and asked if they could delay the

operation. From that small start, I tried topical estrogen therapy with vulvar vestibulitis patients who had never had laser treatment, and found the same positive results. Healing Regimens I instruct my patients to use a small amount of estrogen cream, about the amount of toothpaste one would put on a toothbrush, twice a day. It should be rubbed gently into the painful external skin, not used inside the vagina. (**NOTE** I myself would never use that amt. He has no idea of the pain we can be in, and why we suggest just the small peasize dab, plus he was in a rush to prepare that skin for surgery) DT. The healing process is slow. It often takes at least six weeks for improvement to ''begin''. However, definite progress should be seen within the first six months!! As the condition begins to resolve, increased itching may occur. I caution my

patients that this is not a yeast infection and they should not use anti-yeast medication or steroid creams, but just persevere until symptoms subside. Itching is a sign of healing. In spite of progress, flare-ups or setbacks will continue for a while, especially when a woman is premenstrual or under stress. Gradually, good days outnumber bad days, and the symptoms become less severe. (THIS IS SO TRUE. and eventually there are none. *smile* so don't get discouraged if it happens. DT) Estrogen cream must be used on an ongoing basis. Whenever my patients discontinue it entirely, they have relapses. Many women, however, are able to decrease the dose to one application a day, then every other day, and so on, until they find their individual maintenance levels. When on this regimen, only a minuscule amount of estrogen is absorbed into the system. My patients' blood

levels have been normal when checked; and none have reported any symptoms of hyperestrogenism, such as increased breast size. (Note* Keep that thought in mind even with the much larger amt. he used compared to the small peasize I'd ever use. DT) During the past eight years, 177 of 201 patients (88%) have experienced good results, including 13 who had undergone unsuccessful full surgical excision of the vestibule (variously termed perineoplasty, vestibuloplasty, and vestibulectomy), and 22 who had undergone laser surgery, five of them repeatedly. Over time, topical estrogen has the ability to effect tissue remodeling or reconditioning even in severely damaged or scarred tissue..... " (Me here again, I have many many legitimate articles and studies of the wonderful healing benefits of Estradiol and the skin that certainly backs this up as well. Sorry for the length but hope you found this

enlightening. Dee~ ........