Vulvodynia -- a gynecological condition characterized by constant or recurring complaints of vulvar itching, burning and/or painful sexual intercourse -- is the subject of an ongoing study at the Yale School of Medicine.

"For years, women experiencing chronic vulvar pain have been unable to find the relief and the treatment they so desperately need," says Robin Masheb, assistant professor of psychiatry and lead investigator of the study funded by the National Institute of Child Health and Human Development, a branch of the National Institutes of Health.

"In part, this is because vulvodynia has only been diagnosed recently," she notes. "Often the women themselves have mistaken their symptoms for yeast infections and have tried over-the-counter medications that just don't work. Even many gynecologists don't know what vulvodynia is, much less how to treat it."

Masheb says confusion about the condition has resulted in "too many women losing too much of their lives to debilitating pain."

"Women with chronic vulvar pain can have difficulties that go way beyond the bedroom," she says. "They often have difficulty walking and dressing, feel tired and run down, and experience negative moods. This can, and does, impact their jobs, family lives and normal everyday activities. It is critical that we establish a reliable treatment plan for vulvodynia as soon as possible to help these women return to more normal, fulfilling lives."

Masheb's strategy for establishing a reliable course of treatment is to approach vulvodynia as a chronic pain condition without the use of medication. The first goal is to break the cycle of pain. Chronic pain leads to muscle tension, changes in blood flow, and stimulation of nerves that maintain the problem.

"It also results in negative thoughts and emotions that only serve to make the pain worse," she says. "Thoughts such as, 'There is something terribly wrong with me. My husband is going to leave me.' This is one of the conditions where the mind and body are really working together, almost feeding off each other."

The diagnosis is based on a detailed medical history, pelvic examination and cultures taken to rule out other physical problems, such as a yeast infection or sexually transmitted disease. Although the cause of vulvodynia is unknown, there does appear to be a common thread among women with the disorder -- a large percentage reported an incident that precipitated the onset, such as a yeast infection, childbirth or pelvic surgery.

Masheb says she first became interested in the disorder while in graduate school in 1993, when she met a psychologist in New York City who was successfully treating women with vulvodynia by using biofeedback. Late last year, the journal Pain Medicine published a study by Masheb that found the experience of persistent vulvar pain in general, rather than the level of intensity of the pain, accounts for disturbances in functioning and emotional well-being.

There are no solid estimates on the number of women who suffer from the disorder, notes Masheb. One gynecologist tested every patient that came into her practice over a period of time and found that 15% met the diagnostic criteria for vulvodynia, but Masheb says this figure is probably high since it only included women seeking gynecological care.

Masheb says she has found the study itself is validating for women with the disorder. "Often their doctors had never seen vulvodynia before and did not have a name for it," she says. "When their partners see the problem in black and white, they realize it is something that needs attention."

There are currently 35 women enrolled in the study. Other women experiencing chronic vulvar pain and interested in enrolling in the study can call Christine Lozano-Blanco at (203) 785-5425.

-- By Jacqueline Weaver

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