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Well-Woman Care

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See also:  Herbs/Wild Yam

Cervical Cancer Screening Recommendations Issued by USPSTF [Medscape, 3/22/12]

Cervical Cancer Screening: More Is Not Always Better [Medscape, 3/22/12]

Revised Guidelines on Screening Pelvic Exams Disputed [Medscape, 9/8/14] - ACOG recommends considering a woman's individual needs, requests, and preferences when deciding whether to perform pelvic examinations. However, ACOG believes that annual pelvic examination is useful to detect incontinence and sexual dysfunction.

Editor: Excuse me!  This sounds to me like the ultimate in patronizing chauvinism from a male-shaped system.  Do they think that a woman has problems with incontinence and sexual dysfunction that she doesn't know about?  But that they will discover upon pelvic exam and thus gift the woman with this knowledge about her body?  This is insane!

I much prefer the idea that women can request vaginal exams if they are having an issue they would like help with.  Or if they want cervical specimen collection for screening.

A pictorial guide to not using foot pedals / stirrups during speculum care
, featuring yours truly! This is one of the ways that I try to be a feminist healthcare provider, by eliminating restrictive positions that cause people more discomfort than empowerment in an already uncomfortable exam.

Women's Health: Answers to Frequently Asked Questions - 2womenshealth.com

The Association of Reproductive Health Professionals (ARHP) was founded by Alan Guttmacher in 1963 - Projects include the development and implementation of clinical conferences, visiting faculty programs, monographs, an international peer-reviewed journal (Contraception), and on-line education. ARHP-sponsored programs and conferences feature the latest research, emerging technologies, hands-on training, and useful information for health care practice.

Estronaut.com has lots of useful information about the well-woman cycles, including interpreting Pap results and  HPV and Cervical Dysplasia

How to Have a Happy Vagina - video from Margaret Ladner

New Guidelines Issued on Cervical Cancer Screening CME/CE [11/05/2012] -

Aged less than 21 years     No screening     
Aged 21 to 29 years     Cytology alone every 3 years     
Aged 30 to 65 years     Preferred: HPV and cytology co-testing every 5 years Acceptable: Cytology alone every 3 years     Screening by HPV testing alone is not recommended
Aged more than 65 years     No screening necessary after adequate negative prior screening results     Women with a history of cervical intraepithelial neoplasia [CIN] 2, CIN 3, or adenocarcinoma in situ should continue routine age-based screening for at least 20 years
After total hysterectomy     No screening necessary     Applies to women without a cervix and without a history of CIN 2, CIN 3, adenocarcinoma in situ, or cancer in the past 20 years
After HPV vaccination     Follow the same age-specific recommendations as unvaccinated women     

I used this "treatment" to get my cycle regular again while breastfeeding. Evening Primrose oil - 1 cap. every day Dong Quai - 1 cap every day (although I have read that you should stop taking it 10 days before you are supposed to get your period otherwise it could cause heavier bleeding than normal - has anyone else heard this?)

I think Wild Mexican Yam is my secret and beloved herb for feeling myself through all the changes of maiden-mother-crone years.

Dong Quai (Angelica sinensis) - article states it contains phytoestrogens. Red Raspberry (Rubus idaeus)- article does not indicate a particular hormone involved, but suggests use as a 'tonic' for the uterus and for "runaway" female hormones. "Tonic action is normalizing, and implies relaxation when needed- at the time of labor or during menses- or toning when appropriate- during postpartum or at mid -cycle" Wild Yam(Dioscorea villosa)- Not considered a true tonic substance because bidirectionality has not been established. Article states that wild yams are used in the pharmaceutical industry as a precursor for progesterone- however, the hormone is not found in the plant, and the pathway needed for the transformation of diosgenin(the chemical found in wild yam) to progesterone is not present in the human body. However- wild yam does demonstrate noticeable estrogenic activity and Caution is urged "citing the partially known effects of phytoestrogens[estrogen from plants] effects on breast cancer and PMS on breast.

8 Detox Methods That Really Work from Bulletproof Executive [July, 2017]

Female Ejaculation

The issue of female ejaculation is of significance in midwifery for three major reasons: 1) Many women will think their waters have broken because they have a small release of non-urine fluids late in pregnancy; this is often simply a form of female ejaculation caused by ripening female tissues, increased pelvic perfusion, and hormones as labor approaches.  2) The primary adaptive value of the tissues involved in female ejaculation are to provide a surge of pain relief and lubrication just as the baby's head is about to be born.  3) Women who could ejaculate may have learned to tighten up their pelvic muscles as they near orgasm, in order to prevent fluid emission; this tightening up can be obstructive during labor.

Some of the best pro-women sites about female sexual arousal and ejaculation are:

DoctorG.com - excellent site from Dr. Gary Schubach offers lots of great information, along with products useful for women wanting to become more comfortable with their sexuality for both their own pleasure and for better birthing.

Minor reference to the use of Viagra by women - would this be useful during labor?

Re: female ejaculation-something to do with vestibulitis?

I got the reply from the sex therapist, I'll paste it below. I really think the lack of knowledge about female ejaculation is a big problem. It is about as well understood as PIH/ toxemia- NOT UNDERSTOOD AT ALL! I think a lot of women have variations of the kind of problem referred to in the post about "complicated vestibulitis".  I think we are missing a piece of the puzzle of female anatomy that can help women improve their sex lives, relieve them of various problems that result from repressing this function, or from pathologies that may be occurring in areas that aren't supposed to exist.

Basically, the fluid is supposed to come from the periurethral/skenes glands in the urethra and are considered to be analogous to glands in the male prostate that produce 10-50% of the fluids in male ejaculate. The composition of the female ejaculate is an unknown, but some research found the fluid to contain higher levels of glucose and an enzyme, prostatic acid phosphatase, characteristic of the prostatic component of semen. The levels of creatine and urea are considered residual and not high enough for the fluid to be classified as urine. The strength of the pelvic floor seems to be a factor- the stronger the PC muscles, the more likely women are to experience or notice their ejaculation. It is speculated that 10-40% of women ejaculate, and that a part of the 25% of American women who have never had orgasms may not have had one because they try to repress their ejaculations for fear it is incontinence, and thus never let go enough to orgasm.

I just got a bridal magazine that answered a young woman's question about fluid with her orgasm with advice that she get treated for incontinence, and specifically told her women do not ejaculate like men. Women learn this is not normal or possible. I saw another advice column where a man asked about what to do about his new girl friend who peed the bed when they were intimate. He was also told to delicately encourage her to be treated for her incontinence and get plastic sheets!

"The primary research on female ejaculation has been done by Dr. Beverly Whipple at Rutgers University.  I'm enclosing some sites where you might begin researching this phenomenon.





"In addition, a medline search at any major university library will result in a list of hundreds of research articles which Beverly has written over the years.  Specifically, references will be found to her research on female ejaculation. "

Dr. Whipple can be contacted directly at bwhipple@recomnet.net.  When she is not traveling around the world teaching, she is always responsive to inquiries about her work.

The Clitoris

The Overdue, Under-Told Story Of The Clitoris - I love the jewelry!


In 1969, we put a man on the moon.

In 1982, we invented the Internet.

In 1998, we discovered the full anatomy of the clitoris.

General Sexual Well-Being

Increasing Orgasm and Decreasing Dyspareunia by a Manual Physical Therapy Technique [Posted 12/14/2004] - [Medscape registration is free]

Abdominal massage can help to loosen adhesions which cause sexual dysfunction in women.

The Authoritative Guide to Safer Sex
by Kaitlin Moore

Recommendations for resources for sex in a conservative christian marriage?

"Intended for Pleasure" by Ed Wheat, MD
"Sex Technique and Sexual Fulfillment in Christian Marriage"

These books are the excellent, but the first can be a little sterile.  I recommend "Intimate Issues: conversations woman to woman- 21 questions Christian women ask about sex" by Linda Dillow and Lorraine Pintus


See also: Getting Pregnant/Infertility for information about Natural Family Planning and other types of fertility awareness.

Can you ovulate twice in a cycle? [4/10/13] - This is an excellent review of the 2003 study that was wrongly interpreted to me that women can have two separate fertile ovulations in one month, which is different from releasing multiple eggs during one ovulation.

How to Manage Breastfeeding and Natural Family Planning
[7/3/17] by Bethany Hayes

The Method Explorer is a great little application for helping you learn about the contraception methods that are best suited to you and your lifestyle.

CDC Updates Guidelines for Postpartum Contraceptive Use [7/12/11] - advises postpartum women not to use combined hormonal contraceptives during the first 21 days after delivery because of a high risk for venous thromboembolism (VTE).

Planned Parenthood - they have lots of information about Birth Control, including a nice information web page about Understanding IUDs

The Guttmacher Institute is a nonprofit organization focused on sexual and reproductive health research, policy analysis and public education.

Reproductive Health 2002: Update on Contraception and Medical Abortion From the ARHP Annual Meeting September 11-14, 2002
[Medscape registration is free]

Permanent Birth Control Possible With No Incision and Minimal Recovery Time - [July, 2001] - The Essure pbc procedure uses a proprietary catheter delivery system for minimally invasive transcervical tubal access. Conceptus expects to gain US Food and Drug Administration approval for their system by 2003.

Herbal Contraception - excerpted from "Herbal Abortion: the Fruit of the Tree of Knowledge" by Uni M. Tiamat.

FDA Approves Berlex Laboratories' Intrauterine Contraceptive Implant - Dec., 2000 [Medscape registration is free.]

Contraception Update for the Primary Care Physician - 2000 [Medscape registration is free.]

Lots of birth control information

Breastfeeding as Birth Control

September, 1999 - [Medscape article] The World Health Organization asserts in the September issue of Fertility and Sterility that "...the lactational amenorrhea method is a viable approach to postpartum contraception."

Birth Control by Breastfeeding - (The Lactational Amenorrhea Method) from breastfeeding.com

"Lipstick" or other Saliva Ferning Pattern monitors

The OvuLook™ Ovulation Tester comes with a slide of different ferning phases for comparison.  They also have a cool demo.

The Protectaid Contraceptive Sponge is the same as the old Today sponge, back on the market as of autumn, 1999.

Other resources:




FemCap™. A Phase II/III study on FemCap™, a silicone rubber cervical cap that comes in three sizes, was completed in 1997. FemCap™ has several advantages over existing barrier devices. It has more durable and less sensitizing materials, fewer dislodgments, a lower risk of urinary tract infection (UTI), and size determination based on obstetrical history. Also, its design conforms with the anatomy of the cervix and proximal vagina to provide a snug, comfortable fit, making it difficult to dislodge.

http://www.apothecus.com/misconceptions.htm - contains a great list of misconceptions about contraceptions and how NOT to get pregnant.  Do the review - you might be surprised that you have some "blind" spots since women from an early age are taught not to consider their bodies, just hand them over to some guy.  Take a test: draw your vaginal area from memory, marking the FIVE major areas/organs IN THEIR RIGHT PLACES ...


IUDs: Great Contraceptive, But Not For Nursing Moms from Dr. Dean Edell

When a mother has a decrease in milk supply, often associated with the use of birth control pills. Avoid estrogen containing, or even progesterone only birth control pills or progesterone releasing intrauterine devices (Mirena) while breastfeeding. [from Domperidone, Getting Started by Dr. Jack Newman]

From: Jack Newman
Subject: Mirena IUD
Date: October, 2009?

We are receiving more and more reports from mothers of a decrease in milk production associated with the Mirena IUD.  Today I received two such reports.  Given the constant chronological relationship between the placement of the IUD and the mother’s decrease in milk production (1 to 2 weeks), it is quite possible that the decrease in milk production is a result of the IUD.

Of course, it is also likely that not all women will have a significant decrease; nobody contacts me when they don’t have a decreased production.  But it is also likely that only a tiny percentage of women who do have a decrease actually contact me.

I think we need to be prudent and warn women about this possible side effect of the Mirena.  All hormonal contraceptive methods should be avoided by breastfeeding mothers if possible.

Jack Newman, MD, FRCPC

Contraceptive Injection for Men

Male Birth Control Pill

From: C-afp@clari.net (AFP)
Subject: Doctors report breakthrough on male birth control pill
Organization: Copyright 1998 by Agence France-Presse (via ClariNet)
Date: Tue Mar 17 13:45:49 PST 1998

   SEATTLE, Washington, March 17 (AFP) - Doctors at the Veterans Affairs Medical Center here announced on Tuesday a breakthrough in developing a male birth control pill.
   A six-month study of 23 Seattle men taking the drug Desogesterol, a combination of the hormones testosterone and
progestogen, reported 100 percent success in achieving very low or no sperm production among participants.
   The pill also passed the critical test of being fully reversible, so that sperm counts return to normal after men stop
taking the pill, said  William Bremner, the study's designer.
   There is a catch, however. Besides taking the contraceptive pill every day, participants were required to receive supplementary
injections once a week, an inconvenience that researchers fear would keep some men from using the method.
   They still may prefer it, however, to a pocket-sized male contraceptive gadget developed by a Chinese inventor and unveiled by
Beijing's state-run news agency Xinhua on Sunday.
  Worn inside the underwear, the device is supposed to work by emitting pulses that affect nerves in a man's body and make him
sterile for one month after an hour's use. Fertility is restored after the gadget is not used for two months.
   As for the birth control pill, developers hope to market it in seven years, by that time eliminating the need for shots.

SAO PAULO, Aug 17, 1996 (Reuter) - A Brazilian pharmaceutical company will make the world's first birth-control pill for men starting next June, an official from the company making the product said Saturday.

Hebron S.A. plans to make the pill, called Nofertil, at its plant in Caruaru, some 86 miles from Recife in Pernambuco state.

Hebron industrial director and chief pharmacist Luiz Francisco Pianowski said Nofertil, made from a substance extracted from cotton called gossipol, works by deactivating the enzyme responsible for producing sperm.

The pill was tested on 500 men in eight countries in Africa, Asia and Latin America, including 100 in Brazil, Pianowski said.

He said test results show the pill was 96 percent to 98 percent effective, equal to that of female birth-control pills.

He said the pill, unlike injectable contraceptives that work on hormones, has no side effects. Pianowski said the pill taken for 40 days, renders a man infertile but does not interfere with his sexual activity or the production of seminal fluids. The effects of the pill disappear 20 to 40 days after a man stops taking it.

``We think that the effect in the marketplace will be fantastic,'' he said. ``Many people, particularly women, think it is a great idea.''

He said other companies elsewhere in the world may be working on a similar product but ``we are the first in the launching stage.''

Nofertil took two years to develop and has the backing of the World Health Organization, Pianowski said.

Hebron's lab intends to produce 100,000 bottles of the pill a month but will increase output to five million bottles in two years.

Pianowski credits the pill to studies conducted by Elsimar Coutinho of the University of Bahia.

Emergency Contraception

Call 1-888-NOT-2-LATE for information on emergency contraception (EC).

More info about emergency contraception at www.prescribechoice.org or www.backupyourbirthcontrol.org

http://opr.princeton.edu/ec/states/ has a listing of clinic sites for emergency contraception.

http://www.columbia.edu/cu/healthwise/hw31.html#14 is a once over the top discussion of emergency contraception but contains this very important information: A woman can go to the Health Service Walk-In Clinic, 3rd Floor, John Jay Hall, and be seen by a provider who will review her medical history and in most cases, dispense emergency contraception.

http://www.wwilkins.com/rounds/Rosenfeld/Rosenfeld.html gives a bit more technical information from an M.D. including types of birth control pills used for emergency contraception.

Can anyone tell me anything about clients who are unable to keep down the 2 doses of emergency pills? Any literature on their pregnancy rates and etc.?

Some also prescribe phenergan suppositories along with the OCPs to attempt to counteract N/V. Don't know rate of pregnancy if were unable to keep the OCPs down.

This is what I do: I have her take 50 mg of Benadryl and wait at least 1/2 hr until she starts getting sleepy. Then take the OCP with some milk and crackers and GO TO BED. Same thing 12 hrs later. So far, they have all kept it down.

Emergency Contraception, and a list of clinics that provide it.

New Toll-Free Hotline to Explain About Emergency Contraceptions - (1-888-NOT-2-LATE)

Contraceptive Research and Development Agency.

Pap Results

The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period.
Ahdoot D, Van Nostrand KM, Nguyen NJ, Tewari DS, Kurasaki T, DiSaia PJ, Rose GS.
Am J Obstet Gynecol. 1998 Jun;178(6):1116-20.

CONCLUSION: Postpartum spontaneous regression of Papanicolaou smears consistent with high-grade squamous intraepithelial cells occurs with increased frequency among women who are delivered vaginally versus by cesarean section.

Identifying Women With Cervical Neoplasia - Using Human Papillomavirus DNA Testing for Equivocal Papanicolaou Results

For women with ASCUS, this editorial recommends HPV testing for women under 30, and immediate colposcopy for women over 30.


5/1/08 - CytoCore, Inc. introduces SoftPAP(TM), a revolutionary new cervical cell collector that provides your patients with a more accurate PAP Test, increased reliability, and much less patient discomfort.

ThinPrep Pap

from Kopes-eticHealth.com [FP Revolution Volume 2 Number 2 January 20, 2008]

THINPREP:  THERE HAS NEVER BEEN A BETTER TIME TO ABANDON IT:  Systematic reviews have concluded that the quality of the evidence about liquid-based cytology has not been good enough to judge its performance relative to conventional cytology. In 2003, the USPSTF found insufficient evidence to make a recommendation about using liquid-based cytology. Now we have a new study that seems to settle the issue.(3) In this study the researchers found that the frequency of abnormal cytology results was greater with liquid-based cytology than with conventional cytology (6.3% vs. 3.8%). Detection rates of CIN grade 2 or worse and grade 3 or worse were similar in both study groups. The probability of CIN+ histology after a positive test was lower in the LBC group, indicating that more false-positive results had occurred with the LBC technique.

   The authors of the study comment, "Many people will be surprised to learn that liquid-based cytology was not more sensitive than conventional cytology, especially since the US FDA allows the manufacturer of the technology used in this trial to claim that it is 'significantly more effective' than conventional cytology for detecting cervical abnormalities. In fact, it seems that the main effect of liquid-based cytology was to increase the number of false-positive results, which result in needless referrals for colposcopy." Even the American Cancer Society has recommended less frequent use of LBC. The authors go on to state:

   "Despite the lack of high-quality studies, many clinicians have adopted liquid-based cytology...The evidence supporting fewer unsatisfactory tests with the liquid-based technique, however, is conflicting. Nevertheless, both of these potential advantages of liquid-based cytology are unlikely to outweigh the disadvantage of increased overall colposcopy referral rates because of more frequent false-positive results with liquid-based cytology..."

   "Users of liquid-based cytology should reconsider their decision to adopt this technology and ponder whether the harms to patients outweigh the benefits to the clinical laboratory [where it is less time consuming for technicians]. Those who use this technique for primary cervical cancer screening in women older than 30 years of age because it is easy to combine with HPV testing should realize that the USPSTF considers the evidence to be insufficient to endorse this strategy. Finally, clinicians who use the conventional technique should not feel that their patients are receiving substandard care; indeed, current best evidence suggests the opposite conclusion. COMMENT: I have been saying this since the device was first marketed. You have to admit, it was a stroke of genius by the technology company to find a device that made Pap smears 3 times more costly while generating tons of repeat tests and an army of grateful, rich colposcopists.

Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial.
Ronco G, Cuzick J, Pierotti P, Cariaggi MP, Dalla Palma P, Naldoni C, Ghiringhello B, Giorgi-Rossi P, Minucci D, Parisio F, Pojer A, Schiboni ML, Sintoni C, Zorzi M, Segnan N, Confortini M.
BMJ. 2007 Jul 7;335(7609):28. Epub 2007 May 21.

CONCLUSION: Liquid based cytology showed no statistically significant difference in sensitivity to conventional cytology for detection of cervical intraepithelial neoplasia of grade 2 or more. More positive results were found, however, leading to a lower positive predictive value. A large reduction in unsatisfactory smears was evident. TRIAL REGISTRATION: Current Controlled Trials ISRCTN81678807 [controlled-trials.com].

Cervical Screening: A Clinical Practice Guideline, from Ontario, May, 2005, recommending ThinPrep as the preferred method.


Here's the web page with the self-Pap material and the index page.

This is the material I have always used when teaching people to do their own. I have them get the book, then come to an appointment and talk them through the procedure.

I found the Web page but couldn't find anything about doing self-Paps. Did you mean self-examination, i.e. visualizing one's own cervix? Or did you really mean taking a sample of one's own cervical cells?

The page contains a useful narrative, but it's hard to go from narrative to actual practice, so I've had women bring the info with them to the office, and do the procedure with me talking them through it. That way, they have memories to anchor to the narrative so that they can be successful on their own. So yes, they can do paps themselves.

Pelvic Floor Exercises / Kegels

See also: Postpartum Urinary Incontinence

Pelvic Floor Training from gynzone.net - this Danish video is free and intended for non-professionals.


Average Age of Puberty Getting Younger


DES was used until 1971.

Use of Wet Smears to Screen for Sexually Transmitted Diseases (Medscape CMEs)

Pain during menses

About Pre-Menstrual Syndrome (PMS)

NATURAL Progesterone and Women's Health by Brent Rooney

Natural Progesterone for Post-partum Depression and PMS Psychosis

Phytoestrogens in Foods and Herbs

New Treatment for Genital Warts

When I was a student w/ a CNM in private practice, our teacher frequently recommended "Instant Ocean" that can be purchased from places that sell products for salt water fish tanks for a variety of vaginal/perineal/anorectal complaints and it worked.  When I had a bartholin's cyst, in addition to the 2 grams of duricef a day, I was to soak in Instant Ocean TID--it ruptured w/ in 3 days.  Thankfully, it hasn't recurred.

Gemmotherapy (from plant buds) for Perimenopausal/Postmenopausal (Lactatational?) vaginal dryness, from Dolisos
Cedar of Lebanon (Cedrus Libani) Young Shoots 1DH: 50 drops daily

Mammography / Breast Thermography

Breast Thermography  measures physiologic tissue changes based on metabolic activity.  In general, cells that have high metabolic activity tend to give off higher temperature signals.  Since cancer cells are highly metabolically active, they tend to give off higher temperature signals.  This is a crude explanation of the basis of thermography.  It can generally detect cancer cells earlier than you could on a mammogram.   A clumping of cells in a tumor has to be a certain size before it is detectable via mammogram.  There is also no ionizing radiation or uncomfortable squeezing of the breast with a thermograph.

While the data speaks for itself, many women who do not regularly go for mammography are more apt to do SBE the more it is taught and discussed. Many patients lose track of how long its been since their last study but admit to occasionally doing SBE. We've actually seen more cancers picked up this way than on mammography.

A couple of years ago in Lancet (or was it BMJ?), a guy did some re-working of the numbers from the mammography trials and concluded that nearly all of the benefit was from the clinical breast exam, not from the X-rays per se. He advocated, as I recall, spending the money being allocated for increased mammography to getting more universal clinical exams. I've never seen anything responding to that, though I admit I haven't looked carefully for it.

Swiss Medical Board: No More Mammography Screening Programs [4/30/14] - The Swiss Medical Board has recommended that no new systematic mammography screening programs be introduced, and a time limit should be placed on existing programs.

Mammograms Again Found to Have No Impact on Mortality [7/27/15] - Mammograms do not save lives and may actually harm more women than it helps, according to several studies.

Breast Cancer

SusanLoveMD.com - Dr. Susan Love's Website For Women

Preventing Breast Cancer - Book Completely Online

Breast Cancer Options

Two Sisters' Stories - Twins share their battle against breast cancer.

Breast Cancer Risk From Abortions

Confusion about Link Between Abortions and Breast Cancer

Blood Test for Breast Cancer

This is another Weizmann plug... A researcher here discovered a way to diagnose breast cancer, through MRI (magnetic resonance imaging), without need of a biopsy. A special fluid (not supposed to be harmful) is injected into the tumor and then read by MRI. A malignant tumor looks completely different from a benign one. She made a big media splash a couple of months ago, you may have heard it. It is a real medical and scientific breakthrough. Problem is, it is very expensive, so I don't think it will substitute biopsies very soon.

Weizmann Institute of Science Rehovot, Israel 

Lichen Sclerosis

Some people say that supplemental calcium citrate helps. It binds oxalic acid and so we pee it out and don't have the lesions.

Lichen Sclerosus: The Unspoken Pain with Andrew T. Goldstein, M.D. - 1 hour 22 minutes educational slide show from a medical expert.

Association for Lichen Sclerosus and Vulval Health, Genital Dermatoses

Vulvodynia / Vulvar Vestibulitis / Pelvic Pain

See also: Postpartum Vulvar Dermatitis

Vulval vestibulitis - Is a common and poorly recognised cause of dyspareunia[BMJ  2004;328:1214-1215 (22 May)]

Topical Nitroglycerin Diminishes Vaginal and Labial Pain  [ Medscape registration is free ]

Pelvic Pain in Women -- Better Understanding of an Elusive Diagnosis  [ Medscape registration is free ]

This brief article on Deep Tissue Vaginal Massage has some really good information for women experiencing physical or emotional pain in their genitals after birth; it seems like really useful advice for anyone experiencing genital pain.

Julie's Vulvodynia Web Page - This is obviously the first page to go to.  What a great collection of information and a terrific public service. 

Vulvodynia and Vulvar Vestibulitis from the University of Michigan Center for Vulvar Diseases.

Diagnosis and Treatment of Vulvodynia
Paavonen, Jorma
Annals of Medicine 27, no. 2 (April 1995): 175-81

Simplified Surgical Revision of the Vulvar Vestibule for Vulvar Vestibulitis
Goetsch, Martha F.
American Journal of Obstetrics and gynecology 174, no. 6 (June 1996):1701-7

Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor Musculature
Howard I. Glazer, Ph.D., Gae Rodke, M.D., Charles Swencionis, Ph.D., Ronny Hertz, D.D.S., M.D., Alexander W. Young, M.D.
Reprinted from THE JOURNAL OF REPRODUCTIVE MEDICINE Vol. 40 No. 4, April 1995 With Permission of the First Author

Vulvodynia: Diagnosis and Treatment by Tori Hudson, ND

Vulvar vestibulitis is a vulvar pain/burning syndrome.  Usually no objective s/sx - the woman complains of burning or itching, probably dyspareunia, and on exam all "looks" normal. Be alert also for old episiotomy scar tissue if onset of c/o was after childbirth. Also be aware if nursing a babe, she may be estrogen deprived, and not look especially dry, but is... if no other explanation fits, do a "point-tenderness" exam:  I examine with a cotton-tipped applicator, the soft end and the wooden end both, gently - even light touch with either will elicit pain for her - I draw a "map" ov the vulva and note where she has pain.  This is useful for tracking improvement, etc. I first heard of this by a chance "find" - the newsletter of the American Association for the Study of Vulvar Disease. [Ed. - This organization may now be defunct or replace by the Center for Vulvar Diseases.]

I've seen this in women who did not have any tears or epis.  I always assumed it was some kind of nerve damage by the symptoms and the time it takes to completely resolve. 6-9 months.  It definitely has to do with the pressure receptors,

Vulvar vestibulitis, described previously on this list as extreme itching, burning and other wise extreme discomfort of the vulva and which can cause such life changing problems as dyspareunia, extreme pain etc., can be caused the the Human Papilloma Virus.  I worked with a physician who saw lots of these women who had been told to see shrinks, had marriage problems and generally a pretty tough life due to this.  His treatment was to use (oh brain, help me, the name is gone) these injections into the area and he reported great improvement.  He initially diagnosed some of this with vulvar colposcopy.

I saw an interesting presentation on VV and vulvodynia at a conference and she advocated a multidisciplinary approach, which occasionally includes psychotherapy and marriage counseling, anti-depressants, and even surgery to remove the sensitive tissue. What she stressed, though, was the importance of actually coming up with a diagnosis. We have all seen women who have bounced from provider to provider, diagnosed and treated for BV, yeast, atrophy, prolapse, bad repair, etc. She stressed sending these women to someone who has experience and resources to attack the problem.

She was of the opinion that many cases are actually chronic yeast that has to be attacked quite seriously (i.e. not just a course of terazol) and many are actually the result of musculoskeletal misalignments of the pelvis, for which physical therapy is the treatment. We had an interesting client who had been healthy prior to pregnancy, then went to 42 weeks and was basically uninducable (three days of pit and cervidil and still 1 cm). She started complaining postpartum of painful sex. She appeared atrophied and we tried estrogen cream with some relief. I finally sent her to this expert who diagnosed such a pelvic problem and yeast. She got better with physical therapy and yeast treatment. But now I wonder if her musculoskeletal misalignment had something to do with her "difficulty" with labor. I am crossing my fingers that is the case and hoping for a normal labor next time, now that the problem is resolved.

This speaker also uses topical treatments for women for who the above treatments either don't work or are not appropriate. One unusual, but intriguing topical treatment involved Capasian cream. Capasian is a cream made from hot peppers. It works by depleting the receptors in the nerves of a substance P (stands for pepper?) that sends out the burning signal. Those of you who eat spicy foods might have noticed that the first few bites burn and sting, but then towards the end of the meal you no longer really notice the spice. This is because the contact with the pepper has depleted your substance P in those nerve fibers and you no longer get the sensation.

This Capasian cream is applied several times a day. Apparently it sting like crazy at first and she has them use a topical lidocaine before the application. After a few days? weeks? (can't remember) the cream no longer stings and the burning sensation is permanently gone, as long as they continue to apply the cream regularly. This is in most cases as permanent resolution of the vulvodynia.

I used to SUFFER  from vulvar vestibulitis.  What a nightmare! I saw a great doctor in Phoenix who specializes in vulvodynia. Anyway, he recommends sea salt baths for just about everything. Instant Ocean aquarium salt - about 1 cup to a  standard bath tub. I did 2 soaks a day for 20 minutes, then use a blow dryer on the cool setting.

It saved my life. He also gave me the recommendation of no lotion, soap, oil of any kind between my knees and waist.

I had am immune problem that  affected my reproductive and urinary systems after an insect bite.

British Medical Journal's Online articles about Sexual Medicine including:

ABC of sexual health: Female sexual problems I: Loss of desire what about the  fun?
ABC of sexual health: Female sexual problems II: sexual pain and sexual fears
Antenatal screening for syphilis
ABC of sexual health: Examination of patients with sexual problems
ABC of sexual health: Taking a sexual history
Sexual health
ABC of sexual health: Management of sexual problems

Sounds to me like vulvodynia. The sensation is heavy and often tingly- sort of like when your leg falls asleep and it hurts. It can be super painful, especially when standing for prolonged periods of time.   I believe that vulvodynia is a nervous issue instead of a vascular one. Often the pain is labial, sometimes at the introitus and sometimes higher inside the vagina. It can also create a 'saddle' effect involving the perineum, labia, introitus, etc.  Vulvodynia is commonly felt with the menstrual cycle and with postpartum lochia and less commonly felt when a woman is not bleeding. Vulvodynia *can* be a reaction to sexual abuse and *can* be associated with vaginismus but it is not always connected. But being at a full crown for a long time....that could surely do it! What to do about it??? I don't know! Chaste tree berry over a 3 month time frame is thought to help but it hasn't aided the ladies I've worked with that experience vulvodynia. Pain medicine doesn't help either. The only thing I know of is laying on your back with pillows under your hips until the feeling disappears.

Contact Allergic Reactions of the Vulva: A 14-Year Review [01/04/2005 - Medscape registration is free]


Do other doulas have experience with a mom with vaginismus?

Yes, I had a mama with this condition. I supported two of her births. Completely natural births, both times. No epidurals. Both births we labored at home, and arrived at the hospital when she was ready to deliver. First birth was 18 hours, start to finish. Second birth, 10 hours, start to finish. This mama had a very respectful caregiver, which I feel is key. This mama was in charge and respected. It was specified to everyone that she was not to be touched without her guidance. She guided anyone that touched her vagina with her -own hands. She also had other health issues we needed to address and respect. All in all, both of her births went fine. I feel the best advice is that the mama be straight forward with all of her caregivers about her needs and have a supportive caregiver.

I might add, this mama had regular acupuncture, massage, and therapy throughout her pregnancy. Another key component is that the mother feel safe. She needs to feel safe and respected. She and I met and spoke a lot. She needed a lot of reassurance. Having this condition and delivering a baby can add a lot of fear and anxiety.

I have worked with several women with this condition, and after talking, planning and processing, they planned for a natural birth. Only one had a c section the rest went natural. Also two said the condition was better after birth.

Female Genital Mutilation (FGM)

Tostan supports a revolutionary and very successful program in Senegal, West Africa; this is an extraordinary and historic grassroots movement to abandon FGC.

Amnesty International - The campaign to eradicate female genital mutilation

Rising Daughters Aware provides free online practical information for FGM affected women, their physicians, other health care providers,  social workers, counselors and attorneys.

Stop FGM!

About FGM from International Planned Parenthood Federation (IPPF)

Equality Now

Uterine Fibroids

See also: Fibroids in Pregnancy

Designed for women, Myomin is clinically proven to reduce the size and symptoms of myoma.  Myomin is especially good for fibroid cysts in the breast, uterus, and ovaries. It is also effective for cysts in the thyroid, kidney, and liver.

Fibroid Resource Center from obgyn.net

The Management of Uterine Leiomyomas by Ashraf Fouda, MD - slideshow presentation

I've had repeated success with helping facilitate prevention and shrinking of uterine fibroids, cystic breasts and endometriosis resolution:  For other patients experiences see http://www.drhusbands.com/testimonials.cfm .

The short answer of how this is accomplished is by balancing some basic biochemical & physiologic processes of detoxification, adrenal-thyroid gland function, and hormonal balancing using dietary alterations, individualized herbal, nutraceutical & homeopathic factors, lifestyle modifications , and structural balancing.

For a more detailed answer into the specific herbal and nutritional substances that are have strong evidenced-based support of why and how they support normalization of processes to resolve uterine fibroids, breast cysts, endometriosis, and breast cancer prevention, you can read the following articles.  Please be aware that while the following articles are not specifically focused on uterine fibroids, what's important to keep in mind is that optimization of the PROCESSES involved in development of these disorders cuts across many diagnoses!  When you optimize the processes towards health promotion and maintenance, you get great results influencing multiple diagnoses:

Necessity for optimal detoxification: http://www.drhusbands.com/newsletters/ACF6265.pdf

Balancing thyroid function:  http://www.drhusbands.com/articles/ACF76B.pdf

Nutraceutical/lifestyle/dietary methods for hormone balancing: http://www.drhusbands.com/newsletters/Jan%2007%20Newsletter.pdf,

Uterine Prolapse

Sea Pearls Sea Sponge Tampons can be used to support a prolapsing uterus.

Menarche or Menstrual Resources


MyMoonCards to Learn about the Women's Cycle

Menopause Resources

The North American Menopause Society Recommendations for Clinical Care of Midlife Women [Medscape Oct., 2014] - This is an excellent overview of the medical view of menopause.  I think a reasonable understanding of physiological changes is also very  helpful for those who prefer a more holistic approach.

Jan L Shifren, MD, NCMP, Margery LS Gass, MD, NCMP, for the NAMS Recommendations for Clinical Care of Midlife Women Working Group
Menopause. 2014;21(10):1038-1062.

Herbal Relief for Hot Flashes

Women in the 13th Moon Cycle - notes from MANA conference, 1999

Saliva testing for menopausal hormones

Menopause Hormone Therapy and Cardiovascular Protection from the National Women's Health Network

The following are some resources I've found helpful in understanding hormone replacement therapy, and the importance of women's involvement in their own health care. They seem informative and are very readable. Also, lots of great sites on the Internet.

Birth as an American Rite of Passage by Robbie E. Davis-Floyd
Listening to Your Hormones, by Gillian Ford
Preventing and Reversing Osteoporosis by Dr. Alan R. Gaby
Screaming to be Heard by Elizabeth Lee Vliet
What Your Doctor May Not Tell You About Menopause by John R. Lee
Women's Bodies, Women's Wisdom by Christine Northrup
Reclaiming Our Health by John Robbins
Menopausal Years: The Wise Woman's Years by Susan Weed

Below are some mail order sources for hormone replacement information. All will send you an introductory packet of very helpful information. Might also be sources for providers in your area who will prescribe natural hormones.

Nonprescription Sources
Pro-Gest Body Cream

Prescription Only (lots of good information)
Bajamar Women's HealthCare
(have sublingual natural progesterone)

Women's International Pharmacy

Healthy food choices are always important, omegas, essential fatty acids, salmon, cod liver oil, flax seed oil, borage oil. Black cohosh helps balance the hormones and this is commonly used for menopausal symptoms. Ensuring she drinks plenty of water is ultra important! I have found Nettles to be very helpful for weepy type situations. Nettle infusion, glycerite or including them fresh into your diet would be excellent. Nourishing foods are wonderful and foods generally recommended during one's bleeding cycle...red foods- like berries, red meat, beets, etc... pomegranates are great food too for women's health, especially with them in season right now. I do work with women on a small scale for help with menopause, so you can contact me directly if you like; and we make a great Hot Flash Relief tea if you are interested.

Sweet Herb Medicinals, LLC

Vulvovaginal health in post-menopausal women

Chinese Medicine for Menopause

There is a company called Metagenics that carry a line of Traditional Chinese Medicine (herbs) The formula called TCB 8 (Traditional Chinese Botanical) is fantastic for menopausal symptoms. My Mom is just about done with menopause and she used this for almost the entire time. Never used estrogen replacement. The formula contains Black Cohosh and Angelica partly I believe, but it is in the form of Chinese Medicine. I'm sorry but I'm not an expert in that area and couldn't really explain the difference between just doing the herbs and using the Chinese Medicine form of them. She had horrible hot flashes, anxiety attacks, heavy menses and mood swings before the TCB 8. She swore by it so much that I had to start carrying the product for all of her friends who still get it from me for their ongoing menopause(s). My Mom used to take quite a bit of it every day, now she just uses it a few times a week depending on her needs. I was kind of afraid she was getting somehow "addicted" to it because she would get so upset if I ran out and she needed it. She claimed whenever she went off of it her symptoms came back. The Metagenics company would hold seminars often and I would question them at every seminar about long term usage and they always reassured me that it would be OK. I can only say anecdotally that this proved true with my Mom (so far) - she eventually cut down on her intake as her need decreased. She is a very healthy 55 y/o and is extremely active.

Sexually Transmitted Infections

CDC National STD/HIV Hotline - (800) 227 - 8922

CDC Web Pages on  Sexually Transmitted Diseases


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