Common V complaints

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Most women seek a gynecologist for a far-from-sexy reason: They itch or they're in pain. Vaginitis, the catchall term for unexplained itching, sends 10 million women a year to see a GYN and is the most common reason we make such trips. Another 13 million women experience chronic vulvar pain sometime in their life.

'I itch'
Yeast infections may be the most familiar vaginal infection, affecting three-quarters of all women at some point, but the most common culprit is bacterial vaginosis (BV). Other common causes include trichomoniasis ("trich"); a skin disorder such as eczema or lichen scierosus (an inflammatory disease); or an allergy, such as to your partner's semen. (Who knew that was possible?) Too-tight clothing or too many layers that trap moisture, douching, or using feminine hygiene spray can also produce an itch.

There are so many variables when it comes to vaginal itching. And studies have shown that the best way to figure out the source of the problem is a clinical exam. Be prepared to describe all of your symptoms: Is there discharge, too? Odor? (If so, don't wash before your exam; that will mask the scent.) Does the itching come and go or remain constant?

"Be brutally honest," says Elizabeth Stewart, MD. "Your doctor isn't there to judge your lifestyle or your life choices. He or she simply needs to know about every factor that may have influenced your condition." Also, be clear about where the discomfort is. (See "Vagina 101," page 115, for pointers.)

'It hurts'
What could be more frustrating than vaginal itching? Vulvar pain--varying degrees of burning, stinging, and rawness--that never goes away and can't be diagnosed. Known as vulvodynia (literally, painful vulva), its cause is unknown.

Phyllis Mate was first plagued by an intermittent minor burning in her vulva during her mid-20s. Over the next decade she saw two other gynecologists, a neurologist, and a pain specialist, but no one could find the cause.

Then, after intercourse one day when she was 40, the problem "exploded," says Mate, who now lives in Potomac, Maryland. "Within three days it felt like someone had stuck a small knife in me and never took it out."

The pain became so debilitating, in fact, that the school psychologist spent the next five months bedridden. More doctor visits followed. She even sought information on her own, finding little online or in the nearby National institutes of Health medical library. (Vulvodynia wasn't even named until 1983, and the first federally funded studies began in 2000.)

Eventually, a doctor connected Mate with another patient who had developed her own small network of sufferers. In 1994, their chat group evolved into the 25,000-member National Vulvodynia Association (www.nva.org).

Today, a pain medication called Lyrica, often used for shingles, seems to be helpful for the disorder. "And some people get better with acupuncture," says Hope K. Haefner, MD, director of the University of Michigan's Center for Vulvar Diseases. For others, surgery is an option. The easiest fix? Try wearing cotton underwear and cotton menstrual pads, because synthetic fibers can be irritating.

Vestibulitis (also called vestibulodynia or vulva vestibulitis) is a specific form of the disorder. Unlike general vulvodynia, it almost always causes painful intercourse. Recent research shows that recurrent yeast infections may be its trigger. No single treatment is successful in all women, according to the American Council of Obstetricians and Gynecologists. But effective approaches usually focus on managing pain and include emotional and psychological support, sex therapy, and counseling.

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By Paula Spencer

with additional reporting by Libby Slate

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