Vulvar Vestibulitis
Question
I have a long history of vulvar vestibulitis with the primary symptom being pain upon penetration (Sexual intercourse and use of tampons are for the most part avoided). One treatment that actually helped was application of a topical estrogen cream, however I am currently pregnant and cannot use this.
Are there any substitute treatments in place of estrogen that are safe for pregnancy and nursing? My current doctor is not very familiar with the disorder or treatments. Any advice you have would be greatly appreciated.
Thank you!
Answer
Last Updated: June 14, 2013
Vulvar vestibulitis is one of those conditions for which there is no universal agreement on either its cause, or its treatment. However, current research indicates that surgical removal of nerve fibers in the vestibular area (vestibulectomy) is an effective, long-term remedy for many women. This may be an option for you, once you have delivered your baby.
You mention that estrogen cream has given you relief. Since estrogen levels are increased during pregnancy (both estradiol and estriol), yet you still have pain, I wonder if the relief you experience from the cream is not due to the estrogen itself, but to some other component of the cream. It may be worthwhile to try the same cream without estrogen. A compounding pharmacist should be able to provide the cream without the estrogen. Also, while estrogen is not recommended in early pregnancy, because of the potential for feminizing a developing boy baby, it may be acceptable in later pregnancy, in the small doses present in the cream. This can be discussed with your obstetrician.
You also mentioned that your physician doesn’t know much about vestibulitis. There are gynecologists who specialize in disorders of the vagina and vulva, who are experienced in assessing and treating vestibulitis. You can contact the American Academy of Obstetricians and Gynecologists (ACOG) to find such a specialist. Even if this involved some expense, and travel, it would be well worth it, considering the effects of vestibulitis on your marital relationship.
Gail McNaughton, RN, OGNP
You mention that estrogen cream has given you relief. Since estrogen levels are increased during pregnancy (both estradiol and estriol), yet you still have pain, I wonder if the relief you experience from the cream is not due to the estrogen itself, but to some other component of the cream. It may be worthwhile to try the same cream without estrogen. A compounding pharmacist should be able to provide the cream without the estrogen. Also, while estrogen is not recommended in early pregnancy, because of the potential for feminizing a developing boy baby, it may be acceptable in later pregnancy, in the small doses present in the cream. This can be discussed with your obstetrician.
You also mentioned that your physician doesn’t know much about vestibulitis. There are gynecologists who specialize in disorders of the vagina and vulva, who are experienced in assessing and treating vestibulitis. You can contact the American Academy of Obstetricians and Gynecologists (ACOG) to find such a specialist. Even if this involved some expense, and travel, it would be well worth it, considering the effects of vestibulitis on your marital relationship.
Gail McNaughton, RN, OGNP
Answered By:
Gail McNaughton, NP
Gail McNaughton, NP, is a Nurse Practitioner
