Pelvic Pain Series EP 1 - Vulvar Pain

Welcome to the For Vaginas Only - Pelvic Pain Series where we will discuss the different causes for none other than...pelvic pain! 
In this episode we discuss the vulva and vagina and things that could be causing a bit of discomfort in those areas. Enjoy! 

But don't forget to comment, rate and subscribe! 
~Xo Dr. C

Transcript

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Hey, guys, Welcome to Episode 20 of four Vaginas. Only 20 I probably should have made some sort of, like, give away your special events surrounding episode 20. Maybe I'll do it a little bit later. I have this weird affliction with the number 27 so we'll see. But anyway, welcome to Episode 20. In this episode, we are going to start off my pelvic pain Siri's, which is gonna be a few episodes just talking about the different causes of pelvic pain. In this episode in particular, we're going to discuss pain of the vulva or the outer part of the vagina. If you're not aware with what that area is, please see my first podcast episode on Vagina Anatomy and get your anatomy up. Put seriously, everyone should be listening to or have listen to Episode one of Vagina Anatomy because then you know what areas I'm talking about and you could follow along and you're learning about your body step by step. So if you haven't checked it out yet, please check out Episode one of four vaginas only. But we are in Episode 20 tonight. So let's get started and cue the music hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. Okay, welcome. Welcome to four vaginas. Only if you don't already know. My name is Dr Celestine. I am now a board certified over Joanne. And this is my podcast called for vaginas only where I just like to talk about things that I wish everybody knew about their body. And I want to bring knowledge to as many people as I possibly can. So in this episode of four vaginas on Lee, we're talking about Volvo. Are pain the pain on the outside of the vagina? I do get a lot of patients that come to me to talk about pelvic pain. And a lot of times it is in this area. So I just wanted to go over a few reasons for the pain. Talk a little bit about sometimes when we don't know what is causing the pain. And we're just also gonna touch on what to expect when you go to your doctor's office. What they do in terms of an exam and some possible treatments for the different conditions. So let's hop right into it. First off, let's talk about pelvic pain. We're jumping into the pelvic pain. Siri's Let's talk a little bit about what that actually is. So the female pelvis is the lower half of the abdomen, basically the area below the belly button in, and it encompasses many different structures within the abdomen. It includes not only your uterus, fallopian tubes and ovaries, which are the structures I deal with, but it also includes the bowel, your bladder and includes a bunch of muscles in the abdomen and in the pelvic floor, the bottom of the pelvis. And it also includes part of the spine. And sometimes I have people that have spine pain that radiates to the lower half of the abdomen as well, so there's many structures in the pelvis that can lead to pelvic pain. So commonly I get a lot of people coming to me saying that they have ovary pain. That's not necessarily always the case because there's lots of things on the lower right or lower left hand of your belly or your abdomen that are not just the ovary. In this episode, like I alluded to, we're gonna be talking specifically about the vulva or vaginal pain, which can also be encompassed into the pelvic pain realm as well. So we'll start there. All right, so the outside of your vagina hurts. What is it? What do you do about it? You know what's going on here. Let's talk about the difference also between acute and chronic pain. So chronic pain is something that's been going on for six months, And acute pain is basically anything that's been going on for less than that time on. And that's kind of a way to differentiate, at least when you go and talk to your doctor and they ask you, How long has this been going on? It's a way for us to differentiate what the possible causes could be now for pain on the vulva. It could be many different causes. One is infection. Certain infections, like herpes, can cause pain, especially if you're having a flare up. Um, it can be gonorrhea or chlamydia or any other type of vaginal infection that could be irritating the vulva and causing pain, even including non F CDs like yeast infections and bacterial vaginosis can lead Teoh pain and the vulva. So that's one of the things I always like to rule out. I ask how long the pain has been going on. If you've noticed that you've had any abnormal vaginal discharge or odor, that leads me to believe that possibly well we have causing your pain is some sort of infection. So I would usually go down that route if that's ruled out there's a bunch of other causes. One other additional cause is an inflammatory kind of disease off the vulva, if that's the best way to explain it. And that is like in so like in L. I C H E n. There's like in planets like in sclerosis, like in Simplex Cronicas, which are basically inflammatory diseases of the vulva. And a lot of them are recurrent. They're not necessarily STDs, um, one is kind of more associated with auto immune diseases. One is more closely associated with, like a dermatitis or an allergic kind of picture to it, and they're not anything that you catch from anybody else. It's just a new inflammatory reaction of the skin and tissues of the vulva and Most commonly it presents with itching. Sometimes it can have some skin changes associated with it. It's usually a severe itching. Now, if I rule out infection and possible other causes based off of how our discussion goes, I may diagnosis you with, like in Sclerosis planets or simplex Cronicas. And one of the main things that I D'Oh to evaluate for that is a biopsy of the vulva of the outside of the vagina, which most people don't like to d'oh. But to be honest, it's not that bad. I just normally d'oh, take a little piece of the skin, send it to a lab for analysis so they can tell me what's going on under the skin. And that's how they can see if there's a like in reaction or that inflammatory reaction that is associated with like it. And that's usually treated with topical steroid cream for a designated amount of time. And the infections, like we mentioned previously, are treated based off exactly what infection you have. So that's pretty self explanatory. Now, sometimes another thing that I do biopsies for if I'm concerned, especially if I see a lesion on the vulva or an abnormality in the skin. Or if I've treated you for one thing and it's not really getting any better, I will do a biopsy not only looking for a possible like in or to take a little closer look at the skin of the vulva, but I want to make sure that it's not a cancerous process. So, yes, you can get cancer of the vulva. Some of the cancers of the vulva are related to HPV, similar to the pre cancers and cancers. Changes on the cervix related to HPV, and some are not related to HPV specifically, and the biopsy can show me if that is going on as well. Now, don't jump to conclusions. The majority of the time evolve. Our pain is not related to cancer. I would say it. Not that I know the exact statistic, but just what I see every day is not normally a cancer situation. But I just wanted to let everybody out there know that that is a possibility. And that's why you shouldn't be ignoring any vulvar pain or boulevard discharge her vulva, skin changes that you're experiencing. Make sure that you go see your doctor because it can be something that severe. Okay, Continuing on. And now that I've dropped the C bomb, So another reason why people have pain of the vulva is dryness of the vagina, which actually comes with two different things. One is menopause, which a lot of people are aware of. You get older. The average age of menopause is around 50 one years old. Your estrogen decreases and that causes the tissues of the vagina to be more dry. And it causes the vagina to become more narrow, which usually it can cause some pain without provoking it. But a lot of times I see people come to me complaining of this pain when they have sex. So when the Penis is going into the vagina just on the outside, because the vagina is so narrow and drier than usual, it causes pain, which makes sense, right. But another way that this happens is when you're breastfeeding. Okay, so when you're breast feeding, it also drops your estrogen. So if you ever wondered why you don't necessarily get a period when you're breastfeeding, it's because your estrogen is dropped. For just a simplistic description of why that is for you all and that leads the similar issues with dryness of the vagina, which can cause pain, especially I've seen it with intercourse as well. So those are That's another reason why you can have vulva pain now the treatment for those while usually I can tell from exam and by history as well. What is going on in terms of vaginal dryness? And the first thing I tell people to try is just a K Y jelly, especially if it's only hurting. When you're having sex is to use lubrication, lubrication will help, and it should relieve the symptoms during the time of sex. Now, if you're having symptoms when you're not having sex, lubrication can still work. There's also vaginal moisturizers that can be prescribed. I really just like to start with non hormonal medications prior to jumping into anything like vaginal estrogen, because sometimes they work great, especially if you're only having the vaginal dryness because you're breastfeeding. It's just a temporary thing, short period of time. It should return back to base line once you stop breastfeeding, so just using lubrication here and there, when needed, is usually beneficial. Now those are just what did I mention? 123 45 causes, possibly in generalities of valve. Our pain. There are a few more, but that's the general categories and general gist of what, Um, me as a physician, and any doctor out there is kind of looking for key words, things from us in terms of when it started and how long it's been going on in any additional associated symptoms. You guys know the things we ask when you go to the doctor, but there's also one more thing that could be the cause of pelvic pain, and that is something called Volvo Denia. It's basically and I don't know what's causing your public pain. That's basically what it means. It's three months at least, of having this valve, our pain without any source. We've ruled out infection. We've ruled out inflammation. We've ruled out any vaginal dryness or possible skin changes that could be cancer, although that's a very low chance. We've ruled everything out, okay, and now we're not really sure what it is, and that's when it falls under the category of Volvo Denia. Now that could be localized pain. I've seen people have an exact point where they point to on the outside of vagina that always hurts them. You know, they've tried everything under the sun and it's still there, and it could also be with contact similar to the vaginal dryness. But it happens every time you have sex and there is no dryness. There is no infection. There is no cause that we can come up with. That falls under the category of Volvo Denia, which honestly is the most stressful of the causes. Because you me, I guess I put people through the wringer. You have to test many different things, and then you come up with nothing, and then you have to tell someone, you know, I don't know what's causing this pain. So it is really frustrating. And to be honest, it's frustrating on both sides, not just for you but for me, because I'm really trying to find a cause, because sometimes the I don't know or the Volvo Denia becomes the most complicated to treat. So for Volvo Denia, there's many different ways that treatment could be attempted. It can be some self care measures which I'll get to in a little bit, which I really think everybody should be following, not just those that have any vaginal issue, but it can also be a Siri's of medications. Dietary changes, some physical therapy, some counseling and, as the last resort usually is some type of surgical procedure. Now, the self care stuff. This is what mostly everybody should be doing with their vagina and their vulva. Make sure you're keeping it clean, rinsing with warm water and gently patting it, not severely rubbing it or scrubbing it dry. Okay, don't wear any tight fitting pants or tight fitting underwear. Making your vagina all claustrophobic. That doesn't it's not breathing well. It's not good for anyone. You need to make sure that you're not wearing pantyhose, especially if it's really, really tight pantyhose that don't have a cotton area in the crotch. Don't use any. This is a big one. Do not use any pads or tampons that have sent to them, especially if you're prone to vaginal infections. You should not be using any scented thing. Don't let anything with any type of scent near the vulva. Okay, because since are you know they're added on there with oils and different products, and a lot of people are irritated by them and by ear today I don't just mean you know you're mad at it, but you're a vagina, and your vulva can become red and kind of almost having allergic reaction to it, which could lead to some Volver Pain and valve are diagnoses. Okay, so stay away from those. Do not use any perfume. Soap, I always say Just the plane dove or dial soap? Uncensored. It'd like the one for the sensitive skin that has no extra ingredients in it. That's what you could use if you wanted to kind of just wash the outside of the vaginal area. Do not wash the inside of vagina. Do not put any Do Shing or any water inside the vagina. Especially not any soapy water, anything inside the vagina because that messes with the normal vaginal bacteria and can actually lead to an infection as opposed to keeping it clean. So those are my basic vaginal care strategies, and that's what I tell most people, to be honest and not just those that have all of our pain or evolve our problems that I've diagnosed. But that's also something to keep in mind, especially if you are prone to evolve our pain and issues with the vulva. So yeah, that's it. That's the pretty much rough summary of the causes of all of our pain. Wrapping up the very first episode in the series of pelvic pain. Next time we'll double little bit deeper into the structures in the abdomen and what could be causing pelvic pain and that aspect you know, a lot of people are curious about because I get a lot of lot of patients coming to me talking about like I mentioned ovary pain or uterine pain. That's not necessarily the case, but you don't realize that. So stay tuned for the additional upcoming episodes of Four Vaginas Only where we talk Maura about pelvic pain in the pelvic pain Siri's that is a wrap, guys, Thank you. Thank you so much for listening to Episode 20 of four Vaginas on Lee in the Pelvic pain. Siri's I hope You guys learned a little bit, and I hope you have lots of questions, asked me anything like always. I can't answer any specific medical questions, and I know it's hard for a lot of you guys. It's hard for me too sometimes, but leave me some comments. Please subscribe and rate to this podcast. Please follow for vaginas only on Instagram, where you'll get to know a little bit more about each episode and about little old me. And I can't wait to talk to you guys again in the next episode.