Dr. Reid / Bartholin's surgery

[Guest guest]

Dear folks --

I'm on the vulvodynia list as well, and Dr. Glazer (the biofeedback

innovator) posted the following to the list, from a colleague of his in

Australia. Dr. Reid offers both a detailed theory of vulvodynia (his idea is

that it's the sympathetic, or " unconscious " nerves and not the conscious

nerves that are misfiring) and posits that the 20% of people not cured by

biofeedback (don't know where he got that number) will be cured by a special

surgery that's less radical than a vestibulectomy, wherein the Bartholin's

glands are simply removed.

I wasn't sure what I thought of this last idea, but his particular nerve

theory makes sense to me, and I think the other type of surgery is worth us

all hearing about, just knowing it's out there...

best,

katherine

**********

Dear groupmembers:

A colleague of mine, Dr. Reid, a vulvar pain specialist from

Sydney Australia has requested that I post the following message.

Glazer Ph.D.

Re: vulvar vestibulitis

Posted by Dr Reid, on November 14, 2000 at 16:36:59:

In Reply to: Re: vulvar vestibulitis posted by Jill on August 16, 1999

at

17:02:57:

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Vulvodynia has puzzled medicine for some time. One of the main sources

of

confusion has been the (quite reasonable) search for a specific

“disease”

within the chronically inflamed and painful tissues. In fact, these

areas of

painful vulvar skin do not harbor any concrete “disease” process (such

as

infection, etc). Rather, modern research now sees vulvodynia as a

chronic

pain loop, rather than a structural alteration of tissue architecture

(such

as could be seen through a microscope).

Although vulvodynia is now sometimes referred to as pudendal neuralgia

(pain

resulting from malfunction of the normal “conscious” nerves to the

pelvis),

there is no hard evidence to support such belief. Rather, the weight of

evidence favors the view that this abnormal pain reflex is maintained

through a malfunction of pelvic sympathetic nerves. The term

“sympathetic”

refers to the “unconscious” part of our nervous system that control

various

“visceral” functions (like blood flow, breathing, bowel function, etc).

Under normal circumstances, sympathetic fibres do indeed transmit pain

messages from the viscera (especially from the intestines), but not from

“somatic” structures (like skin, muscle, bone, etc). Unfortunately,

sympathetic nerves can become involved in transmitting somatic rather

than

visceral pain. When this happens, the end result is an unremitting,

burning,

difficult-to-localize pain with very little capacity for spontaneous

regression. The vulvar vestibule and Bartholin’s glands are particularly

susceptible to sympathetic pain loops, because these structures are

formed

embryologically from the “cloaca” (the boundary zone between rectum and

perineal skin, in a fetus).

This information is explained in greater detail in a two-volume set of

Obstetrics & Gynecology Clinics of North America, dealing with Human

Papillomavirus (HPV) infection. Of course, HPV has nothing to do with

vulvodynia! However, my co-editor and I included the topic to help

safeguard

general OB/GYNs against the error of performing CO2 laser surgery on

vulvodynia patients. [Reid, . " The Management of Genital

Condylomas,

Intraepithelial Neoplasia, and Vulvodynia, " Obstetrics & Gynecology

Clinics

of North America Vol 23, No. 4 (December) 1996: 917-991.]

Traditional medical remedies (topical estrogen, Elavil, nerve blocks,

interferon) are generally ineffective (at least for the dyspareunic

element

of vulvodynia). Conversely, biofeedback is a highly efficacious,

non-invasive therapy that will cure about 80% of all patients. The

remaining

20% are also generally curable… no matter how severe the pain or how

long-

standing the symptoms. However, in this 20% subset, cure generally

requires

surgery.

When surgery is being considered, most OB/GYNs offer vestibulectomy (an

operation that cuts off a critical portion of vulvar skin, at the

vaginal

entrance). Unfortunately, vestibulectomy is deforming, unreliable and

ideally should become obsolete. Much better cure rates (95% vs 60%) can

be

obtained with a more intricate and non-deforming operation, called

microsurgical removal of Bartholin’s glands (lubrication glands situated

about 1 inch deep to the tender spots on either side of vaginal

entrance).

Major drawback

of microsurgical removal of Bartholin’s glands is that it requires very

sophisticated surgical skills, and Surgeons trained to do this operation

are

not readily available.

I saw your post while preparing my new Website (“Vulvodynia is

curable”).

This site will take a little more time yet. However, feel free to E-mail

me

back if you want more information.

Reid, MD