Sister needs female pelvic pain expert

Dear Dr. Roach: My 77-year-old sister has what she and I believe is vulvodynia. She’s in horrible pain in her vaginal area and has had every test imaginable. She has been seen by her general doctor and gynecologist, but so far, no one has been able to diagnose her. She feels like she has a constant UTI, but tests come back negative. She’s used estrogen cream, and does Kegel exercises and while the pain goes away, it comes back with a vengeance. I read that there’s some kind of surgery and would like to hear more about that. I hate that she’s in so much pain and suffering, as she is a very active woman. This has been very debilitating.

S.F.

Answer: Vulvodynia, pain in the vulva from unknown cause, has a significant effect on a woman’s quality of life. While it sounds like she has had some appropriate evaluation and attempts at treatment, she continues to have symptoms. This is the case for many women.

Patients with vulvodynia should see a specialist in female pelvic pain, usually a gynecologist who has special expertise in this problem. Most often, a number of interventions are begun, including: careful advice on proper hygiene, especially avoiding soaps, douches and other irritants to the vulva; wearing cotton underwear; practicing stress reduction; getting regular nonirritating exercise; and the use of warm soaks and/ or ice packs.

Another important resource is a pelvic floor physical therapist. Some of my patients have had an improvement in symptoms with cognitive behavioral therapy.

Although there are surgical approaches to vulvodynia, they are reserved for a subset of women with certain types of pain who continue to have pain despite conservative management. The literature reports 60% to 90% success rates in carefully selected patients.

There is preliminary evidence that laser-based treatments may have benefit in some women with vulvodynia.

I would strongly recommend your sister ask for a referral to an expert in female pelvic pain.

Dear Dr. Roach: My dear friend had the coronavirus early in April. She tested positive. Her symptoms were no taste or smell and feeling very sluggish. She has since tested negative. She also tested positive for antibodies. Her sense of smell and taste have not come back. She went to an ENT and was given a CT scan of her sinuses, which showed nothing wrong. She was put on a steroid pack and Flonase twice a day. Ten days have already passed with no improvement. Do you think that her sense of smell and taste will ever return?

K.F.G.

Answer: Although many viral infections can cause loss of taste and smell, this has been a particularly common symptom in coronavirus (30% to 80%). In every case I have seen, it has come back, although the loss can be prolonged for weeks or months. This is a new disease, and it hasn’t been long enough for us to see whether there will be a few cases that are permanent. So far, it looks promising that the sense of taste and smell will come back in most people who lost them due to coronavirus.

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