Dear Dr. Roach: My 77-year-old sister has what she and I believe is vulvodynia. She鈥檚 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 has used estrogen cream, and does Kegel exercises and while the pain goes away, it always comes back.
I read that there鈥檚 some kind of surgery and would like to hear more about that.
S.F.
Vulvodynia has a significant effect on a woman鈥檚 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; practising stress reduction; getting regular non-irritating 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 women with certain types of pain who continue to have pain despite conservative management.
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 friend had the coronavirus in April. She tested positive. Her symptoms were no taste or smell and feeling very sluggish. She has recovered but 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 passed with no improvement. Will she fully recover?
K.F.G.
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鈥檛 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 cases.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to [email protected]
