Can Your Vagina Be Depressed? (Response to Article's Claims)

This article appeared on Popsugar.com September 5, 2017:

"Can Your Vagina Actually Be Depressed? The Answer Is Yes" 

​​Read the responses from two women's health professionals below: 

---

---

Response From Two Women's Health Professionals: 

Women's Health Physical Therapist, Stephanie Pendergast, MPT
Response: 

​The answer is actually no. I am not sure which news outlet started this incorrect and damaging trend of reporting that Vulvodynia is synonymous with a depressed vagina but it has to stop. Last week Rachel Gelman and I contacted Reader’s Digest because they suggested Vulvodynia came from a lack of sex. Rightfully they recognized their mistakes and they are printing a retraction. I am hoping those at Popsugar will consider doing the same, my reasons are listed below. We need to set the record straight on what Vulvodynia is and is not, this type of misinformation in the media is devastating to those suffering from this disorder and it needs to stop. 

First, please use the correct anatomy. A recent article came out stating 50% of men cannot correctly identify a vagina (http://nypost.com/2017/08/31/50-of-men-cant-correctly-identify-a-vagina/). Perhaps this is because the terms ‘vulva’ and ‘vagina’ are incorrectly being used interchangeably in multiple places, including this article. Two structures most commonly affected in women with vulvodynia are the vulva and teh vestibule. These two structures are not synonymous with the ‘vagina’. It is incorrect to say the vagina is depressed and it is incorrect to say the vulvodynia is vaginal pain. However, it is important to note that vaginal pain can exist with vulvodynia. 

Vulvodynia is NOT caused by a depressed vagina. 

There are 7 known causes of vulvodynia and 8 associated causes and depression is NOT one of them. I know because I was part of the task force that reviewed the literature and published a consensus paper in 2015. Ref: Bornstein J, Goldstein AT, Stockdale CK et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain vulvodynia. J Sex Med 2016; 13(4):6-7 -12. The first paragraph of the Popsugar article quotes a sexologist, Kristie Overstreet. She is using the ISSVD definition of Vulvodynia from 2003. This information has been updated but even so, I can assure your the 2003 terminology does NOT list depression as a cause of Vulvodynia. 

The term ‘depressed vagina’ is not synonymous with vulvodynia. 

In all fairness to the writers calling vulvodynia a depressed vagina, I can see how they arrived at this conclusion. This topic is can be complicated. Tricyclic antidepressants (TCAs) are FDA-approved and effective for reducing neuropathic pain. Certain subtypes of vulvodynia have a neuropathic pain component and therefore TCAs are used as treatment. This is not because the woman, or her vagina, are depressed. TCAs reduce pain because they regulate the central nervous system, the dosage used for pain is lower than the dosage used for anti-depressive effects. Sex in the City misconstrued the disorder before we could tweet about our outrage. It wasn’t ok then and it isn’t ok now. 

3. Experts DO know what causes Vulvodynia. 

Reference above. 

4. “ There is no treatment specifically for vulvodynia, and anything that is used is still pretty experimental. But due to the highly intrinsic connection between the vagina and brain, vulvodynia is often treated with antidepressants and other forms of therapy to adjust the serotonin levels in the brain rather than to address the painful symptoms themselves. Any course of treatment is individualised based on the person's experience with the condition.” 

This is completely false. There are a number of treatments for vulvodynia and each treatment plan will vary based on the cause of a person’s vulvodynia. Effective treatments include pelvic floor physical therapy, topical medications, oral medications, medical interventions such as botox injections and nerve blocks and in some cases, surgery. Tricyclic antidepressants are used to treat Vulvodynia because of their neuromodulating effects and are used at a dosage lower than that used for depression. It is incorrect to say its mechanism of action is to influence serotonin levels and therefore ‘undepress a vagina”. Furthermore, the vagina is not the problem, the vulva and the vestibule are the problematic anatomic structures. The anatomy in this article needs to be corrected. 

Reference: Vulvodynia: Assessment and Treatment. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. 
J Sex Med. 2016 Apr;13(4):572-90. doi: 10.1016/j.jsxm.2016.01.020. Epub 2016 Mar 25. Review. 
PMID: 27045258 

Gigi and editor, I speak on behalf of a large group of medical professionals who have dedicated their careers to helping men and women recover from debilitating pelvic pain syndromes, including vulvodynia. While this disorder may seem sensational to you it is most certainly not for those fighting to get better. I am strongly urging you to speak with some of the leading experts on this condition and publish an article that accurately depicts this syndrome and helps women get the help they need. It is possible for Vulvodynia to be successfully treated and they need to know that. I am more than happy to help and I look forward to hearing from you. 

Sincerely, 
Stephanie A. Prendergast
CEO and Co-founder
Pelvic Health and Rehabilitation Center
Los Angeles Branch
www.pelvicpainrehab.com

---

Chronic Pelvic & Sexual Pain Practitioner, Robert J. Echenberg, MD, FACOG
Response: 
​
I have read Stephanie Prendergast's excellent and accurate responses to these distorted, exaggerated, sensationalized and blatantly false articles that have been part of the media's misunderstanding of the disorders that affect approximately 30 million American women.  As she correctly states, there is already plenty of misinformation or lack of information about these complex debilitating physical illnesses that affect women and men alike with chronic pelvic, genital and sexual pain.  Basic anatomy and physiology about the pelvic and genital area is sorely lacking even among many of my colleagues in gynecology, urology, gastroenterology. 

I am a Board Certified Ob/Gyn MD who spent 30 years caring for women with their pregnancies and surgical repairs of their reproductive organs.  I have now spent 16 further years specializing in all of the illnesses that together form the overall category of chronic pelvic pain (CPP).  These disorders include vulvodynia, vestibular non-infectious inflammatory pain,  bladder pain syndromes, pain of irritable bowel, multiple neuropathies of the pelvic region, muscular spasming disorders between the mid-abdomen and mid thigh regions, and a host of other assorted associated "triggers" of pain in the pelvic and genital region in women and also in men.  These patients are socially stigmatized and often become more and more isolated in their lives because they are commonly told these complaints are "made up" and are "in their heads" or are "drug seekers". 

In my experience of seeing over 1400 patients with these complex problems from all over the country and many from outside the US, it is obvious that these patients are desperate for help. Their relationships are in jeopardy, they often cannot work, continue school and have already had multiple surgeries, invasive diagnostic procedures, and every type of blood test, CT scan, MRI, Ultrasound and even young teens are getting many of these tests in the prime of their lives.  There is no such thing as a "depressed vagina" or a "tiny bladder" or "sexual deviations" causing these highly disturbing illnesses.  I have been interviewed countless times for various media and it is almost universal that what I say and try to get across as factual medical science about these issues is routinely edited down to a few "sound bites" of information out of context.

As Stephainie Prendergast said about being interviewed to do an accurate story about these disorders, I too would be more than happy to do so.  A few years ago, I wrote to the NY Times and suggested that they do a series of investigative reports on these issues but only got a reply that indicated they would pass it on to their medical feature writers and I never heard anything further.  If nothing more, it seems to be really important at this point in our debates over the skyrocketing costs of our health care system in this country, that some attention be paid to a very large patient population that is costing the system hundreds of billions of dollars utilizing many wasted procedures and other resources that don't seem to be working well for all chronic pain disorders, not just the ones in the pelvic and genital area.  The study of pain itself is "exploding" but this neuro-science and many of its advancements are not yet "trickling down" to the average clinician, especially those working in the pelvic area of the body. 

Proper acknowledgement and education about diagnosis and treatment that is now a reality in the relatively small medical community of pelvic pain could serve the whole medical care system well - since chronic pain costs our system more than diabetes, stroke, heart disease and cancer combined.  I am attaching that letter I wrote in 2009 to the NY Times. 


With hope,  
​Robert J. Echenberg, MD, FACOG​
Member:  International Pelvic Pain Society and International Association for the Study of Pain
Co-Author:  "Secret Suffering: How Women's Sexual and Pelvic Pain Affects Their Relationships"
Co-Producer:  "Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain"
Bethlehem, PA
www.TheEchenbergInstitute.com  

---

WANT TO HELP?

Send this Blog Post to The Popsugar Author