His and Her Health

Hello Dr. Goldstein,

I have read articles in which you talk about the use of compounded estrogen and testosterone to thicken frail skin in patients with vulvar vestibulitis with positive results. I am interested to know if progesterone could also play a role in making one's skin fragile.

The reason I ask is that I had my hormones tested 2 years ago when my vulvar vestibulitis began and I was found to have PCOS. Like many patients with PCOS, they found that my testosterone was actually a little high (not a surprise, seeing as i have acne and mild hirutism at 23!) My estrogen was said to be normal.

I remember in the article you said most women who responded to this treatment had TOO LITTLE testosterone, which is clearly not my case. I would write hormones off as the cause of the problem, except for one curious clue: when I ovulate, the pain I feel throughout the rest of my cycle is basically non-existent. I resume sex pain free for 3-4 days when ovulating--then for the rest of the month, it is a struggle. I know that ovulation is when progesterone and estrogen are high, so this makes me wonder.

I also notice that the only time I think about/want to have sex is during ovulation. I basically have no sex drive otherwise. I have quite the trouble getting excited or lubricated at any other time. I have also heard that progesterone can fuel one's sex drive, though I am not certain about that informaton.

So, if you can find the time, please let me know if in your experience low progesterone can play a role in vulvar pain. Also, could it be that the blood tests for hormones are useless in determining whether or not the tissue is being supplied with adequate testosterone and estrogen? I am quite interested in your method of treatment, as I observe this extremely marked improvement in both pain and libido at the ovulation stage of my cycle.

I have not found that low progesterone causes vestibulodynia.
However, I have had many women with PCOS who get better with topical estradiol/testosterone.

<small>[ 08-08-2009, 08:36 PM: Message edited by: Moderator ]</small>

Dear mmarge 21,

I know this is an old thread, but I have many of the same symptoms and I was wondering if you ever solved your problem.

I have not had my hormones tested yet. Doctors seem very reluctant to do it. Very frustrating.

I have had vulvar pain for the past year and was recently diagnosed with vulvar vestibulitis.
This pain started very suddenly in my late twenties. At the same time, I developed an anal fissure and hemmorhoid. All new and unusual for me. I have always taken very good care of myself and my health suddenly plummeted.

The pain is related to my cycle, also. The only time sex is possible is during ovulation. It is the only time I have a libido at all. I also have a yellow discharge during the month. I keep telling my doctors about the ovulation connection, but no one seems to listen to me.

Thank you so much!