The Pill Is Causing Your Vulvodynia- Part I

The Pill is causing your vulvodynia/vestibulodynia. 

Time for another anatomy lesson, but this one is a little bit more complex. >I have been responding to many beautiful women who write to me about their vulvodynia and vestibulodyina and want to know why this has happened to them, and also found their symptoms started slowly after beginning beginning birth control pills. Because it can usually take a while, its east to not think its your pill thats causing the issue. 

Also the medical community is kind of divided on this and thats why I really appreciate Dr. Goldsteins work because his team is bringing awareness to this issue and doing the studies that need to be done.  are really only a few specialists and doctors doing research on this stuff so Its harder to find good information out there. 

So to start- let's talk about how the pill affects the vagina. The vagina and the vulva can be thought of as 3 separate parts due to their embryological nature- that is how they developed prenatally. Before you're born and your little genitalia is being developed your cells make 3 different tissue types… Mesoderm, Ectoderm and Endoderm.

The ectoderm makes up the tissue of your outside Vulva (your labia majora, your hood, your clitoris, and your perneum skin).The endoderm is the vulvar vestibule (the skin starting at your harts line on the inner labia minora, and the skin that makes up your hymen and vaginal opening.Lastly, the Mesoderm makes up the inside of your vagina.

So, because thats 3 very different types of tissue, it now makes sense that each area would respond very differently to different hormonal states. And with hormones we know you can have too much, or not enough, or an imbalance. This is also why each area responds differently when you have infections, allergic reactions, irritation or trauma.

Most women with vulvodynia have pain confined to the tissue of the vulvar vestibule, and not the outside vestibule or inside the vagina. SO its really localized (Insert pictures) So i guess its really more appropriate to say vestibulodyina in this case.

So let's continue..... If you remember from my Vaginas 101 video Look at your vagina you will remember I said the Vestibule contains many glands. the Skene’s glands, the Bartholin’s glands, and the minor vestibular glands. These glands, when stimulated by hormones, make that amazing  slippery lubrication that you feel during arousal and intercourse.

So here's problem #1: When most people think of hormones that affect the vagina they think estrogen and progesterone right? Well we forgot one. The glands I just mentioned? They rely on testosterone or hormones called androgens. These androgens act on the androgen receptor in the cells to cause the production of that lubrication.

And this is where things can start to go wrong if you're on the pill. The system can go wrong in a couple ways, you can have a low level of androgens, so those receptors don't receive enough. Also the receptors might not function correctly and this could be genetic. The pill can cause both problems...not enough androgens and also a faulty receptor which would make you more susceptible to the negative effects of birth control pill.

So now that we have discussed that- lets have a quick chat about how birth control pills work. Almost all oral contraceptives contain a combination of synthetic estrogen and synthetic progesterone (called progestin). All pills on the market contain the synthetic estrogen Ethinyl estradiol (for your information this is 1 of 3 estrogens and its the most potent). The ingredient that makes all the various types of birth control pills different is the type of progestin used and the varying amount of ethinyl estradiol.

Since visiting Dr. Goldstein I learned that in the last 20 years most birth control pills contain a new generation progestin. Much different than the birth control pills our parents used to take. These have names like drospirenone (found in Yasmin), Desogestrel found in …. And norgestimate found in Triccyclen and the nuvaring. I was on tricyclen for 10 years and my symptoms of vestibulodynia and chronic pain started 2 years after I began.

Also… when I started the pill ( about 15 years ago..) there was a big movement toward low dose pills, lo lo, alesse, tricyclen lo. And what's crazy is any pill containing 35 micrograms of estrogen is already considered a low dose and these pills contain as little as 10 micrograms. So many women myself included were led to believe oh this is a great idea, Im getting a lower amount of synthetic hormones. Less must be better for my body...and only now are we being told that birth control pills with low dose hormones actually increase your risk of developing vestibuldynia. Also for the record… birth control pills back in the day had about 50 micrograms...so that gives you an idea of why this is a relatively new discovery and a really unfortunate one for many women.

Back to the lesson. Birth control pills work by preventing the production of FSH (follicle stimulating hormone) and LH (Luteinizing hormone). Ovulation is stopped and therefore pregnancy is prevented. Because FSH and LH are not being made, our little ovaries aren't making estrogesn, progesterone or androgens.

The synthetic hormones in the pill are metabolized by our great liver, and our liver produces a protein called Sex hormone binding globulin. SHBG. SHBG is like a little pac man going around chewing up sex hormones. It especially likes androgens. Certain progestins like the ones in Yasmin, tricuclen and the nuvaring are especially good at raising our SHBG levels.

So what does that mean….the combination of our little ovaries not making androgens, and the increased production of androgen eating SHBG, not only reduces our androgens but also makes our androgen receptors sticky or faulty or just turns them off.

Side note: Studies have proven the pill shrinks the size of the labia, reduces the size of the vulvar vestibule and reduces clitoral blood flow. It also makes the tissue more susceptible to tears and fissures and causes sensitivity to pain. So the thing thats supposed to protect us from pregnancy is actually drying out our vaginas and killing our libido, making us more prone to tearing And shrinking our clits. What the heck.

Something else I have learned is that women who take OCP before the age of 17 are 1000% more likely to develop vestibulodynia.

Are there other reasons women develop vulvodynia? Yes absolutely. Pelvic floor issues, tight muscles, pudendal nerve injuries…

So what can be done to fix this? Or reverse the damage. Well again, I am not a doctor and I cant prescribe, although I wish I could. According to Dr. Goldsteins literature women can be successfully treated by having them stop OCPs and by applying a compound that contained topical estrogen and testosterone to the vestibule. On average their vestibular pain dropped from 7.5 to 2 on a ten-point pain scale after three months of treatment. As I mentioned in my volvodynia video this has done wonders for my tissue and pain.

Kathryn, why does this happen to some women, and not to others? I have many friends who have been on the pills for years and never have an issue. It really can be genetic. Some women are born with weaker androgen receptors and therefore would be more susceptible to the hormone change caused by the pill. The strength of your androgen receptor is determined genetically at birth based on your chromosomes and the length of your androgen receptor genes. Theres not much we can do about it.

Here’s an example- its not a good one but it might get the point across. Some women's bodies are like Lambourghinis and some are like eco friendly cars... One goes through gas like crazy and one is super fuel efficient. With lots of gas both work fine. If there isn't enough gas...the Lambourghinis are going to run out of gas way faster than the hybrid. The gas shortage in this case is the birth control pill and the gas guzzling Lambo is a wonky androgen receptor.

Before I GO I wanted to answer a few questions that have come up. If birth control pills are causing my vulvodynia, will stopping the pill make the vulvodynia to go away? Unfortunately, for many women, just stopping OCPs does not cause the vulvodynia to resolve. When I asked my doctor about it i found out This is because even after stopping OCPs the levels of SHBG frequently do not go back down to the levels they were before stopping OCPs. This just leads to low androgen levels and the vulvodynia doesn't go away. In my experience I needed the addition of hormones to start feeling better.

Can I stay on the pill and just use the topical hormones as treatment? So I tried this. For two years, actually as this was the treatment of a physician I was seeing down in Arizona, and at first It got better… but then it just stopped working, and actually I had a lot more burning, and swelling, and unpleasant side effects from staying on the pill while using topical hormones. I later found out progestin in OCPs can turn off the androgen receptor so using topical hormones without stopping OCPs just doesn't work.

If my vulvodynia goes away will I ever be able to go back on OCPs?My personal opinion is why would you want to? I discontinued the pill for a few years during my 20’s and it never resolved.I would consider an IUD but again It would be a non hormonal option and something I would very carefully have to talk to my doctor about. Well thats that- thank you for checking out this video- if you like this stuff make sure to subscribe for new topics and ill see you soon.