It’s that time of year again when people feel motivated to start exercising and getting their health in check.
For women, wellness extends beyond working out or annual routine check-ups. Women’s sexual health should be a top priority, especially if they are experiencing vulvar pain. Treatment can be life-altering.
Dr. Jill Krapf teamed up with Dr. Andrew Goldstein, head of the Centers for Vulvovaginal Disorders, to lead research and treat vulvovaginal disorders. They recently published their latest book, When Sex Hurts: Understanding and Healing Pelvic Pain, along with doctors Caroline Pukall and Irwin Goldstein. Sixteen percent of people experience chronic vulvar pain, which can severely affect their day-to-day activities. Although there are advances in this area of medical practice, the surface has just been scratched.
Chronic vulvar pain includes vulvodynia, vulvar vestibulitis and lichen sclerosus. Having treated thousands of patients worldwide, Krapf and Goldstein are leading experts in diagnosing and helping women gain control of their bodies.
“If we don’t talk about the vagina, we don’t talk about the vulva and we certainly don’t talk about the clitoris,” Krapf shares. “It’s absolutely necessary that we do. One of my big passions within the circle of vulvodynia is a skin condition called lichen sclerosus. This is a condition that affects the vulva. What I noticed as a gynecologist, you see patients of all ages, but you tend to start attracting people that are a similar demographic… I saw many patients in their 20s, 30s and 40s with lichen sclerosus. If you look at the textbooks, you would think that lichen sclerosus does not happen in women of those ages. It’s usually only reported in post-menopausal women and young girls before puberty. So one of the things I try to do is bring awareness to the skin conditions for people of reproductive age.”
Krapf knew from an early age she wanted to work in medicine. During her final year of residency, she attended one of Goldstein’s vulvar vestibulectomy surgeries. This area of gynecology was new to her, and she took an interest in it. Goldstein shared more information about vulvodynia. Krapf decided to do her final research and mentorship with Goldstein, learning as much as she could in this area of gynecology. At this time, he had been running the Centers for Vulvovaginal Disorders for over a decade.
Initially, Goldstein joined the faculty at John Hopkins after completing his residency program. Before knowing the full depths of vulvodynia, he became John Hopkins’ expert on female sexual dysfunction, which prompted him to conduct more research. This led him to meet Dr. Stanley Marinoff, the leading expert at the time for the condition.
Goldstein spent the day with Marinoff shadowing him and absorbing what he could. At one point, Marinoff asked him a question regarding a patient. Goldstein answered in-depth, to which Marinoff offered him a job at his practice.
“I thought when I was talking about female sexual dysfunction, I would be dealing with mainly women’s libido, maybe orgasm issues,” Goldstein shares. “I quickly realized that while people with low desire are very unhappy, people with pain disorders were despondent.”
Goldstein gradually took over Miranoff’s practice expanding on his methodologies. Ultimately, he designed a diagnostic algorithm, which diagnoses and rules out potential causes, and is free for other gynecologists to use on his website. Among his credentials, he is the past president of the International Society for the Study of Women’s Sexual Health and a fellow of the International Society for the Study of Vulvovaginal Disease. Goldstein has been a grant recipient of the National Vulvodynia Association.
After Krapf finished her year studying with Goldstein, she became a junior faculty member at George Washington University, where she restarted the Center for Sexual Medicine. Her husband’s military responsibility led them to Texas. Soon after, Goldstein contacted her, asking her to run the D.C. office. They offer advanced screenings, medication and protocols to help patients.
“I had to make a difficult decision because I was a full-breadth OBGYN,” Krapf explains. “I was delivering babies. I was providing full OB and gynecology care. So to pivot to doing sexual medicine, or what we call genital pelvic pain, vulvar medicine, I wasn’t going to use about 95% of what I trained for. But the decision was clear for me. I was doing it all along, but this allowed me to dedicate all of my practice and energy to vulvar pain conditions.”
It was important for her to be able to teach patients about the conditions and what they could do about it. So Krapf started an Instagram account, which has attracted over 25,000 people wanting to learn more. In addition to the book launch, in which 100% of the proceeds go to the National Vulvodynia Association, they are working on organizing the Vulvodynia Summit.
“Social media is so powerful,” she states. “The more times you see a message, the more comfortable it becomes. There is a generational component… It’s important that we talk about proper anatomic terms. This is essential to teach our children and the next generation what their parts are called, not to use pet names for the parts. We should talk about the clitoris and the vulva and the labia, just like we talked about our elbow and our finger.”
For women experiencing vulvar pain, it’s important:
- Don’t settle for one doctor’s opinion. There are resources out there.
- Get comfortable with talking about the vulva so you can accurately describe to the specialist what is going on.
- Become your own advocate and research as much as possible, so you understand what the specialist is saying.
“I want providers out there to know that there are resources of how to learn about this,” Goldstein concludes. “There are the textbooks and courses to help providers; give them the tools necessary. The National Vulvodynia Association had been working on a residency in medical school education to get more doctors more interested [in the study of vulvar pain disorders]. For those suffering from chronic vulvar pain, there is hope.”