The NICHD (National Institute of Child Health and Human Development) funds and conducts research on many disorders that affect the organs in a woman's abdominal and pelvic areas. In general, most of these disorders don't directly affect a woman's changes of getting pregnant naturally. Some of these conditions include:
Vulvodynia (vul-voh-DINN-nee-uh) is the term used to describe chronic discomfort or pain of the vulva, especially burning, stinging, irritation, or rawness of the area. Health care providers don't agree on the exact definition of vulvodynia. Currently, the term is used to describe a variety of conditions.
The NICHD is also supporting other research on vulvodynia.
Vaginitis (va-jinn-EYE-tiss) is a term used to describe any disorder that causes swelling or infection of both the vulva and the vagina. Vaginitis is different from vulvodynia because it affects the vagina, which is inside the woman's body; vulvodyina only affects the vulva, which is outside the woman's body.
The most common types of vaginitis include:
- "Yeast" infections--Infections caused by the fungus Candida. The most apparent symptom of a yeast infection is a thick, white vaginal discharge; some women also experience a red, itchy vulva. There are many over-the-counter and prescription treatments for yeast infections. If you think you have a yeast infection, talk to your health care provider about how to treat it.
- Bacterial vaginosis--Caused by an overgrowth of bacteria that are normally present in the vagina. This type of vaginosis is the most common vaginal infection for women of reproductive age. The most common symptom is a vaginal discharge, which is usually thin and milky; it may also have a "fishy" odor. Your health care provider can recommend medications to treat bacterial vaginosis.
- Sexually transmitted forms of vaginitis--These types of vaginitis are most often spread through sexual contact (vaginal, oral, or anal intercourse or intimate contact), and are also called sexually transmitted diseases (STDs) or sexually transmitted infections (STIs). Some types of sexually transmitted vaginitis include:
- Trichomoniasis--Is a curable infection. Many women with this condition don't have any symptoms; but some women do. Common symptoms include: vaginal discharge that is bubbly, greenish-yellow, and has an odor; itching and soreness of the vulva and the vagina; and burning when you urinate. Most health care providers will prescribe an antibiotic to treat and cure trichomoniasis; however, for treatment to work properly, sexual partners should be treated at the same time.
- Chlamydia--Is a curable infection. Because chlamydia does not make most people sick, you can have the infection and not even know it. Symptoms of chlamydia include a mucus-like or pus-like vaginal discharge or pain when you urinate. But these symptoms can be mild. The bacteria can also infect your throat, if you've had oral physical contact with an infected partner. A pregnant woman infected with chlamydia can transmit the infection to her infant during delivery. In the infant, the infection can cause the lining of the eye to become swollen and red (often called pink eye). If left untreated, chlamydia can move inside the body and cause pelvic inflammatory disease (PID), which can be serious. Health care providers will prescribe an antibiotic to treat and cure chlamydia; however, penicillin, an antibiotic used to treat other infections, won't cure chlamydia.
- Herpes simplex virus (HSV)--Also called "genital herpes," is caused by a virus. Genital herpes can be controlled, but not cured. Most women with genital herpes will have sores or lesions on the vulva, or on the outside of the vagina; sometimes these sores are found within the vagina, and can only be seen during a gynecological exam. The sores are often the source of pain for women infected with genital herpes. Your health care provider can recommend ways to control the symptoms of genital herpes.
- Human papilloma virus (HPV)--Is caused by a virus. It can be controlled, but not cured. Some women with HPV don't have any symptoms; they don't find out they have the virus until they get the results of their annual pap smear. Other women with HPV have genital warts, usually gray, white, or purple, that grow in their vagina or rectum, or on their vulva or groin. Genital warts can be painful. Some types of HPV are known to lead to certain types of cervical cancer and other cervical problems. Efforts are now underway to develop a vaccine to protect women from HPV, which could also prevent certain types of cervical cancer.
- Noninfectious vaginitis--Is typically the result of an allergic reaction or an irritation to vaginal sprays, creams, and spermacides, or to soaps, detergents, and fabric softeners. Once you stop using the product that caused the reaction, your symptoms should go away. But, your health care provider may suggest a medicated cream to reduce the symptoms until the reaction goes away.
NICHD is currently conducting a one-year longitudinal study on bacterial vaginosis and the factors associated with the condition. Results from the study are expected in 2005.
The National Vaginitis Association also provides patient information on these types of infections.
Pelvic Floor Disorders
The term "pelvic floor" refers to the group of muscles that form a sling or hammock across the opening of the pelvis. These muscles, together with their surrounding tissues, keep all of the pelvic organs (bladder, uterus, and rectum) in place so that the organs function correctly. A "pelvic floor disorder," then, is a problem with these muscles or the surrounding tissues that leads to dysfunction of one or more of the pelvic organs.
This understudied area of women's health includes a variety of problems, the most common of which are:
- Pelvic Organ Prolapse--Includes: Uterine prolapse--A woman's uterus drops down into her vagina. Vaginal prolapse--Often occurs after a hysterectomy (when the uterus is removed); the top of the vagina loses its support and drops.
- Urinary Incontinence--Can occur when the bladder drops down into the vagina. Because the bladder is not in its proper location, urine can leak out easily and without a woman's control.
- Anal Incontinence--Can occur when the rectum bulges into or out of the vagina. The rectum's location makes it difficult for a woman to control leakage. Anal incontinence can also occur when there is damage to the anal sphincter, the ring of muscle that keeps the anus closed. An estimated one-third of all women are affected by one type of pelvic floor disorder. Nearly 10 percent of that group will undergo surgery to correct a pelvic floor disorder.
While some pelvic floor disorders may result from pelvic surgery or radiation treatments, in some of cases, the initial trigger for the problem is vaginal delivery of a child. However, researchers don't clearly understand how vaginal delivery is related to pelvic floor disorders; they can't determine which women will develop pelvic floor disorders based on length or intensity of labor.
Many women with pelvic floor disorders also reported chronic pain as a symptom of their condition. These women noted that the pain's frequency and intensity had a major affect on their quality of life. Because of its chronic pain feature, vulvodynia is sometimes included as a pelvic floor disorder.
Although researchers know little about the causes or features of pelvic floor disorders, research in underway on a variety of topics related to pelvic floor disorders. In July 2001, the NICHD established the Pelvic Floor Disorders Network (PFDN) to support research projects that examine problems related to pelvic floor disorders. The PFDN includes seven clinical sites around the country, and a central data collection center. Through this research, the NICHD hopes to learn more about: normal pelvic floor function, the characteristics of known pelvic floor disorders, the effects of hormones on these conditions, injury during vaginal delivery and how it is related to these conditions, and the development of tools to help health care providers understand the level of function, dysfunction, or pain.
Pelvic pain is a general term that health care providers use to describe steady pain, or pain that comes and goes, that occurs mostly or only in the lower abdomen area. In some cases, the pain might be severe and might get in the way of daily activities; in other cases, the pain might be dull and occur only during the menstrual cycle. Pelvic pain also describes pain that occurs during sexual intercourse.
In general, pelvic pain signals that there may be a problem with one of the organs in your pelvic area: uterus, ovaries, fallopian tubes, cervix, vagina, lower intestines, or rectum. Or, it might be a symptom of an infection.
Your health care provider will likely conduct a number of tests to find the cause of your pain. Treatment varies by what the cause is, how intense the pain is, and how often the pain occurs. Sometimes pain medication is the best option. Other times, an antibiotic may be necessary. If the pain results from a problem with one of your pelvic organs, for example, if you find out that you have endometriosis, then your treatment may be more involved.
The International Pelvic Pain Society offers patient information about pelvic
pain and chronic pelvic pain, as well as some suggestions for how to talk with
your health care provider about pelvic pain.
Source: National Institutes of Health (www.nih.gov)