Vulva

This Banner Ad Now Available!

Vulva
www.VulvaHealth.com

Everything Dads & Husbands Must Know About:
Vulvovaginal Health, Feminine Hygiene, Gynecology & Menstruation
and Safer, Healthier Environmentally-Friendly Products

Especially For Dads who are "Raising Girls Without Women"

Advertising Inquiries:
Email: femgynhealth @ yahoo . com
Tel. (716207)2419141-141312919

"Vulva health" is a term that covers the many health issues of a woman's - or young girl's vulva. This includes vulva care, gynecology, feminine hygiene, vaginal health/hygiene, menstruation, and the changes in women's vulvas from menarche to menopause.

Husbands and fathers - as well as women and mothers need to learn more about vulva health, to provide the care and support the special women in their lives may need. Husbands and fathers have a unique role in providing the healthcare and knowledge, especially those single dad's that have young daughters.

Vulva health is an area that is related to the health and care of the vulva. Many men and women are afraid to use the term "vulva" due to its' technical, and medical sound, and most simply prefer to call the vulva a "vagina." Yet that would be incorrect. The vagina is just one part of the vulva. Nobody, with the exception of a doctor, can see a woman's vagina, and only he/she can see a woman's vagina by looking into the vagina, using a special instrument called a speculum.

It's time to begin calling a "spade a spade." When mother's and fathers are bathing, or toilet training their daughters, they should explain that the vulva, which is on the outside, has several parts, and that her vagina, is on the inside.

Vulvodynia-chronic vulva discomfort, vulvar vestibulitis, dysesthetic vulvodynia

Vulvar dystrophy-broad term to describe various epithelial changes. In 1987-ISSVD International Society Studies of Vulvar disease found the following symptoms; a. nonneoplastic. b.intraepithelial neoplasms - spuamous cell CIS c. nonsquamous intraepithelial neoplasia

Women with HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginal discharge, sores on labia, anus, perineum, buttocks, thighs, dyspareunia Vesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina

Women with syphilis report painless sores in vulvovaginal area. Primary - red, round, firm ulcer with granular base with well-formed edges. Secondary- moist, mucus lesions which resemble herpes. Moist cutaneous lesions called condyloma lata, appear flat and gray. Adenopathy, maculopapular rash.

Women with CA report new bump: itching, generalized pruritus, last pap. Warty, flesh colored, sharp and pointed, cauliflower, + acetowhite

Women with candidiasis report burning, itching, discharge, dyspareunia, vulvar edema, h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/o steroids, HIV.

Women with barthloin's gland infections eportr unilateral bump. Reports active sex, recent trauma, new sexual partner leading to infections, fever, complaints of pain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/O Crohn’s disease.

Women with contact dermatitis report vulvovaginal itching, rash, and increased incidence when wearing tight pants. The vulva skin is red, inflamed, edematous, vesicles or bullae if severe, weeping, crusting and lichenification.

Women with LS report vulvovaginal itching, familial linkage, edema, superficial ulcers, burning, area feels different. Women with LS in all ages, show symptoms in clitoris, prepuce, labial majora, minora, edema, scarring, color, appearance of tissue paper of skin.

Lichen Planus - Women with lichen planus report vulvar itching, burning, with vulvovaginitis symptoms on mucosal surface of vulva. Dyspareunia, painful erosive areas. Bleeding on contact, stenosis of introitus. The vulva has white raised lesion with reticular, lacy pattern. Erosive reddened area bordered by reticular white epithelium. External labia has appearance of lichen sclerosus + acetowhite. Other signs may appear in her mouth.

Vulvar Neoplasm-Melanoma - affects mostly postmenopausal women that affects the clitoris and labia majora. Usually no symptoms.

Vulvar Intraepithelial Neoplasm - Pruritus, vulvar burning, pain, discharge, bleeding, may report urethra, vaginal and anal symptoms. White, dk, red, ulcerated, raised warty, or nodular lesions. Labia mayora most common site, minora, clitoris and perineum.

Vulvodynia (Vulvar Pain Syndrome) - Various levels of burning, stinging, pain, dryness, irritation, rawness. No pruritus. May report long term hx.

Vulvar Vestibulitis is a burning, dysuria, frequency, with repeated yeast infections or HPV. Significant/severe pain with touch or attempting intercourse.

Vulvar Pruritis, usually affecting older women. The vulva appears red/tan with scaly lesions.

What is Vulvar Cancer?

Vulvar Vestibulitis is a condition which causes redness and pain of the vestibule. Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands.

Vulvar Vestibulitis may include all the area around the opening of the vagina but is normally seen in the lower part of the vaginal opening.

Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What are the signs and symptoms of Vulvar Vestibulitis?

* Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).

* Vaginal entry such as tampon use or intercourse.

* Burning, stinging, irritation, or raw sensation within the vestibular area.

* Vestibular redness

* The urge to urinate frequently or suddenly.

How is vulvar vestibulitis diagnosed (identified)?

Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.

What causes vulvar vestibulitis?

The exact cause is unknown, but many studies are being conducted to determine the cause of vulvar vestibulitis.

The following factors have been associated with vulvar vestibulitis:

* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterial infections
* Chronic changes of pH (acid-base balance in the vagina)
* Chronic use of chemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for vulvar vestibulitis?

Treatment may include any of the following:

* Follow the Guidelines for Vulvar Skin Care
* Steroid Ointments

How it is used: A thin layer is applied to the vulvovaginal areas.

How it Works: Decreases redness, irritation, and burning. Caution: Use only as prescribed by your doctor. Overuse may result in thinning of the skin which will make your problem worse rather than helping it.

* Trichloroacetic Acid (TCA) may be used in some cases as determined by the severity of the symptoms you have. TCA is a chemical that is used to destroy small areas of the irritated skin allowing new healthy skin to grow in its place.

* Interferon Injections are used to increase your body's response to infection.

Helpful treatment hints for vulvar vestibulitis:

* Vitamin A and D Ointment How it is used: Apply to the areas of discomfort.
How it Works: Protects the skin, decreases irritation, heals, and soothes.

* Lidocaine Gel may be prescribed after initial treatment.
How it is used: Apply lidocaine gel to the vulvovaginal areas of discomfort.
How it Works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time ( 5 to 10 mins.) after the gel is applied.

* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas of discomfort.
How it Works: Decreases burning and irritation after intercourse and urinating.

* Cleansing Bottle - Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.

* Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg. elemental calcium every day. How it Works: Thought to decrease certain crystals in the urine which may cause burning.

* Cranberry Juice How it is used: Drink an 8oz. glass every day.
How it Works: Increases the acid content of the urine to decrease bladder irritation.

* Limit High Oxalate Foods - May decrease amount of oxalate crystals in urine. Oxalate crystals cause urinary symptoms such as the urge to urinate frequently or suddenly.

* Baking Soda Soak- Soak in luke warm bath water with 4 to 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times a day for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons of baking soda.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

Pelvic Prolapse is another term used for "pelvic organ prolapse." Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

Baby girls are born with special glands that are located on the inner surfaces of the clitoral hood. These glands produce an oily substance called sebum that lubricates the glans of the clitoris. The glans of the clitoris is the end or the tip of the clitoris that is sometimes exposed or can be exposed when you retract the clitoral "hood." The clitoral hood is that portion of the vulva where the labia minora come together above the vagina and urethra and looks like an inverted "v" ^ . The clitoral hood protects the clitoris and in particular, the glans of the clitoris which is very sensitive.

The sebum that comes from the glands that surround the clitoris produces a shiny appearance on the glans of the clitoris. When the sebum or oily substances are not regulary cleaned or bathed away, it accumulates, and then it is called smegma. Smegma has a white cheesy appearance, that becomes sticky and begins to adhere to the skin surrounding the vulva with greater, the longer it is not cleaned or washed away.

Without proper care and hygiene, the smegma will collect under the hood that covers the clitoris and the glans of the clitoris, which can result in pain, irritation and/or inability to experience orgasm. When the smegma is not properly cleansed from the vulva, and in particular, the areas surrounding and under the clitoral hood, the clitoral hood will adhere to the glans of the clitoris, which is referred to as a "clitoral adhesion." When the clitoral hood adheres to the clitoris, either partially or entirely, this prevents the hood from properly protecting and caressing the glans, making orgasm difficult or impossible.

It is very important for the glans of the clitoris to have adequate lubrication. This permits the the clitoral hood to slide over the glans of the clitoris easily and without undue sensitivity or discomfort. The clitoris, and especially the glans of the clitoris, is usually most sensitive to frictional stimulation, versus direct pressure. Womens masturbation methods almost always involve sliding the clitoral hood in various back and forth or circular motions across and over the glans of the clitoris. Without proper lubrication from the glands next to the clitoris, pain will result in the stimulation of the clitoris and when there is movement of the clitoral hood.

The smegma accumulations of the vulva, specifically in the area of the clitoris, needs to be cleaned on a regular basis. Otherwise, the smegma can accumulate and dry out, causing the smegma to harden beneath the clitoral hood, which causes resulting irritation leading to significant pain. This can result in pain during masturbation, vaginal intercourse, and perhaps when walking, or wearing tight pants. In addition, using sanitary napkins may be painful.

This accumulation of smegma also occurs in infants and preadolescent girls. Parents should check their daughter's vulva for these accumulations of smegma at every diaper change and bath by gently separating the vulva and looking for the cheesy-white accumulations and gently wiping/cleaning away. Always be sure to wipe her from the top of the vulva toward the bottom or rectum to prevent germs and bacteria from entering her vagina. In mild cases the dried smegma may only slightly irritate the clitoris, resulting in your daughter's need to rub or scratch it. This can result in infants and young girls masturbating frequently. The resulting redness, irritation, caused by the frequent masturbation may conceal the primary problem. Adult women may also be distracted by this mild irritation, feeling a need to masturbate or engage in sex frequently. This sensation should not be confused with that of having an erect clitoris. When the irritation is severe though, while the desire to touch the area is there, the inflammation makes any contact extremely painful. So accumulated smegma can either increase the desire for sexual contact, or make it impossible.

Proper bathing and care of the vulva prevents clitoral adhesions

Preventing clitoral hood adhesions means that you need to retract the clitoral hood each time you bathe or shower, and wash out the secretions from this area. Most women need to be aware that simply wiping their vulva with a washcloth or their hand may not be enough to keep it clean. The spaces between the labia minora, labia majora and the area under the clitoral hood can retain the sebum from the glands around the clitoris, as well as other accumulations such as sweat, vaginal lubrication, toilet paper, menstrual fluid, urine, bacteria and feminine hygiene products. The normal body fluids don't expose a woman to any harm as long as they are removed before bacteria that are normally present are able to reproduce, resulting in infection and odor.

Special "feminine" soaps and washes are not necessary to clean your or your daughter's vulva. All one needs to use to clean the vulva is plain water. In fact, the use of soap and feminine hygiene products can irritate the delicate genital tissues. And douching is rarely, if ever needed, to cleanse your vagina. (NEVER PLACE/CLEAN OR INSERT ANYTHING, INCLUDING MEDICINE OR VAGINAL DOUCHES, INTO A YOUNG GIRL'S VAGINA UNLESS MEDICALLY PRESCRIBED AND WITH A DOCTOR'S DIRECTIONS.)

Douches, vaginal deodorants or vulva deodorants, and chemical additives pose unnecessary risks when applied to the vulva and vagina. These products have been linked to increased cases of vulvovaginitis and vaginal yeast infections.

Clitoral adhesions

Clitoral adhesions or labial adhesions limits or prevents the clitoral hood to slide across the glans of the clitoris. If you have adhesions, when you pull on your clitoral hood, the glans of the clitoris moves with it instead of the hood retracting by itself, i.e., the glans of the clitoris moves with your pulling the clitoral hood. This can be very painful, even excrutiating, for young girls, and women of any age.

You may not be able to pull the hood back far enough to expose the entire glans if you have clitoral adhesions. This could make cleaning the clitoral area difficult if not impossible.

Minor clitoral adhesions may be remedied by without the need for a doctor's intervention. The clitoral adhesions may be released through pressure on the clitoral hood. Things like bathing, masturbation, bicycle riding, and horseback riding. If you do not properly wash your vulva in a manner that places traction on her hood, or masturbate in a manner that causes you to pull back the clitoral hood, you may not separate any clitoral adhesions that form, or prevent the formation of adhesions in the future.

If you believe you have clitoral or labial adhesions, you may be able to eliminate them by repeatedly pulling on your clitoral hood, in 360 degree directions (up, down, left, right, rotating in circles as well), or by taking a hot bath.

Clitoral adhesions will not disappear immediately as it took some time for the clitoral adhesions to form.

Women who experience pain can ask their partner or doctor to examine their vulva, and separating the labia, attempt to locate the source of the pain or by using a mirror and seeking the source of the pain themselves. If you experience a clitoral adhesion, either you or your partner can moisten a q-tip with baby oil or vitamin E to clean and loosen the secretions. Remember, the clitoral hood needs to "glide" easily over the clitoris. To lubricate the clitoral hood and loosen the secretions underneath, you or your partner may want to massage the area with a topical cream or baby oil. This may require you and/or your partner to do this for several days or for several weeks. Due to the sensitive nature of the clitoris and clitoral glans, it may be painful during the cleaning or massage due to the adhesions.

In the event you are unable to treat the symptoms of clitoral adhesions, and you or your partner cannot determine the reason for the pain, a doctor may need to be consulted. If your clitoral hood extends well past the glans, or if your clitoral hood is thick or closed, the adhesions may be totally concealed, with no visible indications. You should be very explicit in your office visit with the physician regarding your pain and show him the exact location of the any pain, even retracting your clitoral hood, if necessary for his viewing.

The clitoral adhesions caused by the accumulated smegma is caused by the two tissues surfaces growing together, due to failure to wash away these accumulations. As a result, the body tries to heal and eliminate the source of the irritation, thus causing the tissues to fuse as adhesions. These clitoral adhesions, or labial adhesions in the event the labia minora fuse together, may also form as a result of the hood laying in constant contact with the glans of the clitoris.

Additionally, either you or your partner may want to massage baby oil, vitamin E, or a petroleum based lubricant or antibacterial ointment up under your clitoral hood and on the glans of the clitoris.

Naturally, one of the best ways to keep from having clitoral adhesions is through proper washing of the vulva and to wash away the secretions before they turn into smegma. Proper care of your vulva or your daughter’s vulva means to wash away these secretions at every bath or shower. When you wash your vulva, it is important for you to retract the clitoral hood and wash this area. Also, be sure to wash the inner and outer portions and folds of the labia minora.

Parents can teach their daughters how to properly wash their vulva and help prevent them from experiencing the pain of clitoral or labial adhesions. Parents need to educate their young daughters about the various parts of their vulva so that they know they have more than "just a vagina," which they can't see, but a clitoris, clitoral hood, labia minora and labia majora, that they can see.

Proper cleaning of your daughter's vulva includes the following;

1. Gently spread the inner and outer labia and wash between them.

2. Place upward traction on the clitoral hood (in the direction of her bellybutton) while washing the exposed surfaces.

3. The glans of the clitoris may not be exposed when you do this. If there are adhesions, don't forcibly try to remove them.

4. Do not use any soap or other harsh ointments while cleaning away the, sebum, secretions or smegma.

5. You may need to use a q-tip or cotton ball moistened with baby oil or vitamin E to help loosen any stubborn smegma collections. If doing this, use another q-tip or cotton ball that is moistened with water to remove the baby oil or vitamin E.

6. Make sure that you are very gentle and use only light pressure when cleaning your daughter's vulva due to the sensitivity.

7. When your daughter is old enough to understand how to wash her vulva, may also be the right time to teach her the correct parts of her vulva, as well as explaining that her vulva is "private," and that she should be the one that cares for it. Also, when she is old enough, ask her permission to wash her vulva at bath-time, or ask her if she wants to wash her own vulva, following your directions to make sure that she removes the accumulated secretions or smegma.

SPECIAL NOTE:

Talcum powder has been linked to numerous cancers, including vulva, vaginal, cervical, uterine and ovarian. NEVER USE TALCUM POWDER NEAR YOUR DAUGHTER'S VULVA.

Instead of using talcum powder, you may want to consider the use of corn starch in this area, making sure that the corn starch is used externally and never placed in or near her vagina.

The doctor says that our daughter has labial adhesions. What are labial adhesions?

Young girls, and even adult women may get “labial adhesions.” Labial adhesions occur when the labia minora (sometimes the labia majora) or the “lips” of the vulva surrounding the vagina — have become stuck together. This happens to about 5% to 10% percent of all young girls. Young girls and women with labia that are stuck or fused together should immediately be seen by a pediatrician or gynecologist as the urine flow (and menstrual flow in adult women) can become blocked and a serious infection or infections are very likely to occur if she is not seen by a doctor.

What causes labial adhesions?

This probably happened because your daughter has little to no estrogen. Baby girls get a large dose of estrogen while they're still in the uterus. About one to two months after her birth, the maternal estrogen level drops off, and this hormonal change can affect many parts of a baby's body, including the lining of a girl's labia. Her labia may even stick together. This "adhesion" of her labia can continue or come and go throughout childhood, according to many pediatricians.

What can be done to treat labial adhesions?

First of all, parents should NOT try to pull or separate your daughter's labia apart, since that might hurt. Unless the adhesion is causing any problems, it's best to leave it alone. The idea of your daughter having labial adhesion probably worries you more than it bothers her. However, if the adhesion extends to cover the opening of the urethra and is trapping urine in the genital area, then you'll definitely want to see your child's doctor about treatment. Trapped urine can cause irritation and possibly infection. You'll know if your daughter's labial adhesions are covering the urethral opening if you find less urine in her diaper (for a young child) or she's having trouble peeing, or if her genital area looks irritated, she's irritable and crying, and she has a fever (due to infection).

Normally doctors prescribe a topical estrogen cream to treat the problem. Your doctor will tell you to apply this cream directly to the affected tissue, and in about two weeks it should unseal the labia. You'll probably start by applying the cream two or three times a day, then two times a day, then just once a day. It's important to reduce the amount of estrogen cream you use gradually. If you just stop the treatment suddenly, the labia will close up again.

Will our daughter always have labial adhesions?

Your daughter may continue to have adhesion off and on throughout childhood, but the labia tend to unstick when a girl approaches puberty and her body starts producing higher levels of estrogen. Until then, though, there's no reason to worry about the adhesion if it's not causing any problems. Many little girls never even know they have it.

By the time your daughter reaches puberty, she should already be able to properly care for her vulva, and her parents, have already taught her proper feminine hygiene and vulva care.

Puberty in girls is the time when she changes from a girl into a young woman, who is able to become pregnant and become a mother. There are many changes that take place but the biggest change a girl will experience will be menstruation.

Special note to Dad's: Your daughter needs your love and support now more than ever. Be involved!! Menstruation and growing up is a normal part of YOUR daughter's life and not something to shy away from. Talk with your daughter about these topics, let her know that you know what she will be experiencing. And when she has her first period, celebrate the day and make a big deal of it... take her out on a special “daughter - daddy date" to her favorite restaurant, buy her flowers, take her shopping.... let her know that you are thrilled about her becoming a young lady!!

Some of the other changes a girl will notice will be that she changes from a girl's body to a young woman's body. All girls develop and mature at their own pace. In girls, puberty can start anywhere between age 9 and 14.

Her whole body grows in height, weight and her waists expand and become contoured in order to have the room in her pelvis for a baby.

Her breasts grow. Starting about 2 years before menarche or first menstruation, the nipples start to bud and the breast begins to grow.

Her genitals grow. This includes the vulva, labia majora, labia minora and clitoris, all of which begin to expand and grow. Before her first period, she may notice a discharge from the vagina that may be whitish in color. Immediately prior to first menstruation, the color may change to light brown. The labia minora, or inner lips, begin to elongate and may protrude from the labia majora or outer lips. The clitoral hood becomes more pronounced.

Also, her emotions will be changing as well. BE PREPARED!!

Parents need to be prepared for all of these changes and this starts with having good communication skills with your daughter. Do not neglect this important time in her life. Talk to her, encourage her and educate her. Make sure she can talk to you about these changes, before these changes start!! If you are too embarrassed to talk to her about sex, menstruation or what she will soon be experiencing, buy a book on the subject, let her read it and make sure that she asks you any questions she may have.

Her vagina gets longer and its walls get more elastic so they can stretch wider.

Her vaginal secretions increase, and she may begin experiencing sexual arousal. Some young girls when going through puberty, may produce copious amounts of vaginal lubrication fluids when sexually aroused. So much so, that her panties may become "drenched" and she may become alarmed about the increasingly greater amounts of vaginal fluids. If she asks about why her panties are so wet, be frank, candid and honest, letting her know, that this is a normal change in her body's development, and that she is becoming a young woman. Ask her if she has maybe started getting her period? If she is overly concerned, or you become concerned, that this is not normal, this may be the time to take her for a gynecological visit for his/her examination. Also remember, she may have a vaginal yeast infection or other condition, that may require a doctor's exam.

As girls go through puberty, they get taller, in a short time, they spurt in growth and many become taller than boys of the same age.

A girl becomes a young lady when she begins menstruating. Her first menstruation, or menstrual period, is called "menarche" which means the date she had her first period. A young lady's first period or menarche usually begins between the ages of 9 and 14, although sometimes as early as 8 and as late as 16. Her first period is also a sign that puberty has begun.

For more information about your daughter's puberty, see Puberty: When Your Daughter Becomes a Young Woman. Special note to Dad's: Your daughter needs your love and support now more than ever. Be involved!! Menstruation and growing up is a normal part of YOUR daughter's life and not something to shy away from. Talk with your daughter about these topics, let her know that you know what she will be experiencing. And when she has her first period, celebrate the day and make a big deal of it... take her out on a special daughter - daddy "date" to her favorite restaurant, buy her flowers, take her shopping.... let her know that you are thrilled about her becoming a young lady!!

Women normally menstruate until they are 45 to 55 years old, when menopause begins. Menopause is when a female stops menstruation. An operation called a hysterectomy, which removes some or all of the female reproductive organs, also stops menstruation.

Girls have thousands of tiny eggs in their ovaries. Each month, or approximately every 21 - 42 days, on average, one of the eggs leaves an ovary and travels through a fallopian tube. When the egg leaves the ovary, this is called ovulation. Normally, the ovaries alternate each month, releasing an egg from the left ovary one month and then releasing an egg from the right ovary the next month.

As the egg travels in the fallopian tube, a soft spongy lining forms in the uterus. This lining is mostly made of tiny blood vessels and is called the endometrium. The lining gives nourishment in case an egg and sperm meet to form an embryo, or baby, that begins to grow in the uterus.

If the egg is not joined by a sperm, the endometrium or lining of the uterus is not needed. It flows out of the vagina. This bleeding is called a period. This whole cycle is called menstruation.

Menstruation is just one part of the menstrual cycle, in which a woman's body prepares for pregnancy each month. A cycle is counted from the first day of one period to the first day of the next. An average cycle is 28 days, but anywhere from 23 to 35 days is normal.

Estrogen and progesterone levels are very low at the beginning of the cycle. During menstruation, levels of estrogen, made by the ovaries, start to rise and make the lining of the uterus grow and thicken. In the meantime, an egg (ovum) in one of the ovaries starts to mature. It is encased in a sac called the Graafian follicle, which continues to produce estrogen as the egg grows.

At about day 14 of a typical 28-day cycle, the sac bursts and the egg leaves the ovary, traveling through one of the fallopian tubes to the uterus. The release of the egg from the ovary is called ovulation. Some women know when they're ovulating, because at mid-cycle they have some pain--typically a dull ache on either side of the lower abdomen lasting a few hours. The medical word for this is mittelschmerz, from the German, meaning middle pain. Some women also have very light bleeding, or spotting, during ovulation.

After the egg is expelled, the sac--now called a corpus luteum--remains in the ovary, where it starts producing mainly progesterone. The rising levels of both estrogen and progesterone help build up the uterine lining to prepare for pregnancy.

The few days before, during and after ovulation are a woman's "fertile period"-the time when she can become pregnant. Because the length of menstrual cycles varies from one person to another, many woman ovulate earlier or later than day 14. It's even possible for a woman to ovulate while she still has her period if that month's cycle is very short. Oftentimes, stress can play a role in this occurring.

If a woman has sex with a man during this time and conception occurs (his sperm fertilizes the egg), she becomes pregnant.

The fertilized egg attaches to the uterus, and the corpus luteum makes all the progesterone needed to keep it implanted and growing until a placenta (an organ connecting the fetus to the mother) develops. The placenta then makes hormones and provides nourishment from the mother to the baby.

If an egg is not fertilized that month and the woman doesn't get pregnant, the corpus luteum stops making hormones and gets reabsorbed in the ovary. Hormone levels drop again, the lining of the uterus breaks down, menstruation begins, and the cycle repeats.

In the illustration below, an egg has left an ovary after ovulation and is on its way through a fallopian tube to the uterus.

Vulvodynia, one of the types of focal pain syndromes in the female, is a complex, multifactorial, underdiagnosed clinical syndrome of unexplained vulvar pain, sexual dysfunction and psychological disability. An earlier controversy surrounding this group of disorders ranged from opinions questioning their existence to suggestions that they were of a purely psychosomatic origin. More recently, this has been largely counterbalanced by
an extensive recent literature attesting to the organic nature of these disorders. At present, neither the prevalence nor the etiology of this enigmatic condition is accurately known. A specific secondary cause can usually be diagnosed in only a small minority of the patients experiencing the symptoms of vulvodynia. Only empirical treatment options are available at present.

While cures for pain in a woman's vulva, and more specifically, vulvodynia are uncommon, some measure of pain relief can be achieved in nearly all patients using a multidisciplinary approach involving pain medications, local treatment regimens, physical therapy and psychological support. Medical management usually employs medication protocols designed to treat neuropathic pain and has been under-investigated to date.

Vulvar pain management techniques such as biofeedback and behavior therapy have been reported in some instances to provide positive outcomes. Surgery involving invasive and often irreversible therapeutic procedures has been stated, arguably, to be the treatment option with the highest success rate for certain subtypes of vulvodynia.

Vulvar pain syndrome (vulvodynia, burning vulvar syndrome) was first described as a syndrome at the end of the last century. Although more than a hundred years have passed in the interim, the cause(s) of the disorder remain(s) undiscovered. Several subtypes of vulvodynia have, however, now been recognized and identification of the distinct subset of patients presenting with vulvodynia has been stated to be a prerequisite for its successful
management. The most common subtypes recognized are vulvar vestibulitis syndrome, cyclic vulvovaginitis,and dysesthetic vulvodynia. Vulvar vestibulitis, thought to be the major subtype of vulvodynia, has been found in
some studies to be present in as many as 15% of patients in a general clinical practice.

Vulvar vestibulitis syndrome (VVS) characterized by severe, chronic pain on vestibular touch or attempted vaginal entry is thought to be the most frequent cause of dyspareunia in premenopausal women.

Other frequently misdiagnosed vulvar or vaginal conditions which can also cause vulvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent confounding problem in the differential diagnosis of vulvodynia. While studies have been reported that describe the histological abnormalities observed in patients with vulvar vestibulitis as the result of a chronic inflammatory reaction of the mucosa of the vulvar vestibule, the cause of the latter remains unclear. Reports proposing a clinical role of urinary oxalates as nonspecific irritants, contact allergy, candidiasis or human papilloma virus (HPV) infection in women presenting with vulvodynia remain without consensus and are controversial.

Vulvar Vestibulitis may include all the area around the opening of the vagina but is normally seen in the lower part of the vaginal opening. Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What causes vulvar vestibulitis?

The exact cause is unknown, but many studies are being conducted to determine the cause of vulvar vestibulitis.

The following factors have been associated with vulvar vestibulitis:

* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterial infections
* Chronic changes of pH (acid-base balance in the vagina)
* Chronic use of chemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for vulvar vestibulitis?

Treatment may include any of the following:

* Follow the Guidelines for Vulvar Skin Care
* Steroid Ointments

How it is used: A thin layer is applied to the vulvovaginal areas.

How it Works: Decreases redness, irritation, and burning. Caution: Use only as prescribed by your doctor. Overuse may result in thinning of the skin which will make your problem worse rather than helping it.

* Trichloroacetic Acid (TCA) may be used in some cases as determined by the severity of the symptoms you have. TCA is a chemical that is used to destroy small areas of the irritated skin allowing new healthy skin to grow in its place.

* Interferon Injections are used to increase your body's response to infection.

Helpful treatment hints for vulvar vestibulitis:

* Vitamin A and D Ointment How it is used: Apply to the areas of discomfort.
How it Works: Protects the skin, decreases irritation, heals, and soothes.

* Lidocaine Gel may be prescribed after initial treatment.
How it is used: Apply lidocaine gel to the vulvovaginal areas of discomfort.
How it Works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time ( 5 to 10 mins.) after the gel is applied.

* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas of discomfort.
How it Works: Decreases burning and irritation after intercourse and urinating.

* Cleansing Bottle - Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.

* Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg. elemental calcium every day. How it Works: Thought to decrease certain crystals in the urine which may cause burning.

* Cranberry Juice How it is used: Drink an 8oz. glass every day.
How it Works: Increases the acid content of the urine to decrease bladder irritation.

* Limit High Oxalate Foods - May decrease amount of oxalate crystals in urine. Oxalate crystals cause urinary symptoms such as the urge to urinate frequently or suddenly.

* Baking Soda Soak- Soak in luke warm bath water with 4 to 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times a day for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons of baking soda.