Vulvodynia- The unspoken disease of millions of women

On August 7, 20/20's Medical Mysteries presented a segment on painful sexual intercourse moderated by Dr. Timothy Johnson, ABC's chief medical editor. Through the course of interviews with 2 medical exerts and 3 female patients Dr. Johnson presented the deleterious impact of vulvo-vaginal diseases on the lives of patients and their families. While some critics of the program complained that the medical conditions vulvodynia and vulvar vestibulitis were not identified and the sexual nature was emphasized to the exclusion of all of the other health problems these diseases cause, this was a major step forward for the television communications industry in recognizing female health issues. Many of these health problems which include vulvodynia, vestibulitis, and yes, even breast cancer are a source of shame and ignorance among women.
During the 1970-1980's I administered a vulvodynia clinic which I ran through my dermatology practice. In contrast to the literature approximately 80% of the patients were able to obtain some relief and less than 20% went into remission. Vulvodynia is a disease characterized by chronic burning and itching of the vulva and when it involves the opening of the vagina it is often called vaginal vestibulitis. Often these symptoms are not associated with easily observed clinical disease and patients seek doctor after doctor with increasing frustration and absence of improvement. While these symptoms are often attributed to subclincial disease, the release of immune mediators in the skin, and to neuroses, there are a number of conditions which can be identified as the cause of the disease and which are treatable. Among these are eczema, a chronic itching disease of skin; lichen planus, an autoimmune skin disease; lichen sclerosis, a potentially precancerous disease of the skin and mucosa; contact dermatitis, an irritant or allergic reaction to chemicals; yeast and fungal infections; vaginal discharge; precancerous and cancerous skin lesions; and senescent tissue atrophy from loss of estrogen. In addition chronic pain syndromes which include vulvar pain syndromes may be treatable.
After speaking with Dr. Mia Song, a gynecologist and my partner Dr. John Rachel's wife, I learned that this area of women's health is still woefully under served. For that reason I have resurrected a vulvodynia program within our practice at MetropolitanMD.
To learn more about vulvodynia go to our website at www.metropolitanmds.com and click on skin/dermatology/vulvodynia. You can view the 20/20 segment online at http://abcnews.go.com/2020. Under August 7th click on "Millions of Women Find Sex Unbearable". You may also go to the website for National Vulvodynia Association.

Smartlipo Breast Reduction

Breast reduction in women who are either "blessed" with excessively large breasts or have developed excessive breast enlargement with weight gain or pregnancy has traditionally been a difficult procedure with potential significant complications and always accompanied by large scars. By contrast breast reduction in men has been successfully treated with liposculpture since 1992 and has a long history of success and pleasing cosmetic results.
Smartlipo liposculpture introduced the use of laser energy under the skin in combination with traditional tumescent liposculpture techniques to further tighten the skin after liposculpture. As cosmetic surgeons gained proficiency in Smartlipo they also gained confidence in the procedure and it was logical that Smartlipo liposculpture would be used on males with enlarged breasts. Not unexpectedly, men who underwent the procedure tended to have quicker recoveries and subjectively smoother skin.
A Dutch dermatologic surgeon, Luke Habeema, should be credited with popularizing the liposculpture technique in women with large breasts, although many surgeons subsequently added their positive experiences. It was therefore logical that Smartlipo liposculpture would be added to the procedure in women with the anticipation of less scarring, quicker recovery, and better skin contraction. This has generally proved to be the case.
The advantages of Smartlipo liposculpture are that it is usually performed with the patient awake, does not involve any cutting or suturing, does not leave any large scars, and is less expensive than traditional breast excisions. Patients do have to wear a sports bra for 1-3 months and all patients have noted breast firmness and tenderness for up to 3 months which did not interfere with their daily activity. Bruising has been more prevalent than on the rest of the body but it generally disappears within 4 weeks. While the breasts will rise after the procedure the one drawback is that nipple position and direction is not elevated and patients must accept that before agreeing to have the procedure.
To date patient satisfaction has been very high and cosmetic surgeons and patients alike are very pleased with the cosmetic results. You may go to our website at www.metropolitanmds.com and click on breasts/smartlipo breast reduction to view before and after pictures and male and female patients.
This is a good example where advances in technology can combine with previous experience to further the art and science of minimally invasive surgery.

I watched the President's speech and I am co-dependent

I watched President Obama’s speech last night and I found myself filled with anger. I dreamt about the speech and I awoke with anger. I watched bobble-head Nancy and I was angry. I watched the Republicans sit on their hands or wave their sheaf of papers in derision and I was filled with anger. I heard the Congressman from South Carolina shout at the President and call him a liar during his speech and I was filled with anger. And I saw the broad self-congratulatory smiles of the Democrats and I was filled with anger. As each individual aggrandized his own position I expressed derision.
This morning I asked myself to calm down and remove my anger so I could respond rationally. And almost immediately I realized that once again I am feeling co-dependent. Co-dependency occurs when an individual needs another person to complete himself. In the attempt for completion the individual must control the behavior of another to complete his self. In other words, if the “other” does what he wants and not what the co-dependent wants, the co-dependent individual is not complete because the other person is not conforming to the picture of the part of the co-dependent that the “other” is supposed to fill.
So, I am co-dependent with regard to Congress and the Senate. These people’s behavior simply does not conform to my view of how the world should be, how a government should govern, how a leader should lead. To me these people do not have integrity, are self serving, and do not engage in compromise for the good of the people. Did you notice bobble-head Nancy did not pop up and applaud when the President mentioned tort reform? That is because she and her friends are profiting from the laws she is writing. And that makes me mad. And I am co-dependent because I need bobble-head Nancy to believe as I do and vote as I wish her to do.
Maybe, just maybe, that is why the nation is angry. Maybe we are all co-dependent and so are our elected leaders. Maybe that is why we shout rather than talk, wave our fist rather than hug, respond before we hear what the other person has to say. I have been co-dependent all of my life. Still, I am going to recognize that I am responding with anger and intentionally put my anger aside. I am going to put my anger aside and respond to the obvious distortions of our leadership with more rational thoughts. I will recognize that when Sara Palin spews her vicious form of bigotry and hatred and spreads outright lies like we are promoting death camps for old people that I cannot control her behavior and I do not need her to complete me. I will continue to express my opinion and it will be my opinion.
I will also fall off the wagon. Fortunately I have an endearing wife who will coach me and maybe I will re-read this blog to remind myself that I can be part of the problem.