DEAR DR. DONOHUE: For the past nine months I have had vaginal discomfort with itching and pain on intercourse. On a scale of one to 10, the pain is a 10. At first I treated with over-the-counter meds for yeast infection. Then I saw a gynecologist. He advised Replens Moisturizer. It gave slight improvement. The doctor said the only other treatment was hormone replacement. I have been on estrogen/progesterone tablets for two weeks without any change. What advice can you give? — C.C.

DEAR DR. DONOHUE: How much longer will women have to deal with no adequate explanation for vulvar problems? Please tell women about vulvodynia (VUL-voh-DIN-ee-uh). The National Vulvodynia Association is a source of assistance at www.nva.org or 301-299-0775. — N.S.

ANSWER: These two letters arrived in the same batch of mail. I read C.C.’s first and considered vulvodynia. Then I read the one from N.S., and I thought I should combine them.

Vulvodynia is pain of the vulva, the external genitalia (the labia, the clitoris and the entrance to the vagina). The pain is described as burning or stinging. Itching might be prominent. Intercourse can be agonizing or impossible.

Other conditions have to be considered. The candida yeast infection is on the list, as is infection with trichomonas. Nerve damage, hormonal disturbances, cancers and disorders like lichen sclerosus have to be thought of. If none of these is found, then vulvodynia becomes a reasonable diagnosis. Its cause hasn’t been determined.

Afflicted women should not wear pantyhose. Cotton underwear is preferable. They must avoid tight jeans and scented soaps. Dietary changes are sometimes helpful. Avoid alcohol, citrus fruits, tomatoes, chocolate, caffeine, spices and artificial sweeteners. Lidocaine cream, a numbing agent, can bring relief. Amitriptyline often is used in conjunction with it. Desipramine can be substituted for amitriptyline. Nerve blocks have worked.

C.C. should find a gynecologist experienced in this affliction, and she should contact the NVA, as N.S. suggests.

DEAR DR. DONOHUE: Twenty years ago, I had X-rays that showed a spot on my lung, which resulted in a thoracotomy (surgical exploration of the chest and lungs). It turned out to be a fungus.

Now when I have an X-ray, the doctor’s report states that I have COPD. I have had lung tests that show I do not have COPD. One doctor in a different state, when told I had had a fungus of the lung, said, “You must be from the Midwest.” I am. I have never heard of anyone else with a lung fungus. Is it rare? — L.S.

ANSWER: Fungal lung infections are not rare. In the Ohio and Mississippi valleys, the fungal illness called histoplasmosis is quite common. Most infected people have no symptoms. It can, on the rare occasion, cause a serious illness. Blastomycosis is another example of a fungal lung infection in the same region.

In parts of the Southwest, coccidioidomycosis is a very common fungal lung infection.

You are right about chronic obstructive pulmonary disease, COPD, which includes emphysema and chronic bronchitis. The principal sign of emphysema is severe shortness of breath when attempting even slight exertion. The principal sign of chronic bronchitis is a persisting cough productive of yellowish sputum.

Breathing tests trump X-rays when it comes to making the diagnosis of COPD.

DEAR DR. DONOHUE: Is sleep before midnight the best? Or doesn’t that old wives’ tale really mean anything? My mother insists that it is true. Please set the record straight. — P.P.

ANSWER: To tell you the truth, I had never heard that before. I don’t know if it’s an old wives’ tale or an old husbands’ tale.

I do know that the deep stages of sleep slightly predominate in the first third of the night, but not to the degree that this time of sleep provides more refreshment than the other two-thirds.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

Copy the Story Link