Sex Possibly Linked
to Pill in Some Women
NEW YORK (Reuters Health) - Women with vulvar vestibulitis, a
condition marked by painful intercourse, are more likely than
other women to have taken birth control pills for long periods
of time and to use those with a particular composition of hormones,
according to Quebec researchers.
The findings do not prove that oral contraceptives cause the
condition, but suggest an avenue of further research. Dr. Celine
Bouchard of the Hospital du Saint-Sacrement in Quebec told Reuters
Health that physicians should not discourage women from taking
oral contraceptives (OC).
"Until our results are validated by another similar study with
a larger cohort of patients, I would be reluctant to suggest to
physicians to inform young girls about this association. OCs prescribed
to girls under the age of 16 is still the best method of contraception
to prevent undesired pregnancies," she said.
"If a young girl is being prescribed OCs for non-contraceptive
benefits, I would suggest that this entity should be addressed,"
The authors found that women with vulvar vestibulitis were much
less likely (4% vs. 17%) to have never taken the pill than their
pain-free peers. Furthermore, women who had used oral contraceptives
were almost 7 times as likely as those who hadn't to develop vulvar
vestibulitis, and the risk increased to more than nine-fold in
women who started using the pill before the age of 16. Chances
of developing vulvar vestibulitis increased further in women who
used the pill for up to 2 to 4 years.
Bouchard and her team interviewed 138 women with vulvar vestibulitis
about their use of birth control pills before being diagnosed,
along with 309 women without the condition.
Women with vulvar vestibulitis feel pain in the tissue surrounding
the opening of the vagina during intercourse, or when the tissue
is touched. The condition most commonly affects young women.
Not surprisingly, vulvar vestibulitis can have a significant
impact on a patient's ability to have intercourse. Treatment of
the condition is only rarely successful, and women may undergo
surgery to remove the sensitive tissue from the opening of their
vaginas in order to have sex without pain.
Researchers remain equally puzzled over the cause of vulvar
vestibulitis. Although some initial investigators suggested the
condition might be psychosomatic, more recent theorists have proposed
that the pain develops from multiple physical instigators, possibly
from chronic yeast infections, an altered pH balance in the vagina,
or the use of irritating creams.
However, say Bouchard and her colleagues, previous investigations
into the cause of vulvar vestibulitis have included small numbers
of women, and no later studies have found the same results. Recently,
they and others have proposed that oral contraceptives might play
a role in the onset of the condition, and one study found that
women with vulvar vestibulitis used oral contraceptives for longer
periods than those who were pain-free.
In the new study, a particular type of oral contraceptive was
linked to a higher risk of developing the condition, Bouchard
and her team note in the recent issue of the American Journal
More specifically, pills that contained higher amounts of the
sex hormones androgen and progestin and a low amount of estrogen
were more likely than other pills to be linked to vulvar vestibulitis.
In an interview with Reuters Health, Bouchard explained that
she and her team suspect that oral contraceptives may act on receptors
present in the vulvar tissues, causing the tissues to become more
sensitive to irritating chemicals. Eventually, the tissues may
become painful to touch, she noted.
Bouchard emphasized that the pill is not associated with all
cases of vulvar vestibulitis--some women with the condition report
never having used oral contraceptives.
Nevertheless, the findings from the present study suggest that
in some cases, the link exists.
"We are very confident that there is a link between OCs and
the development of vulvar vestibulitis," she said.
"This is a major public health problem since a large percentage
of women uses OCs for some time in their life," Bouchard added.
SOURCE: American Journal of Epidemiology 2002;156:254-261.
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