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What is dyspareunia?

July 9, 2018

Here’s something almost nobody wants to discuss – painful sex. Yes, this is a symptom otherwise known as dyspareunia. In fact, 3 out of 4 women will experience painful sex during some point in their lives. It may be temporary, or it may be a long-term problem. 

Why does dyspareunia happen?

According to the experts, dyspareunia is not its own health condition. It’s a symptom that occurs alongside something else. There can be many reasons why someone may experience painful sex.

They include:

  • Vaginismus

  • Vulvodynia

  • Inadequate lubrication

  • Postpartum dyspareunia

  • Vaginal atrophy

  • Endometriosis

  • Infections

  • Psychosexual causes

  • Interstitial cystitis

  • Pelvic adhesions

  • Retroverted uterus

  • Uterine myomas

  • Irritable bowel syndrome

  • Pelvic floor issues

  • & more

Risk Factors for dyspareunia

  • Young age

  • Education below a college/university degree

  • Urinary tract symptoms

  • Poor to fair health

  • Emotional distress

  • Stress

  • Decrease in household income

Where does dyspareunia happen?

Pain might be felt in the vulva, vaginal opening (known as the vestibule), within the vagina itself, or perineum. It can also be felt in the lower back, uterus, or bladder as well. 

Quick anatomy lesson (mostly because I love this image):

  • VULVA: Is the external genitalia, surrounding the opening to the vagina. It includes the prepuce, clitoris, urethral opening, vulval vestibule, labia majora, labia minora, and the vaginal opening. 

  • VULVAL VESTIBULE: part of the vulva between the labia minora into which the urethral opening and the vaginal opening open.

  • VAGINAL OPENING: Is the opening to the vaginal canal. 

  • PERINEUM: Not shown in this image, but it is the area between the vulva and anus. 

dyspareunia, vulva, toronto naturopath, naturopathic doctor, painful sex

Superficial or insertional dyspareunia

Sharp, burning or stinging pain at or near the vaginal opening, experienced on penetration. This can happen with vulvodynia, vaginismus, infections, and more! 

Deep dyspareunia

This pain is felt within the pelvis, and is associated with deep penetration into the vagina. It can be due to endometriosis, surgery, pelvic tumours or inflammatory diseases, and more. Certain sex positions may also elicit pain, especially if the penis makes contact with the cervix. 

Classification of dyspareunia

PRIMARY You’ve experienced pain the first time you’ve had sex and it has continued each time after.

SECONDARY: You’ve had sex before and it wasn’t painful. But you are now experiencing pain during sex. May be due to an underlying condition.

Naturopathic approach to dyspareunia

Because dyspareunia is a symptom and not a disease, Naturopathic Doctors will aim to discover the root cause of this symptom. This usually involves a:

  • Detailed health history

  • Examination – abdominal and vaginal

  • Blood work (if necessary)

NDs will create a treatment plan based on their findings. For example: if yeast infections are found to be the root cause, then that treatment plan will commence. This will be different if endometriosis is found to be the the reason why painful sex keeps happening.  

Final Thoughts

A woman’s mental and physical health can be negatively impacted by dyspareunia. Not to mention the effects on her body image, relationship with her partner and desire to conceive. It may lead to sexual dysfunction disorders down the line as well. If you are experiencing pain with sex, now is the time to find out why it’s happening, and work on getting this symptom to go away for good. If you’re looking for a holistic approach, consider working with a Naturopathic Doctor.  

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References

Seehusen D, Baird D, Bode D. Dyspareunia in Women. Am Fam Physician. 2014;90(7):465-470.

Cassis C, Mukhopadhyay S, Morris E. Dyspareunia: a difficult symptom in gynaecological practice. Obstetrics, Gynaecology & Reproductive Medicine. 2018;28(1):1-6. doi:10.1016/j.ogrm.2017.10.006.

Vulvodynia and Diet

June 25, 2018
vulvodynia and diet, toronto naturopath

Can there be a connection between what we eat and how we feel? Absolutely! Today, I’m talking about vulvodynia and its complex relationship with food. 

What is Vulvodynia

Vulvodynia refers to pain (burning, stinging, irritation, and rawness) at the vulva. The vulva is known as the external female genital area (and is often thought as the vagina). Vulvodynia is pain that lasts longer than 3 months, and is not caused by an infection, skin disorder, or other medical condition.

Vulvodynia is often seen in combination with two conditions: interstitial cystitis and irritable bowel syndrome. Because of this, I wanted to discuss which diets are often used in these conditions, how they may apply to vulvodynia, and why food sensitivity testing may be the best way to proceed. 

Interstitial Cystitis and Diet 

I’ll be writing a post on IC in the future, but generally it’s pain, discomfort, burning of some kind (in urethra, pelvis, or low back). It’s thought that a leaky gut may be a contributing factor to this condition. 

Leaky gut happens when there is damage to the gut lining, making it more permeable. It can be due to stress, certain medications, environmental toxins, nutritional deficiencies, microbiome dysbiosis, and food sensitivities. Permeability of the lining can lead to unwanted digestive system symptoms like gas, bloating, constipation, loose stools. Other symptoms like fatigue, mood changes, or rapid heart beat can also occur.

If you’ve followed my work for a while, then you know that I like focusing on food as medicine. We may not always be able to take supplements and get acupuncture, but we’re usually always able to eat. With IC, there have been specific foods known as potential triggers for this condition. Women often find relief by avoiding these foods. 

While this specific diet has not been studied in women with vulvodynia, it would be interesting to see if any relief is felt by avoiding these foods.  

Irritable Bowel Syndrome and the FODMAPs Diet

I’ve mentioned this particular diet on the blog before, especially as it’s being considered for the relief of digestive symptoms associated with endometriosis

A quick recap on IBS:

You may have IBS if you have recurrent abdominal pain on average at least one day/week in the last three months, associated with two or more of the following criteria:

  • related to defecation

  • associated with a change in frequency of stool

  • associated with a change in form (appearance) of stool

Studies have shown that a FODMAPs diet may be helpful in relieving symptoms associated with IBS. Similar to the IC diet, it would be interesting if women with vulvodynia experience similar relief. 

Vulvodynia and the Diet

Low Oxalate Diet

If you’re familiar with vulvodynia, you’ve probably heard about the low oxalate diet. Oxalates are organic acid found in plants, and bind minerals within the body. In some individuals oxalates may cause kidney stones, and has been proposed as a trigger for vulvodynia. Unfortunately there are only 2 studies looking at oxalates and vulvodynia. 

A 1991 study concluded that urinary oxalates may be nonspecific irritants that aggravate vulvodynia, but they are unsure if oxalates are the true instigators. And a 2008 study concluded that dietary oxalate consumption does not appear to be associated with an increased risk of vulvodynia. 

Elimination Diet

One case study looked at the elimination diet in the treatment of vulvodynia and found it to be helpful, as the woman noticed a relief of symptoms.

An elimination diet is when you avoid all foods containing allergens for at least 3 weeks (although it should be 4-6 weeks), and reintroduce foods one by one to see if they cause any distressing effects. 

When to consider Food Sensitivity Testing

As you can see, there are at least 4 diets on the table for vulvodynia. If you have this condition, and are looking to see if food can make a difference, you can certainly try each of these diets and see if they help. This may, however, take a couple of months with the avoidance and reintroduction periods. One of the benefits of doing this, is that you are able to experience the effects of a particular food. 

A faster way to determine which foods may not jive well with your system is through food sensitivity testing. This is an IgG test, which is a delayed reaction (in this case, to food). Collected via a blood draw, an IgG test can tell you how reactive you are to 120 or 200 foods and herbs. Once you have the results you can stay away from the ‘elevated’ foods, or you can test how exactly they affect you through a diet challenge (where you would consume a serving of food twice in a day, and wait 48 hours to see which symptoms present).

Next Steps

Whether you choose to go the diet or blood test route, having support is always helpful. Book an appointment with a Naturopathic Doctor who is well versed in pelvic health, so you can finally achieve relief! 

References

Baggish M, Sze E, Johnson R. Urinary Oxalate Excretion and Its Role in Vulvar Pain Syndrome. Obstet Gynecol Surv. 1998;53(2):80. doi:10.1097/00006254-199802000-00012.

Harlow BL et al. Influence of dietary oxalates on the risk of adult-onset vulvodynia. J Reprod Med. 2008;53(3):171-8.

Drummond J, Ford D, Daniel S, Meyerink T. Vulvodynia and Irritable Bowel Syndrome Treated With an Elimination Diet: A Case Report. Integrative Medicine. 2016;15(4):42-47.

Friedlander J, Shorter B, Moldwin R. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012;109(11):1584-1591. doi:10.1111/j.1464-410x.2011.10860.x.

What is a UTI?

June 4, 2018
UTI, urinary tract infection, naturopathic doctor toronto, toronto naturopath

If you’re not one of the 50% of women who has ever experienced a urinary tract infection, you get a high five! But if you are, this article is for you!

What is a UTI?

UTIs are bacterial infections of the urinary tract (not the vaginal tract, but I often include it as one because it’s still within the region). It can be classified in a variety of ways, depending on where the infection is presenting. For example, if it’s presenting in the bladder, it’s known as cystitis. 

What are symptoms of a UTI?

Symptoms of a UTI include:

  • painful urination

  • burning urination

  • urinary incontinence

  • urinary urgency

  • fever

  • pain in the lower abdominal area (around the pelvic bone)

  • pain in the ribs

Sometimes, a UTI may present without any symptoms at all. 

A simple dipstick test can indicate if white blood cells or nitrites are high, or you can get a more comprehensives urinalysis to determine if you do have a UTI.

How does a UTI happen? How does a UTI recur?

UTIs occur when a bacteria, normally present in the gastrointestinal tract, is exposed to the the urethra and urinary system. The pathogen will spread from the rectum to the vagina, and then make its way up the urinary tract. 

If you’ve experienced a UTI in the past, then you may be familiar with their recurrence. In fact 2-4% of women will frequently experience a UTI. UTI recurrence is especially prominent after treatment with antibiotics. 

Which bacteria causes UTIs?

The most common culprit is E.coli. However, other pathogenic bacteria include: Staphylococcus saprophyticus, Klebsiella, Proteus, Enterobacter spp, and Enterococci. 

What are the risk factors of a UTI?

  • Certain types of contraception like diaphragms and spermicides

  • Frequency of sex

  • New sexual partners

  • Recent use of systemic antibiotics

  • Estrogen deficiency

How to treat a UTI

Establishing a Healthy Microbiome

Because the primary treatment for UTIs are systemic antibiotics, it’s important to repopulate the gut, vagina, and urinary tract. Look for probiotics rich in Lactobacillus. 

Just as E. coli makes its way from the rectum to the urinary tract, probiotics will do the same. 

Acupuncture for UTI

Acupuncture may not be the first treatment you think of when you have a UTI, but can help – especially for chronic infections.

Herbs for UTI

If you asked anyone what the most common natural remedy for UTIs is, they’ll likely say cranberry. And they’re right! Cranberry is an herb that acts as an anti-adhesive, preventing the E. coli sticking on the tissue.

Other actions of herbs to look for are antimicrobials, and immunostimulants. 

Diet for UTI

Unfortunately, there isn’t any evidence in one diet being more effective than another. However, a few things to keep in mind: fermented dairy products could add beneficial probiotics to the body. In addition, because many people are aware that cranberry can be effective in treating UTIs, they should be mindful of the type of juice they are drinking, and the amount of sugar in juice (consider pure and unsweetened).

Hygiene Practices

  • Wiping front to back

  • Urinating after sex

  • Showering after sex

  • Wearing breathable underwear, avoiding thongs

  • Switching up contraceptive options

  • Stay hydrated throughout the day

Final Thoughts

The most important message here, is that you don’t need to live or suffer with chronic UTIs. Working with a Naturopathic Doctor can help you achieve this goal through simple changes and focused support. 

UTI