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This is adapted from an interview with Dr. Howard Glazer, who has developed a treatment for this condition using a form of biofeedback. This initial interview, covers the history of the disease, as well as Dr. Glazer's background. The subsequent sections will cover treatment, results, and follow-up information.
Dr. Mark Smith: "Dr. Glazer, why don't you give us a general history of vulvodynia, then kind of lead into how you got involved in it."
Dr. Howard Glazer: "The diagnosis of dyspareunia does not, in fact, appear in historical medical literature, which is very interesting. If you look at the pain literature and the definitions of all of the sources of pain, dyspareunia is absent and appears only in psychiatric literature. Therein lies the history of the ignorance of the disease because if doctors cannot identify growths - anatomical or physiological pathology, infectious diseases, dermatoses, neurological, or whatever - then these disorders are labeled as functional.
When you're dealing with women's genitals and women who do not by appearance or diagnosis have anything wrong with them, of course, the conclusions are often psychological in origin, and I think the literature has shown that. One of the interesting quotes was from the 1950's essentially suggested that these women are all 'frigid.' Now, we're talking about pretty recent history - 40 or 50 years ago, not thousands of years ago. So I think the gynecology literature has basically ignored these conditions as psychologic in etiology. Of course, we now know that they are very much not, although there are psychological mediating factors that we can talk about.
It wasn't until the formation of the International Society for the Study of Vulvovaginal Diseases (ISSVD) - formed not that long ago, I guess, in the 1970s, by a specialty group of dermatologists, gynecologists, and pathologists who study vulvas - that people began taking this condition seriously and the medical community started studying it. So only in the past 20 to 25 years has it been seriously looked at from the dermatological, infectious diseases, pain kind of perspective. In the past ten years, we've been looking at the role played by pelvic floor muscle dysfunction and broadened out our perspective with respect to medications.
Dr. Mark Smith: "Interesting."
Dr. Howard Glazer: "Given the overlap in incidence of occurrence between these conditions and other inflammatory disorders, including irritable bowel syndrome, interstitial cystitis, fibromyalgia, and other mucous membrane inflammation disorders, I think this is a spectacularly important finding which should lead to something. It looks like inflammation is a tremendously important central element in these conditions. That kind of brings you up to date on the conditions, in a broad picture."
Dr. Mark Smith: "Could you tell us how you got involved in this?"
Dr. Howard Glazer: "Sure. I have a Ph.D. in neurophysiology and a Ph.D. in clinical psychology. My original doctoral work was done in neurophysiology and neurochemistry, and then I moved into behavioral medicine with an emphasis on sex therapy, so it kind of all comes together with respect to pelvic floor muscle dysfunction. About twenty years ago I started doing surface electromyography of the pelvic floor, mostly related to gastroenterological disorders and to urologic disorders of incontinence and retention, some interstitial cystitis, functional constipation, and things like that. This leads to some very interesting stuff, relating to how a psychologist comes into this field to begin with, which may seem strange.
Pelvic floor muscle surface electromyography is a form of biofeedback. Biofeedback has its origins in learning theory and neurophysiology of learning theory. It was first used in the laboratory to try to determine whether or not different branches of the nervous system were subject to different kinds of learning, namely Pavlovian versus instrumental learning. This technology was seen as a way of studying whether animals could be trained to directly control visceral responses such as blood vessels and things like that, then to see whether they could also do so as a result of the administration of rewards and punishments. So learning how to increase or decrease blood flow, gut activity, or bladder activity so the muscles can be controlled as much as striate muscles can/would presumably prove that there was only one kind of learning process. It was what we call instrumental learning, and not Pavlovian conditioning, so that was the birth of biofeedback.
I have been in the field of biofeedback and electromyography since the late sixties and early seventies, and I started out with pelvic floor muscle dysfunctions and sphincteric related stuff. In 1980, I had started looking at the treatment of vulvovaginal pain conditions. Then the Columbia College of Physician and Surgeons asked if I would have a look at some women with respect to their pelvic floor muscles, since they had noticed on intravaginal palpation that they all seemed to have tight levators and that this might be related to it. They had asked around to see who in the area specialized in pelvic floor muscle dysfunction and were in turn referred to me, and that's kind of how I got into the field."
