How To Get Help For Sexual Dysfunction and Multiple Sclerosis (MS)

7/2/2014

Here is My Question:
IV steroids made my vagina hurt A LOT. It has been almost a month and the pain is not going away, in fact it is worse since my period ended. I have seen a gynecologist and I do not have an infection, UTI or yeast overgrowth. My neurologist thought that I got an infection from my immune system being suppressed but also mentioned that steroids affect hormone levels. How do I go about pursuing this possibility? Do I get my hormone levels tested? Is there a course of therapy neurologists use for women who take IV steroids and then experience this side effect? How do I level things out again?

Answer:
All solutions in medicine revolve around a good history and exam by an individual with experience. You need to see a gynecologist who specialized in sexual dysfunction. Your question as stated provides insufficient information to arrive at a diagnosis. There are many possible reasons for the vaginal pain and it may not be related to the steroids at all. Keep an open mind and get several opinions. It is doubtful that a neurologist will be the doctor who discovers the cause and the solution.
Good luck

Rip Kinkel, MD

Emily Royce

7/2/2014 11:31:20 am

I was trying to keep the question simple, but here is the background: I have vulvodynia and have for years. I have seen the best specialists in the state. I have tried all conventional therapies for this and most recently am doing pelvic floor massage with a world renowned PT. This was progressively alleviating my pain. Then I got the IV steroids and the pain skyrocketed on the 4th day of the steroids. I tried to get pelvic floor massage that week but the pain was too great to tolerate it. It has been a month since I have had massage now, again because the pain is too great. I recognize that a neurologist will not be able to diagnose this but a gynecologist was not able too either. I am looking for the occurrence of this happening with IV steroids and what the steroids POTENTIALLY do, with hormones or otherwise, that could cause this pain so that I know better how to pursue this with the next doctor. Could you explain how steroids affect the body's hormones so that I have more knowledge around this? I know that hormone levels affect my ups and downs with vulvodynia, which is further why I think that might be the link here. I have experienced sexual dysfunction with ms, where my nerves feel deadened or, on the flip side, too sensitive to the touch, but this is not that. Could steroids cause something like that? Again, I keep coming back to the steroids because that is when this symptom flared up, on the fourth day right when the migraine hit (my migraines are affected by hormone fluctuations as well.)

Dr Kinkel

7/3/2014 09:31:16 am

Now you got me stumped so allow me to speculate. First, let me tell you that I did an extensive search on pelvic pain and corticosteroid therapy and found nothing. This would also be consistent with my experience until hearing of your problem. I certainly have seen many woman develop temporary menstrual irregularities with short term corticosteroid treatment. This is usually explained by a temporary inhibition of gonadotropin hormone release by the high dose steroids. However, this should not cause pelvic pain unless your vulvadynia was highly responsive to sex hormones. If this were the case, oral contraceptives may prevent this problem during future corticosteroid treatments.
Another possibility is fluid retention and swelling in the pelvic floor region. This could conceivably increase your discomfort. Similarly an infection (vaginitis or yeast infection) could be caused by steroids and increase discomfort. Lastly, you could have another process worsening your pelvic pain such as tendonitis or strain of one of the pelvic floor muscles. Other problems are possible but if the pain eventually disappears, I suspect the problem was temporary inhibition of gonadotropin release by the pituitary or fluid retention and edema in pelvic floor structures which in turn increased your pain. An irregular menstrual cycle following the steroid treatment would favor the former explanation. I hope this helps

7/4/2014 01:26:01 am

Thank you for speculating- this does help! I did the same search and came up with nothing. But searching for gonadotropin's affect on vulvodynia yields quite a bit. In fact, it is used as a treatment for pain. Since my menstrual cycle was highly irregular after the steroids, and my pain has been particularly dependent on progesterone levels in the past, I think it is likely this has at least something to do with the pain. Will the hormone levels even out on their own? About how long does this take? Lastly, the muscular pain point you raised got me wondering. I still can't do my regular yoga routine and strength training because any body movement leaves me feeling sore and bruised all over for days. I read this can happen with steroids (but do not know why.) it is possible that all the stretching I do (runner's stretch, butterfly, resting in a deep squat or "crow pose" for example) could actually be making my pelvic floor muscles sore just like it is the rest of my body?

7/7/2014 10:01:43 am

Normal menstrual cycles usually return within 1 to 3 months; so I assume this is duration of effect on gonadotropin secretion. Corticosteroids may infrequently create muscle pain or myalgias especially during the taper. This usually goes away within a week. Hope this helps

7/8/2014 10:24:28 am

What causes the muscle pain? As with most side effects, mine are lasting longer than the typical range! I have stopped my stretching and strengthening routine the last three days and the vaginal pain is still heightened but better, so I think muscle aggravation has something to do with it. Is it best to continue to just rest until the muscle stuff resolves itself or is there something else I could be doing? I don't like that I am getting stiffer and weaker post steroids but can continue to lay low to let my body recuperate if that is what it needs.

7/11/2014 06:26:29 am

It is always best to heed the advice being provided to you by your body and do not force yourself too much if this is causing further pain. The pain is likely related to the delayed catabolic effect of steroids on muscle. This doesn't occur in everyone but is likely to be more pronounced if there is an underlying muscle problem. See the following article:
http://ajs.sagepub.com/Medicine
The American Journal of Sports
http://ajs.sagepub.com/content/27/1/2
The online version of this article can be found at:
1999 27: 2
Am J Sports Med
John M. Beiner, Peter Jokl, Jacek Cholewicki and Manohar M. Panjabi

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