Vulvovaginal Disorders Program

The Vulvovaginal Disorders Program at Massachusetts General Hospital provides comprehensive evaluation and treatment for women with vulvar and vaginal complaints, including pain, infection and irritation.

Overview

There are more than 10 million doctor's office visits in the United States each year for vulvar and vaginal complaints, but many women who suffer from vulvar or vaginal symptoms feel uncertain of their diagnosis or treatment options. The goal of the Vulvovaginal Disorders Program at Massachusetts General Hospital is to provide women expert diagnostic care and find relief.

Vulvovaginal symptoms can be due to a straightforward cause, such as a yeast infection, or may have no easily identifiable source. Even symptoms due to an infection that is diagnosed may not be easily treated. In the face of these challenges, patients and primary care providers may feel frustrated about pursuing treatment options for vulvovaginal symptoms.

Our program is dedicated to a systematic approach to diagnosis and treatment. We methodically evaluate patients for possible causes of symptoms, provide an individualized treatment program, and follow patients throughout the continuum of care to assess treatment success and changes as necessary.

Learn more: About the Vulvovaginal Disorders Program

Comprehensive Evaluation

A consultation in our clinic involves a thorough assessment of a patient's symptoms, previous treatments and medical history, as well as a detailed physical examination. After the initial visit, ongoing evaluation is often necessary to confirm or refine a diagnosis. We are committed to finding the right treatment for each individual.

In cases where a diagnosis or treatment plan is not easily determined, we consult with a multidisciplinary team of experts including dermatologists, allergy and infectious disease specialists, reproductive endocrinologists, neurologists and pelvic floor specialists to help determine the best course of management.

Learn more about how you can prepare for your vulvovaginal appointment.

We are now offering fractional laser treatment to treat postmenopausal vaginal discomfort, including dryness and pain with sex and some cases of lichen sclerosis. Read the laser treatment frequently asked questions to learn more about this treatment.

Our Team

Our core team includes obstetrician and gynecologist Caroline Mitchell, MD, MPH, and nurse practitioner Alisa Pascale, DNP, WHNP-BC, with more than 20 years of combined experience in treating vulvovaginal disorders. We also work closely with dermatologist Maryanne Senna, MD. Our clinical staff are committed to creating a safe and welcoming environment for patients.

Research to Improve Clinical Care

Patients in the Vulvovaginal Disorders Program have the opportunity to participate in research that will improve our understanding of the causes of vulvovaginal symptoms and may lead to new diagnostic tools or treatments for vulvovaginal disorders.

Learn more about Dr. Mitchell's research on bacterial vaginosis and its causes.

Appointment Preparation

We understand how anxious many people feel about coming to the gynecologist, especially if you have had multiple visits and exams recently.  We do our best to put our patients at ease and to make the experience as low-stress as possible. It can often be helpful to do some preparation before appointment so that you will get the most out of it.

What to Expect at Your Appointment

Your provider will take a history of your symptoms and previous treatments and will review your medical history form to be sure that we have a complete picture of your health. Your provider will then do a thorough exam, focusing primarily on the genitourinary system.  This exam includes:

  • A careful inspection of the skin and external anatomy
  • A speculum exam with collection of swabs for lab testing
  • An internal exam to evaluate the pelvic muscles and internal structures

After this is complete, your provider will discuss the exam findings, assessment of your clinical situation and, if relevant, possible treatment options.

What to Bring with You

  • Completed health history form: this form should be mailed to you ahead of time, or you can download the form here.
  • Your medical records: any records of prior testing, biopsies, cultures, ultrasounds or other relevant evaluations to help us understand what has been done before. We find that it is easiest if you get these from your previous providers and bring hard copies to the first appointment.  
  • List of treatments: any medications, supplements, ointments, creams or treatments that you are currently using for your symptoms.
  • A list of questions about your condition: We may not be able to answer them all, but it can be helpful to come prepared. It can sometimes be hard to remember everything in the moment, so writing down a list ahead of time can be helpful.

General Vulvar Care

Vulvar skin can be quite sensitive. It can react to products that you tolerate well in other parts of the body, and products you have used for years may suddenly cause irritation. In addition, once the vulva is irritated, a cycle of itching and scratching can develop that leads to more irritation and more itching.

When caring for the vulva, less is more: less clothes, fewer products, less washing and less scratching will all help the skin heal and stop the cycle of irritation. The list below explains some things you can do to support vulvar health and some things you should avoid.

Do:

  • Wear cotton underwear – or no underwear when possible
  • Use petroleum jelly (like Vaseline®), olive oil or coconut oil on your vulvar skin daily to keep it hydrated and to create a protective barrier
  • Avoid using scented laundry detergents or fabric softeners for clothes that touch vulvar skin
  • Take a sitz bath (sitting in a few inches of lukewarm water) once or twice a day to soothe the area
  • Apply ice or cool compresses to soothe the area
  • Sleep with gloves or socks on your hands if you scratch in your sleep – scratching causes irritation and more itching
  • Use tampons when possible – constant contact with a pad can cause more irritation. If you have to use pads, avoid Always® brand
  • Use a lubricant to make sex more comfortable – there are may options on the market, but patients have recommended Astroglide®, Slippery Stuff®, Yes™, Good Clean Love or simple coconut oil. Remember, however, that oils should not be used with condoms

Soak and Seal

Often we will recommend doing “soak and seal” a few times a day to keep the skin hydrated and protected:

  1. Get the area moist – either in the shower, by sitting in a lukewarm sitz bath or using a cool compress.
  2. Apply something to trap the moisture in – you can use Vaseline®, coconut oil or Aquaphor®. 
  3. Do this as many times a day as needed.

Do Not:

  • Wash the vulva. If you feel like you need to wash the vulvar area, do not scrub
  • Use feminine wipes, powders, creams or other over-the-counter products (even those that say they are meant for the vulva)
  • Use a douche
  • Apply tea tree oil, witch hazel, Gold Bond® Medicated Powder, Epsom salts or other “cleansing” products – these can irritate the skin further
  • Use over-the-counter yeast treatments without talking to your provider – many of these can be irritating to the vulva and may not treat the underlying condition

Laser Treatment FAQ

Use of a fractional laser to treat vaginal complaints is an emerging technology in gynecology. We have recently begun offering this treatment to appropriate patients because we think the treatment may be able to help some women who don’t tolerate other therapies.

However, there are few high quality studies to tell us how effective this treatment is, so we recommend that women try other treatments first. But please note, this is not vaginal rejuvenation.

What is fractional vaginal laser treatment?

The laser we use are the same as those used by dermatologists on the face and body to treat scars, discoloration and other skin conditions.

The vaginal laser creates tiny holes in the vaginal lining to stimulate your body’s natural repair functions and make the vaginal lining thicker. The treatment is called “fractional” because the holes are made in only a small fraction of your total vaginal lining.

How well does it work?

Only one randomized study has compared laser treatment to vaginal estrogen cream. Results from this study showed similar effects from both treatments on vaginal dryness and pain with sex.

Other studies have been conducted without a comparison group. They showed improvement in symptoms for 80-90% of women treated with laser.  However, this could be due to a “placebo effect,” where believing that things will get better works as well as the actual treatment.

Why does Mass General offer this treatment?

We believe that there is evidence the laser may provide symptom improvement for women who can’t or don’t want to use estrogen to treat menopausal vaginal symptoms.

Are there risks associated with the treatment?

The treatment may not work, and you may not have any improvement in your symptoms.

Your symptoms may worsen after laser treatment, but this is rare.

Any time a laser is used, there is a risk of burns or damage to the skin or eyes. For this reason, eye protection must be worn during the laser treatment.

What about the FDA warning?

An FDA statement in July 2018 expressed concern about inaccurate marketing statements for multiple devices from multiple companies, including the device we use here at Mass General.

Laser and radio frequency devices being marketed for “vaginal rejuvenation” are used by many different types of providers, including non-medical personnel. However, we feel that in the hands of a gynecologist and used for treatment of specific vaginal and vulvar symptoms along balanced and complete counseling about treatment options, laser treatment is still a reasonable and safe option for our patients.

Is it covered by insurance?

Currently, this procedure is not covered by insurance and must be paid out-of-pocket. Payment for the treatment will be collected at the beginning of each visit. The current standard is to start with three treatments, each six weeks apart.

In addition, several experts recommend getting an additional treatment each year.

Resources

Frequently Asked Questions

Vulvovaginal specialists Caroline Mitchell, MD, MPH, and nurse practitioner Alisa Pascale, DNP, WHNP-BC, answer some common questions about the diagnosis and treatment of some common vaginal problems.

Videos

Other Websites

Contact

Vulvovaginal Disorders Program

Yawkey Center for Outpatient Care
55 Fruit Street, Suite 4E
Boston, MA 02115
Phone: 617-724-6850

Please note: We require a referral from your gynecologist or primary care provider for the initial appointment. 

Our clinic currently has a waiting list, so it may take up to six months to get your initial appointment. If you have not already seen a gynecologist, we encourage you to work with your provider or see one of the providers in our General Gynecology Program, who can also provide evaluation and treatment for vaginal and vulvar problems.

Request a New Patient Appointment

If you have not previously seen a doctor within the Partners HealthCare network, please call the Mass General Registration & Referral Center at 866-211-6588 to register as a patient.

Once you have registered, please call 617-724-6850 to request a new patient appointment with the Vulvovaginal Disorders Program. If you see a primary care provider (PCP) at Mass General, you may instead ask your PCP to submit a referral through the CRMS program.

Our new patient coordinator will call you back to schedule the appointment, and will send you our initial questionnaire to complete before your first appointment. Clinic sessions are held on Tuesdays and Wednesday afternoons.

Refer a Patient

Health care providers may refer a patient to the program by calling 617-724-6850 or faxing a referral to 671-724-4707.

Providers within Mass General may submit a referral through CRMS.

Conditions & Diseases

The Vulvovaginal Disorders Program at Massachusetts General Hospital treats the following conditions.

  • Candidiasis (Yeast Infection)

    Candidiasis, sometimes called moniliasis or a yeast infection, is an infection caused by yeast on the skin and/or mucous membranes.

  • Cervicitis

    A painful irritation of the cervix, cervicitis often lasts several months or longer, sometimes occurring after childbirth or use of oral contraceptives.

  • Vaginitis

    Vaginitis refers to any inflammation or infection of the vagina.

  • Vulvitis

    Vulvitis is simply an inflammation of the vulva, the soft folds of skin outside the vagina.

  • Vulvovaginal Atrophy

    Vulvovaginal atrophy refers to a condition when a woman develops pain, dryness, itching and irritation of the vagina and vulva caused by low estrogen levels, usually as a result of menopause.

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