In the same edition of “The Obstetrician & Gynaecologist” (August 2011) a Scottish psychiatrist writes on “Medically Unexplained Gynaecological Symptoms” and cognitive behavioural therapy (CBT). Aside from the new, and unfortunate, acronym – MUS – he suggests that uterine, vaginal and vulval pain are examples of MUS – and – that they improve with CBT and antidepressants !
Readers of this website will be familiar with the view that both vulval and vaginal pain may result from injuries to pelvic nerves – not in all cases, but certainly in most cases. Suggesting that these symptoms may improve with CBT may not be well-received by sufferers. Adding an anti-depressant is another matter. We know that some psychiatric drugs have a positive effect on neuropathic symptoms though it is important to put this in the context of the causal aetiology (injured nerves), the interval since the injury (latent period) and the “autonomic condition” of the women (Is there stress, alcohol, tobacco, drugs that is contributing to the symptoms). Most cases are preventable. Once the nerves are out of their myelin sheaths and starting to proliferate then they require specific treatment tailored to the individual situation. Discussions of these matters are beyond contemporary textbooks.