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Expertise in Treating Vulvodynia and Vestibulodynia
Women with vestibulodynia - pain at the vaginal opening - see an average of four to seven providers before anyone gives them a correct diagnosis. That is not because their pain is mysterious. It's because most providers were never trained to examine the vestibule, identify what's wrong, and treat it.
If sex feels like you're hitting a wall, or touching the vaginal opening produces a burning, raw, or stinging sensation - that is a medical problem with medical solutions. It is not anxiety. It is not a need to "just relax." It is tissue that needs a proper diagnosis.
The vestibule is the tissue at the entrance to the vagina - the transition zone between outside and inside. Think of it the same way you'd think of the vestibule of a building: it's the entry point. This tissue is highly hormone-sensitive. It has receptors for both estrogen and testosterone, and it needs those hormones to stay healthy, resilient, and pain-free.
When hormone levels drop - from menopause, from using the birth control pill, from postpartum hormonal changes - the vestibular tissue can become thin, dry, and exquisitely sensitive. Even gentle touch triggers pain. This is physiology, not psychology.
From menopause, oral contraceptives, or postpartum changes. The vestibule requires both hormones to maintain normal tissue and sensitivity. Topical hormone therapy directly to the vestibule is highly effective.
Tight, overactive pelvic floor muscles create tenderness at the vaginal opening and can perpetuate pain even after the original cause is treated. Pelvic floor PT is essential when this is a factor.
The vestibular tissue of some patients has a significantly higher density of pain nerve fibers than normal - called neuroproliferation. This creates a hypersensitive response to light touch.
Lichen sclerosus, lichen planus, and contact dermatitis can all affect the vestibule and cause pain that mimics other causes. Accurate diagnosis requires careful examination - and sometimes biopsy.
Soaps, detergents, hygiene sprays, pads with fragrance, and even certain condom materials can chronically irritate vestibular tissue. Eliminating triggers is often the simplest and most overlooked step.
The right treatment depends entirely on identifying the actual cause. A careful vestibular examination - including a Q-tip test to precisely map where sensitivity is located and how severe it is - gives Dr. Toubi the information needed to build an effective, individualized plan.
Treatment options may include topical estrogen and testosterone directly to the vestibule, pelvic floor physical therapy, low-dose tricyclic antidepressants or gabapentinoids for neurogenic pain, nerve blocks, elimination of irritants, treatment of underlying skin conditions, and in carefully selected cases, vestibulectomy - a surgical procedure with strong evidence for refractory vestibulodynia.
A note on the birth control pill: Combined oral contraceptives suppress ovarian testosterone production and can cause vestibular atrophy and pain - even in young women. This connection is underrecognized and often not discussed. If your pain started after starting hormonal contraception, that history matters and should be part of your evaluation.
If you've been told to "just relax," referred back to therapy, or dismissed by providers who couldn't find an explanation - Dr. Toubi's Beverly Hills practice offers the specialist evaluation you deserve. One careful examination can provide more answers than years of dismissed symptoms.
Schedule an evaluationVulvar pain, medically known as vulvodynia, is characterized by persistent discomfort or pain in the vulvar area, which surrounds the vagina. Unlike infections or clear causes, vulvodynia doesn’t have a straightforward explanation and typically endures for three months or longer.
Living with vulvodynia can make even everyday activities, such as sitting for extended periods, a challenge. The discomfort may lead to avoidance of sexual intercourse, potentially causing self-consciousness, embarrassment, and even depression when experienced over an extended period.
Persistent pain in the vulvar area, not linked to an infection or another identifiable cause, often falls under conditions like Vulvodynia or Vestibulodynia. These conditions can profoundly impact daily activities, relationships, and emotional well-being. Dr. Toubi is here to provide a beacon of hope, clarity, and effective solutions.
Vulvar pain and soreness are the primary symptoms of vulvodynia. Patients often describe sensations such as:
The pain can either be constant or intermittent, sometimes becoming evident only upon touch. While some cases may exhibit mild swelling or inflammation, many vulvar pain sufferers have a vulva that appears entirely normal despite their discomfort.
Determining the cause of vulvar pain can be challenging. Several factors may contribute, including:
Dr. Toubi conducts a thorough medical history and pelvic examination, performing tests to look for infection, nerve disorders, inflammation, skin conditions, hormonal imbalances and pelvic floor dysfunction to identify the underlying cause of vulvar pain.
Her approach focuses on diagnosing and treating the root cause of the problem to help alleviate symptoms.
Some women find relief through specific topical medications, C02 laser, nerve blocks, vaginal botox or low intensity shockwave therapy.
In rare cases, in women with Neuroproliferative Vestibulodynia, a vestibulectomy can be curative.
Dr. Karen Toubi has a whole team of experts who work together to treat the cause of the pain.
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