There are two important sub diagnoses with pain. There is a pain syndrome where the birth control pill in particular is the cause. And this is where hormones are off. We measure hormones and all women with sexual pain problems. And if their testosterone values or free testosterone values or sex hormone binding globulin values or dihydrotestosterone values are off, we can provide hormonal support to these women. And more than 50% will become pain-free. So it's a fabulous medical management that is not often practiced in this country, and really helps people. The other side is women who have a condition called neuro [?], proliferative, meaning nerves are growing a vestibular [?] or pain in the opening to the vagina. This is a disorder of a cell called a mast cell, which releases a product called nerve growth factor and women who have this condition have thousands of nerves growing in the vestibule tissue. The only real solution is surgery. We have a procedure that we perform at Alvarado hospital, pretty regularly, that is called complete vestibulectomy. So we actually removed their vestibule and then we join the vagina to the vulva. So the track where a sexual activity will occur will not engage the tissue that has the thousands of nerves that aren't really wanted. So it's a fabulous opportunity to take a person that would otherwise always have pain all her life and give them about an 80% chance of being pain-free.
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