eventually reabsorbs the sperm. Vasectomy does
not alter a man’s sexual desire or erectile function
(ability to have an ERECTION). The ejaculate con-
tains about the same amount of SEMENas before
vasectomy; the semen does not contain sperm,
which slightly reduces its volume. There is a very
slight risk for spontaneous reanastomosis (recon-
nection of the cut ends of the vas deferens) that
can result in unexpected FERTILITY. Surgery to
reverse vasectomy is sometimes possible to restore
fertility, though multiple variables affect its suc-
cess. Men should consider the loss of fertility with
vasectomy to be permanent. Vasectomy does not
provide protection against infection with SEXUALLY
TRANSMITTED DISEASES(STDS) orHIV/AIDS.
See also FAMILY PLANNING; SEXUALLY TRANSMITTED
DISEASE(STD) PREVENTION; SURGERY BENEFIT AND RISK
ASSESSMENT; TUBAL LIGATION.
VBAC Vaginal birth after CESAREAN SECTION. In
cesarean section, the obstetrician makes a surgical
incision through the wall of the UTERUSto deliver
the baby, then sutures (stitches) the incision
closed. The SCARthat forms when the surgical
wound heals is somewhat weaker than the sur-
rounding MUSCLEof the uterus. When the incision
is low and horizontal (transverse) in the uterus
this slight weakness has little consequence. If the
uterine incision runs vertically, however, there is
an increased risk that the wall of the uterus could
rupture along the scar during the intense contrac-
tions of labor and delivery. Uterine rupture is life
threatening for the woman and the baby.
The obstetrician attempts to assess the likeli-
hood of uterine rupture as the woman’s PREGNANCY
becomes advanced. The risk for uterine rupture is
high enough with a vertical uterine scar that most
obstetricians strongly discourage the woman from
attempting vaginal delivery with subsequent preg-
nancies. If the obstetrician believes the risk for
uterine rupture is low, which is usually the case
with the low horizontal scar, VBAC is of little
additional risk for the woman. Other factors that
may influence the decision between a woman and
her obstetrician about VBAC include the reason
for the previous cesarean section and the woman’s
overall health status in her current pregnancy.
About half of women who have cesarean deliver-
ies are able to have vaginal deliveries in subse-
quent pregnancies.
See also CHILDBIRTH; PRENATAL CARE.vulva See GENITALIA.vulvodynia Chronic and sometimes severe vul-
var PAIN a woman experiences. Though many
women who have vulvodynia have had chronic or
recurrent VAGINITIS(vaginal INFECTION), the connec-
tion between vaginitis and vulvodynia is unclear
and only a small percentage of women who have
vaginitis develop vulvodynia. There are few other
discernible circumstances that could account for
the symptoms of vulvodynia; doctors most often
consider vulvodynia a CHRONIC PAINsyndrome.
The symptoms of vulvodynia often come on
suddenly and may include- intense burning, stinging, or itching of the
vulva (labia, CLITORIS, and opening to the
VAGINA) - discomfort and soreness when sitting or walking
- PAINduring SEXUAL INTERCOURSE(dyspareunia)
The diagnostic path includes a thorough PELVIC
EXAMINATIONwith cultures for yeast INFECTION(CAN-
DIDIASIS) and SEXUALLY TRANSMITTED DISEASES(STDS)
such as GONORRHEAand CHLAMYDIA. In vulvodynia,
such test results are negative and the pelvic exam-
ination is normal. Treatment options include med-
ications such as ANTIHISTAMINE MEDICATIONS, which
lessen itching, and tricyclic ANTIDEPRESSANT MEDICA-
TIONS, which act to block NERVEimpulses related to
pain. Other medications sometimes helpful for the
pain of vulvodynia include certain antiseizure
medications and topical CORTICOSTEROID MEDICA-
TIONS. Other methods of pain relief that some
women find helpful include cold compresses to
the vulva, BIOFEEDBACK, ACUPUNCTURE.
Vulvodynia may persist for several months;
rarely, symptoms may continue for more than a
year. Eliminating any underlying causes for symp-
toms generally speeds recovery from vulvodynia
as well. Relaxation techniques and compassionate
communication between the woman and her sex-
ual partner help with the emotional and sexual
aspects of vulvodynia.vulvodynia 355