Mast Cells and Vestibulodynia: The Inflammation Root Cause and A New Treatment Trial I Dr Jill Krapf

For years, the hormonal and muscular causes of vulvar pain have become easier to understand and treat. Inflammation is the part we still understand the least - and it may be one of the biggest missing pieces in provoked vestibulodynia. Dr Jill Krapf returns to the podcast for one of the most cutting-edge conversations we've had on vulvodynia. She's a gynaecologist specialising in vulvovaginal disorders, the co-author of When Sex Hurts, and the principal investigator on a brand new clinical trial testing a topical treatment for provoked vestibulodynia. In this episode: • What a mast cell is and why Dr Krapf calls them the body's alarms • The difference between inflammatory, hormonal, muscular and neuroproliferative vestibulodynia • Why "everything looks normal" is the hardest case to treat • How yeast infections, their treatments, and everyday irritants can trigger mast cells • The link between mast cell activation, Ehlers-Danlos, hypermobility, POTS and IBS • Why vulvar pain can be a sign of a whole-body process • Why surgery has been the only proven option for neuroproliferative pain, and its downsides • H1 and H2 antihistamines, mast cell stabilisers, and other current options • The new topical ketotifen trial and how to take part About the study: Dr Krapf and the CVVD are running a randomised, double-blind, placebo-controlled trial of a topical ketotifen cream. Ketotifen is a well-established mast cell stabiliser that has never been studied as a topical treatment for vestibulodynia - and was the number one therapeutic identified at the 2024 Vulvodynia Research Summit. The trial runs over roughly 15 weeks with a screening visit plus four study visits, supported by a grant from the National Vulvodynia Association. The study is enrolling adults aged 18 and over with secondary provoked vestibulodynia: people who were once able to insert a tampon, dilator or have intercourse without pain, and now experience pain with insertion. You do not need an existing diagnosis to take part. Primary or congenital cases do not qualify Three locations - you need to be local or able to travel for four to five visits: • New York City - Dr Andrew Goldstein • Washington DC - Dr Chailee Moss • Tampa, Florida - Dr Jill Krapf To find out if you're eligible, email [email protected] (mailto:[email protected]) or [email protected] (mailto:[email protected]) . Connect with Dr Jill Krapf: • Book: When Sex Hurts (https://www.amazon.com/When-Sex-Hurts...) • @jillkrapfmd (  / jillkrapfmd  ) • Website (https://www.vulvodynia.com/) Connect with Mathilde: • @theworldstightestcommunity  (  / theworldstightestcommunity  ) • theworldstightestcommunity.com (http://theworldstightestcommunity.com)   • Support the podcast (https://theworldstightestcommunity-sh...) This episode is sponsored by Pelva (https://pelva.com/) . Use TWTC10 at checkout to receive 10% off your first order.