MCAS symptoms 'down there' with Dr. Tania Dempsey

Dr. Tania Dempsey reviews how MCAS can affect the genitourinary region, highlighting pain with intercourse (dyspareunia), mast‑cell–driven vulvovaginitis, and dysfunctional uterine bleeding—sometimes dramatically responsive to simple H1/H2 blockade (e.g., loratadine plus famotidine). She discusses localized/novel approaches when standard antibiotics/antifungals fail, including compounded or topical mast‑cell–targeted therapies (e.g., diphenhydramine suppositories/douches; investigational topical ketotifen), and emerging interest in neuroproliferative vestibulodynia where mast cells cluster near proliferating nerves; potential agents under study include ketotifen, luteolin, and specialized pro‑resolving mediators (SPMs). Hormones play a major, nuanced role: topical vaginal estrogen and/or DHEA can help perimenopausal/menopausal vulvovaginal atrophy and discomfort; steady estrogen may be stabilizing whereas rapid swings can trigger MCAS; progesterone often stabilizes mast cells and can be used across ages when hormonally indicated; testosterone may stabilize in some but can aggravate those with PCOS or androgen sensitivity; oxytocin may aid bonding/sexual connection though not libido per se. Practical tips: some patients react to ultrasound gel ingredients and to pressure/vibration from imaging; consider gels with fewer allergens (e.g., EcoVue: no dyes/parabens/propylene glycol), patch‑testing, requesting lighter probe pressure or non‑automated scans, spacing mammogram and ultrasound, and premedicating when needed. Overall message: think mast cells when GU inflammation is refractory, personalize hormone and mast‑cell therapies, and collaborate on safer testing strategies; this is informational only, not medical advice.