Vulvar vestibulitis syndrome: an overview

Article Abstract:

The vulvar vestibulitis syndrome exists when severe pain is felt in the vulvar vestibule (the area between the labia minora) when it is touched or entered; tenderness is experienced in response to pressure; and vulvar erythema (redness) is noted. Pain is associated with intercourse, insertion of tampons, biking, or wearing tight pants. The vulvar vestibule is of endodermal origin in development, which, among other factors, makes it less responsive to sex hormones. In the main study published on the histopathology of vulvar vestibulitis, patients were found to have a chronic inflammatory response in the superficial layers of the vulvar tissues. Allergic or hypersensitivity reactions were not seen. Vulvar vestibulitis that has lasted more than three months is considered chronic. Acute vulvar vestibulitis may be the consequence of infection by agents such as Candida species, Trichomonas, or other bacteria. It can also result from the use of irritants (soaps, douches, or sprays) or chemical therapeutic agents (antiseptics or creams), certain treatments that destroy tissue (as for venereal warts), or drug reactions. Chronic vulvar vestibulitis can develop as a result of subclinical (asymptomatic) infection with human papillomavirus (which causes venereal warts) or in women with recurrent bacterial vaginosis (vaginal irritation), associated with a discharge that irritates the vestibule. Chronic candidiasis (infection with Candida organisms), other conditions that change the acid-base balance of the vagina, and other disorders (inflammatory bowel disease) or treatments (systemic chemotherapy) can also cause vulvar vestibulitis. Treatment for acute vulvar vestibulitis consists of appropriate drugs, removal of contributing treatments, and topical steroids after the infection is controlled. Surgery is only appropriate for patients with long-standing pain during intercourse who cannot be treated any other way. It consists of removal of vulvar tissue and movement of vaginal tissue to cover the region. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Urethral pressure variation in women with vulvar vestibulitis syndrome

Article Abstract:

Women with vulvar vestibulitis syndrome have a greater variability in urethral pressure than women without the syndrome. Vulvar vestibulitis syndrome is characterized by reddened, inflamed, very painful areas in the vestibular glands of the vulva. It is often accompanied by pain during intercourse, pain during urination and increased frequency of urination. The variability in urethral pressure was compared in 12 patients with vulvar vestibulitis and 13 patients with chronic pelvic pain complaints and 23 patients without pain. The urethra is the tube that drains urine from the bladder. Urethral pressure was measured under two conditions: during relaxation and while the patient was engaged in a mental-status examination. Patients with vulvar vestibulitis syndrome had significantly more variability in urethral pressure than the patients with chronic pelvic and than those without any pain symptoms.

Urethra

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Vestibulodynia - a subset of vulvar vestibulitis or a novel syndrome?

Article Abstract:

Women with constant pain or burning of the vulva may differ substantially from women with vaginal pain or tenderness at attempted intercourse. Researchers compared 25 women with vestibulodynia, or constant pain at the entrance to the vagina, and 66 women with vestibulitis, or pain when the vagina is touched. Women with constant pain were an average of 6 years older, more likely to have pain with urination, and more likely to have evidence of human papillomavirus in their vagina than those with tenderness only to touch. Surgery often failed in those with constant vaginal pain.

Health aspects, Papillomaviruses, Papillomavirus, Vulvovaginitis

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