Vulvar vestibulitis - Symptoms and Signs
Vulvar vestibulitis is characterised by inflammation (redness) of the vestibule (the entrance to the vagina - Figure 2.2) or pain in the vestibule with no abnormality that can be seen. It is characterized by entry dyspareunia, discomfort at the opening of the vagina, a positive swab test, tenderness localized within the vestibule, and focal or diffuse vestibular erythema.
Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.
There may be dyspareunia (pain with intercourse –Painful Sex) or pain on introducing a tampon. Usually the painful area tends to be at the back of the vestibule but it can sometimes be specifically located at the sites of the ducts from the Bartholin’s glands (Figure 2.2). In the majority of cases of vestibulitis a cause cannot be identified. Some cases of vestibulitis seem to be triggered by candida (thrush). Other suspected causes include recent use of chemical irritants, a history of destructive therapy such as carbon dioxide laser or cryotherapy, or allergic drug reactions. Viruses, notably the wart virus (HPV) have been implicated as possible causes of vestibulitis but their role remains debatable.0704 Chronic vestibulitis lasts for months to years, and patients may experience entry dyspareunia and pain when attempting to insert a tampon. Typically there is tenderness demonstrable with a cotton wool bud particularly in the area of the Bartholin's ducts.
There is a relationship between vulvar vestibulitis and facial pain suggesting that their may be an underlying defect in the mucosa (skin).0802 Women with vulvar vestibulitis seem to be more sensitive to pain.0603
Microscopic examination of symptomatic vestibular tissue has demonstrated the presence of mixed chronic inflammatory infiltrates in the superficial stroma (underlying tissues), but inflammatory cells have not been found to invade the vestibular glands or gland lumens (ducts), vessels or nerves.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
