Information from Libby Edwards, MD - Mid-Charlotte Dermatology & Research

VULVAR VESTIBULITIS

Although the term vulvodynia means burning or irritation of the vulva in general, vulvar vestibulitis refers to burning or irritation at the opening of the vagina. The term vulvar vestibulitis may sound impressive and give the impression that a diagnosis has been made, but this term is really simply a description. "Itis” simply means inflammation and "vestibule" is that area of the vulva at the opening of the vagina. Therefore, the term vulvar vestibulitis, or irritation of the vestibule, is like saying headache, or ache of the head. There are many different things that can cause vestibulitis, most of which are probably unknown.

Patients with vestibulitis have pain to any kind of pressure at the vestibule. This includes intercourse, binding by tight pants or blue jeans, and riding bicycles. There is often, but not always, redness of the skin of the vestibule.

This tenderness is sometimes caused by yeast or another vaginal infection; it is sometimes caused by inflammation of a nerve or nerve injury; and it was once felt to be due to a genital wart infection, although this is no longer believed. Some patients have muscle spasm of surrounding muscles that worsens the pain and some physicians feel that oxalate crystals from the urine may burn this area and cause pain. Sometimes a skin condition in the vagina or vestibule produces vestibulitis. Often, no one specific cause can be found.

The treatment for vulvar vestibulitis includes the identification of any kind of infection or skin abnormality. When all specific causes have been ruled out or treated, the usual first-line treatment is amitriptyline, sometimes better known as Elavil. Although this medication was originally developed as an antidepressant, it is now widely used for nerve pain and often produces significant improvement, although not cure, in many patients with vestibulitis. Some patients respond to topical cortisone ointment, and occasionally some patients do well with treatment for several months for yeast infection, even when yeast is not identified. If these measures fail, the next line of therapy is local infections of interferon. Interferon is a protein normally made by the body to help fight off infections, and this treatment was used during the time that vestibulitis was felt to be due to wart infection. Surprisingly, about one in three patients will experience significant improvement with interferon therapy, even though there are no warts present. Finally, in some patients whose pain is very well localized to the opening of the vagina, surgical removal of this area produces an impressive improvement in pain. In all cases, cure is uncommon but control to the point where the patient considers her problem a minor aggravation is very common. Most patients are able to resume intercourse and to enjoy it.

There are ongoing research trials that investigate the cause and treatment for this disease. In addition, research studies have shown this to be an extraordinarily stressful condition for women, not only because of the pain and their inability to have comfortable sexual intercourse, but also because of the damage that it does to a woman's self image and sexuality.