Vulvar vestibulitis
Vulvar vestibulitis syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis, is
Provoked vestibulodynia, pain provoked by contact localized to the vulvar vestibule, is the most common subtype of vulvodynia among premenopausal women.[2] The condition has been cited as affecting about 10% to 15% of women seeking gynecological care.[3]
Symptoms
Vestibulodynia is characterized by severe pain with attempted penetration of the
The pain may be provoked by touch or contact with an object, such as the insertion of a tampon, with vaginal intercourse, or with the pressure from sitting on a bicycle seat, (provoked vestibulodynia)[6] or it may be constant and not provoked by a physical stimulus (unprovoked vestibulodynia). Some women have had pain since their first penetration (primary vestibulodynia) while some have had it after a period of time with pain-free penetration (secondary vestibulodynia).
The disease may have social and psychological ramifications. Many people with vulvovaginal pain experience of chronic frustration, disappointment, hopelessness and depression because of the impacts that the disease has on their lives. It can negatively impact a person's quality of life, their romantic and sexual relationships, and their ability to participant in normal activities.[7]
Causes
The mechanisms underlying vestibulodynia are not yet fully understood. There are thought to be several subtypes.
Others develop neuroproliferation later in life (
Vestibulodynia can also be mediated by hormonal imbalances (hormonally-mediated vestibulodynia), and sometimes caused by hormonal contraceptives. Estrogen-based birth control has been shown to increase the risk of vestibulodynia by up to 11 times.[9] Labs may show high sex hormone binding globulin or low free testosterone.[10]
Hypertonic pelvic floor dysfunction is present in many people who have vestibulodynia. Tight muscles can even contribute to and cause pain in the posterior area of the vestibule. People with hypertonic pelvic floor dysfunction may experience urinary symptoms like urgency and/or symptoms like constipation, rectal fissures, hip pain, and/or lower back pain. [10]
Pain extending outside of the vulvar vestibule may have other sources. Damage to the pudendal nerve ("pudendal neuralgia" or pudendal nerve entrapment) can cause unilateral or bilateral pain. Persistent genital arousal disorder can also cause pain in the vulvar vestibule. Spinal pathology can also cause vulvar pain.[10]
In recent years, diagnostic algorithms for the diagnosis of the various sub-types of vulvodynia have been developed and refined.[10] The International Society for the Study of Women's Sexual Health (ISSWSH) supports this diagnostic algorithm.
Diagnosis
For many people with
Diagnosis is made by the q-tip cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. Laboratory tests are used to exclude bacterial, viral or yeast infection. Laboratory tests can also be used to check the patient's sex hormones to see if there may be a hormonal component. A careful examination of the vulvovaginal area is conducted to assess whether any atrophy is present.
Treatment
Treatment depends on the subtype of disease.
For congenital neuroproliferative vestibulodynia, the gold-standard treatment is a surgery to remove the vestibule, called vestibulectomy. Acquired neuroproliferative vestibulodynia and inflammatory vestibulodynia may be treated with topicals. When such conservative treatments fail, vestibulectomy may be an option.[10]
Hormonally-mediated vestibulodynia is treated by stopping offending medications (commonly, hormonal birth control) and applying topical estradiol combined with topical testosterone. This allows the vulvar tissue to return to a healthy state.[10]
Pelvic floor dysfunction can be treated with pelvic floor physical therapy.
Treatment typically requires a multidisciplinary team including a gynecologist, a pelvic floor physical therapist, sometimes a surgeon, and sometimes a counsellor to help patients navigate the psychosocial burdens of the condition. [13][14][15][16]
References
- ^ "Home". issvd.org.
- S2CID 73485304.
- ^ .
Bergeron S, Binik YM, Khalifé S, Pagidas K (1997). "Vulvar vestibulitis syndrome: a critical review". Clin J Pain. 13 (1): 27–42.PMID 9084950. - ^ PMID 1659198.
- ^ PMID 3963075.
- ^ http://www.abc.net.au/radionational/programs/healthreport/treatment-of-sexual-difficulties-and-research-into-asexuality/4058034 Suggested treatment for sexual difficulties and research into asexuality, Dr Lori Brotto, 11 June 2012, ABC Radio National
- ^ Goldstein, Andrew; Pukall, Caroline; Goldstein, Irwin (2021). Female Sexual Pain Disorders: Evaluation and Management (2 ed.). p. 143.
- ^ a b Rubin, Rachel; W., Caitlin. "Neuroproliferative Vestibulodynia". www.prosayla.com. Retrieved 29 March 2024.
- ISSN 2710-2297. Retrieved 29 March 2024.
- ^ a b c d e f Goldstein, Andrew; Pukall, Caroline; Goldstein, Irwin (2021). Female Sexual Pain Disorders: Evaluation and Management (2 ed.). pp. 157–162.
- PMID 24080300.
- PMID 21963307.
- ^ https://www.socialstyrelsen.se/publikationer2018/2018-6-16[permanent dead link] Socialstyrelsen. Kartläggning av vestibulit: Förekomst och behandling av flickor och kvinnor med vestibulit samt behov av kunskapsstöd Sweden: Socialstyrelsen; 2018
- ^ https://www.sfog.se/natupplaga/ARG_nr%2071_webae1437d4-8cc5-4457-9eac-f5c6550a614b.pdf SFOG. Vulvovaginala sjukdomar Sweden: Elanders AB; 2013. 71
- ^ Faye RB, Piraccini E. Vulvodynia. [Updated 2020 Jan 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430792/
- ^ Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and Treatment. J Sex Med, 13(4), 572-590. doi: 10.1016/j.jsxm.2016.01.020