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Capstone

The diagnosis and Treatment of Vulvar Vestibulitis: A Literature Review

1 August 2005

Abstract

Context Vulvar vestibulitis is a characterized by persistent itching, burning, and vulvar pain that appears to be more prevalent in young females today. In light of the accelerated prevalence of this condition, there is a serious need for a better understanding of this condition since evidence suggests, although not life-threatening, vulvar vestibulitis appears to have a significant impact on quality of life.

Objective To systematically review the background, etiology, and efficacy of methods advocated for prevention and treatment of vulvar vestibulitis.

Data Sources, Study Selection, and Data Extraction The CINHAL, MEDLINE, and OVID databases were searched for articles published between January 1980 and May 2005 using database-specific keywords. Bibliographies of retrieved articles were searched, along with the Cochrane Library. and relevant websites. Reference textbooks were also searched for further background and supporting information. The retrieved literature was reviewed for pertinent information.

Data Synthesis. Vulvar vestibulitis syndrome was recognized over a century ago, yet the etiology still remains unknown. Definitions of pain provocation, quality, duration, and distribution vary, but patients typically have a history of pain localized to the vulvar vestibule described as burning or stinging; discomfort is elicited by direct pressure to the affected area. Activities such as tampon insertion, wearing tightly fitting clothing, biking, and horseback riding can result in extreme pain. Sexual activity can be problematic, and severe dyspareunia can lead to partial or complete cessation of intercourse. Most women experience at least 2-3 years of vulvar discomfort before being properly diagnosed. Many other treatable conditions have similar presenting symptoms, so a thorough patient history and physical exam is necessary . Because external genitalia often appears normal on gross inspection, vulvar vestibulitis is often overlooked. If gentle pressure is applied with a cotton applicator, and focal areas of tenderness can be elicited; this is diagnositic. Treatment requires a multidisciplinary approach with clinician and counselor involvement; there have been some promising results in small clinical trials, but there has not been one effective proven method to eradicate all symptoms.

Conclusions It is important that health care practitioners learn to recognize this crippling, chronic condition; No one specific treatment has been proven effective in clinical trials. Therefore, each individual needs to be examined and tested to rule out other causative agents. Documentation of a thorough patient history and attention to specific patient variables will help guide the medical provider in selection of the most appropriate treatment options.


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