Vulvar vestibulitis
Encyclopedia
Vulvar Vestibulitis Syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis is vulvodynia
localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain.
The pain of vulvodynia may extend into the clitoris; this is referred to as clitorodynia.
Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia that affects premenopausal women - the syndrome has been cited as affecting about 10%–15% of women seeking gynecological care.
and complaints of tenderness with pressure within the vulval vestibule
. Usually there are no reports of pain with pressure to other surrounding areas of the vulva. The feelings of irritation and burning can persist for hours or days following sexual activity, engendering a sense of hopelessness and depression
. VVS also can often cause dyspareunia
.
The pain may be provoked by contact with an object, such as with the insertion of a tampon or penis or with the pressure from sitting on a bicycle seat, or it may be constant, as in the case of generalized vulvodynia. Some women have had pain since their first penetration (primary vulvar vestibulitis) while some have had it after a period of time with pain free penetration (secondary vulvar vestibulitis).
Relationship problems often occur as the result of chronic frustration, disappointment, and depression associated with the condition.
tous sores in the vulval vestibule.
It may be indicative of focal vaginitis
- a number of causes may be involved, including sub-clinical
human papillomavirus infection, chronic recurrent candidiasis
, or chronic recurrent bacterial vaginosis.
Muscular causes have been implicated as well, since chronic vulvar pain may be the result of chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some investigators have postulated the existence of neurological causes such as vestibular neural hyperplasia
. Finally, psychological factors may contribute to or exacerbate the problem, since the anticipation of pain often results in a conditioned spasmodic reflex along with sexual desire and arousal problems.
Vulvodynia
Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause or visible pathology categorized in the ICD-9 group 625—specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs...
localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain.
The pain of vulvodynia may extend into the clitoris; this is referred to as clitorodynia.
Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia that affects premenopausal women - the syndrome has been cited as affecting about 10%–15% of women seeking gynecological care.
Symptoms
VVS is characterized by severe pain with attempted penetration of the vaginal orificeVaginal orifice
The vaginal orifice is a median slit below and behind the opening of the urethra; its size varies inversely with that of the hymen.-External links: - "The Female Perineum: The Vulva"...
and complaints of tenderness with pressure within the vulval vestibule
Vulval vestibule
The Vulval vestibule is a part of the vulva between the labia minora into which the urethral opening and the vaginal opening open...
. Usually there are no reports of pain with pressure to other surrounding areas of the vulva. The feelings of irritation and burning can persist for hours or days following sexual activity, engendering a sense of hopelessness and depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
. VVS also can often cause dyspareunia
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
.
The pain may be provoked by contact with an object, such as with the insertion of a tampon or penis or with the pressure from sitting on a bicycle seat, or it may be constant, as in the case of generalized vulvodynia. Some women have had pain since their first penetration (primary vulvar vestibulitis) while some have had it after a period of time with pain free penetration (secondary vulvar vestibulitis).
Relationship problems often occur as the result of chronic frustration, disappointment, and depression associated with the condition.
Diagnosis
Diagnosis is readily made by the 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 or viral infection, and a careful examination of the vulvo/vaginal area is conducted to assess whether any atrophy is present.Causes
VVS involves multiple tiny erythemaErythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
tous sores in the vulval vestibule.
It may be indicative of focal vaginitis
Vaginitis
Vaginitis is an inflammation of the vagina. It can result in discharge, itching and pain, and is often associated with an irritation or infection of the vulva. It is usually due to infection. The three main kinds of vaginitis are bacterial vaginosis , vaginal candidiasis, and trichomoniasis. A...
- a number of causes may be involved, including sub-clinical
Sub-clinical
Sub-clinical is a medical term referring to a disease process that has initiated but has not yet manifested symptoms.One example is sub-clinical hypothyroidism, where a patient will manifest none of the typical symptoms of hypothyroidism, and blood tests will show a normal T3 and T4, but an...
human papillomavirus infection, chronic recurrent candidiasis
Candidiasis
Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...
, or chronic recurrent bacterial vaginosis.
Muscular causes have been implicated as well, since chronic vulvar pain may be the result of chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some investigators have postulated the existence of neurological causes such as vestibular neural hyperplasia
Hyperplasia
Hyperplasia means increase in number of cells/proliferation of cells. It may result in the gross enlargement of an organ and the term is sometimes mixed with benign neoplasia/ benign tumor....
. Finally, psychological factors may contribute to or exacerbate the problem, since the anticipation of pain often results in a conditioned spasmodic reflex along with sexual desire and arousal problems.