Summary about Disease
Vulvar vestibulitis (VV), also known as provoked vestibulodynia (PVD), is a chronic pain condition that affects the vulvar vestibule, the area surrounding the opening of the vagina. It's characterized by pain with touch or pressure, such as during tampon insertion, gynecological exams, or sexual activity. The pain can range from mild discomfort to severe burning, stinging, or throbbing. It is not an infection, sexually transmitted or otherwise, and it's considered a form of chronic localized vulvodynia.
Symptoms
Pain, burning, stinging, or rawness in the vulvar vestibule.
Pain with touch or pressure to the vestibule (e.g., tampon insertion, sexual intercourse, sitting).
Pain during gynecological exams.
Pain that is often described as "sharp" or "burning".
Dyspareunia (painful intercourse).
Some women also experience itching or throbbing in the area.
The affected area often appears normal on visual examination, although some redness or inflammation may be present.
Causes
The exact cause of vulvar vestibulitis is not fully understood. Contributing factors and theories include:
Inflammation: Chronic inflammation in the vulvar vestibule.
Nerve Hypersensitivity: Increased sensitivity of the nerve endings in the vestibule.
Genetic Predisposition: A possible genetic component may make some women more susceptible.
Pelvic Floor Dysfunction: Muscle spasms or tightness in the pelvic floor.
Hormonal Factors: Hormonal imbalances or sensitivity to hormonal changes.
Inflammatory or Immune Conditions: Some research suggests a link to underlying inflammatory or immune system conditions.
History of Yeast Infections: Some theorize recurrent yeast infections may contribute in susceptible individuals.
Chronic rubbing or irritation: Chronic friction from tight fitting clothes.
Medicine Used
Topical Anesthetics: Lidocaine ointment or cream applied to the vestibule before activities that may cause pain.
Topical Estrogen Cream: May be prescribed if hormonal factors are suspected.
Tricyclic Antidepressants (TCAs): Low doses of TCAs (e.g., amitriptyline, nortriptyline) can help manage nerve pain.
Anticonvulsants: Medications like gabapentin or pregabalin may be used to manage nerve pain.
Capsaicin Cream: A topical cream that can help desensitize nerve endings (use with caution).
Compounded Medications: Some pharmacies can create customized creams or ointments with multiple medications to address specific symptoms.
Botox Injections: In some cases, Botox injections into the pelvic floor muscles may be used to relieve muscle spasms.
Calcineurin inhibitors: Topical ointments like tacrolimus or pimecrolimus might be prescribed to reduce inflammation.
Is Communicable
No, vulvar vestibulitis is not communicable. It is not an infection and cannot be spread through sexual contact or any other means.
Precautions
Avoid Irritants: Use gentle, unscented soaps and detergents. Avoid douches, feminine hygiene sprays, and scented tampons or pads.
Wear Loose Clothing: Avoid tight-fitting pants, underwear, and pantyhose. Choose cotton underwear.
Use Lubricant: Use a water-based lubricant during sexual activity.
Avoid Aggressive Rubbing: Be gentle when washing the vulvar area.
Manage Stress: Stress can exacerbate pain conditions. Practice relaxation techniques like yoga, meditation, or deep breathing.
Pelvic Floor Therapy: Consult a physical therapist specializing in pelvic floor dysfunction.
Dietary Changes: Some women find that avoiding foods high in oxalates can help. Consult with a healthcare professional before making significant dietary changes.
How long does an outbreak last?
Vulvar vestibulitis is not characterized by "outbreaks" in the same way as a viral infection like herpes. It's a chronic pain condition. Symptoms can fluctuate in intensity. Some women may experience periods of relative remission, while others have persistent pain. Without treatment, the pain can persist for months or years. With appropriate management, symptoms can be significantly reduced, but there is no guarantee of a permanent cure.
How is it diagnosed?
Diagnosis is primarily clinical, based on the patient's symptoms and a physical exam.
Medical History: The doctor will ask about the patient's symptoms, medical history, and sexual history.
Physical Exam: A pelvic exam is performed to rule out other causes of vulvar pain.
Q-Tip Test: A cotton swab is gently applied to different points in the vulvar vestibule. Pain with light touch in specific areas is a key diagnostic criterion.
Exclusion of Other Conditions: The doctor will rule out other potential causes of vulvar pain, such as infections, skin conditions, or nerve disorders.
No specific blood tests or imaging studies are used to diagnose vulvar vestibulitis.
Timeline of Symptoms
The onset of symptoms can be gradual or sudden. There is no fixed timeline, and the progression can vary greatly among individuals.
Initial Onset: Pain may start after a specific event (e.g., yeast infection, childbirth, injury), or it may begin without a clear trigger.
Early Stages: Pain is often intermittent and may only occur with specific activities (e.g., intercourse, tampon insertion).
Progression: Over time, the pain may become more frequent and intense. It may begin to interfere with daily activities and relationships.
Chronic Stage: Pain becomes persistent and significantly impacts quality of life.
Fluctuations: Symptoms may fluctuate over time, with periods of increased pain (flare-ups) and periods of relative relief.
Important Considerations
Vulvar vestibulitis can significantly impact a woman's quality of life, including sexual function, relationships, and emotional well-being.
It is crucial to seek help from a healthcare provider experienced in treating vulvodynia and related conditions.
Treatment often involves a multidisciplinary approach, including medication, physical therapy, counseling, and lifestyle modifications.
There is no single "cure" for vulvar vestibulitis, but symptoms can be managed effectively with appropriate treatment.
It is important to be patient and persistent with treatment, as it may take time to find the right combination of therapies.
Support groups and online communities can provide valuable information and emotional support.
Open communication with partners and loved ones is essential for coping with this condition.
Because the exact cause is unknown, treatment is focused on relieving symptoms.
Vestibulectomy (surgical removal of the affected vestibular tissue) is sometimes considered, but is not always successful and is typically reserved for severe cases that have not responded to other treatments.