Vulvar Vestibulitis - Symptoms, Causes, and Treatments

Introduction:

Certain disease conditions affect the private parts of females, especially the vaginal and the vulvar area. Vulvar vestibulitis is a condition that affects the vulvar vestibule causing severe aches and discomfort. It is also known as vulvar vestibulitis syndrome. This article elaborates on the causes, symptoms, and diagnosis of vulvar vestibulitis syndrome.

What Is Vulvar Vestibulitis?

Vulvar vestibulitis is a highly painful and unbearable condition. In addition, it is marked by symptoms of inflammation, like extreme tenderness, flushed skin, and warmness, all around the vestibule. Vulvar vestibulitis syndrome, localized provoked vulvodynia, vestibulodynia, and vestibular adenitis are some of the synonyms for vulvar vestibulitis. The vulvar vestibule is the soft tissue that extends from the clitoris to the vaginal opening. In vulvar vestibulitis, the vestibule gets into a condition called inflammation. It typically affects young females in the premenopausal stage and is generally long-standing.

What Are the Symptoms Associated With Vulvar Vestibulitis?

Hallmark changes associated with the development of vulvar vestibulitis syndrome include the following:

• The vestibule becomes extremely sensitive, interfering with day-to-day activities. Sometimes the slightest touch or pressure evokes aches in the patients.

• Burning sensation encircling the vaginal opening.

• Sex becomes highly painful, and the term dyspareunia knows the condition.

• Vestibular skin becomes warm and flushed.

• Redness around the vaginal mouth.

• Soreness intensifies while riding a bike or cycling.

• Extremely tight-fitting inner garments precipitate pain.

• Atypical form of discharge from the vaginal opening.

• Itching and prickling sensation in and around the vagina.

• Pain while placing a menstrual cup or tampon.

• The vulva appears sore and raw.

• Irritation, discomfort, and pain are confined within the vestibular area.

What Causes the Development of Vulvar Vestibulitis?

The exact cause that leads to the development of vulvar vestibulitis is still unclear. Researchers are trying to figure out the culprit behind this neuroinflammatory condition. However, certain factors may increase the chance of developing vulvar vestibulitis syndrome. They are responsible for evoking this kind of inflammatory condition. Some known infections and irritants that can induce the development of vulvar vestibulitis include the following:

• Human papillomavirus infections.

• Bacterial vaginal infections (bacterial vaginosis).

• Infections in the vagina are caused by certain varieties of yeasts.

• Imbalance in the vaginal pH levels.

• Habitual infections in the vagina.

• Allergy or hypersensitivity toward certain chemicals (soaps, lubricants, detergents, spermicides, douches) used in private areas.

• Insult to the nerve in the vulvar area precipitates vulvar vestibulitis syndrome, as it is neuroinflammatory.

• Dramatic response of the immune cells against injury or insult to the vestibular tissue.

• Emotional stress.

• Muscular disorders typically affect the pelvic floor muscles.

• Endometriosis.

• Painful bladder syndrome.

What Are the Different Types of Vulvar Vestibulitis?

Generally, it can be of two categories - primary and secondary.

• Primary Vulvar Vestibulitis: It develops following the first impact or insult to the vaginal area, like penetrative sex.

• Secondary Vulvar Vestibulitis: It develops after persistent sexual contact. Initially, there would not be any discomfort during sex, but later, pain and discomfort develop abruptly.

How Vulvar Vestibulitis Is Diagnosed?

Detailed clinical findings and in-depth medical history throw significant light on the diagnosis of the condition. Q tip test is performed to confirm the soreness encircling the vaginal opening. It is done with the help of a cotton swab. Other infections can be ruled out with the help of appropriate blood tests. However, complex diagnostic procedures are routinely not performed to diagnose the condition.

How Is Vulvar Vestibulitis Treated?

Vulvar vestibulitis is a more frequently encountered condition; hence, symptomatic treatment is advised.

• Tricyclic Antidepressants: They are prescribed to tackle soreness and aches. Routinely advised antidepressant tablets include Norprawin, Amitriptyline, and Nortriptyline.

• Anticonvulsant Drugs: Anticonvulsants like Gabapentine are suggested for resistant cases that do not respond to antidepressant medicines.

• Topical Anesthetics: Topical Lidocaine in the form of cream or gel relieves the pain, and routine application imparts anti-inflammatory effects.

• Corticosteroids: Steroids are also prescribed for managing vulvar vestibulitis, but no significant evidence proves their effectiveness.

• Cognitive Behavioral Therapy: As the condition significantly hampers the psychological, and mental health of the person, cognitive behavioral therapies are advised supplementary to other treatment strategies.

• Alpha-Interferons: Interferon administration is also suggested; however, there is no scientific evidence flagging the effectiveness of Interferon in vulva vestibulitis. It can be given as local injections or systemic administration.

• Electromyographic Biofeedback: Muscles in the pelvic floor are trained using the biofeedback technique.

• Physical Therapy: Physiotherapies are advised to deal with the muscles' abnormal contractions (spasms) in the pelvic floor region.

• Surgical Interventions: Surgical treatments are reported to be more effective in treating persistent vulvar vestibulitis, and different surgical approaches are available.

• Vestibulectomy: The outer tissue layer of the vestibule is removed (excised), hardly two millimeters in death. It can also be removed using a laser technique (laser ablation).

• Vestibuloplasy: Unlike vestibulectomy, only the underlying vestibular secretory cells (glands) are excised. In vestibuloplasty, only those areas which elicit soreness upon touch will be removed.

• Perineoplasty: It is similar to vestibulectomy in a technical approach. But in perineoplasty, the perineal tissue and the vestibule's outer layer are removed.

What Are the Associated Complications?

Vulvar vestibulitis is seen in association with psychological and emotional issues as it significantly impairs the sexual life of the person and leads to complications. Some of the potential complications include the following:

• Quality of life compromised.

• Vaginismus.

• Sexual dysfunctions.

• Stress.

• Anxiety attacks.

• Depression.

Are There Any Other Conditions That Mimic Vulvar Vestibulitis?

Certain other conditions also produce similar clinical findings as vulvar vestibulitis syndrome, and some of them include the following conditions:

• Vulvovaginitis, inflammation, or irritation caused in the vagina.

• Vaginal dermatitis occurs when the vulva causes redness, pain, and itchy sensation.

• Pelvic floor myalgia is the inability to control the muscles of the pelvic floor.

• Genital psoriasis is a form of skin disorder.

• Vaginal dermatosis is a burning sensation or irritation caused in the vaginal region.

• Vaginal candidiasis is a yeast infection caused in the vagina.

• Erythematous lichen planus.

• Desquamative vaginitis results in inflammation and irritation and produces lots of vaginal discharge.

What Are the Associated Risk Factors?

• Too soon onset of periods (menarche).

• Use of birth control pills in teenagers.

• Commencement of sexual life in the early teenage.

Conclusion:

Vulvar vestibulitis syndrome is a relatively familiar painful condition affecting the vaginal and vulvar areas. Raw and sore vestibule makes intercourse (sex) worse and more painful, which in turn influences the quality of life to a great extent. As it affects the private parts, eliciting dyspareunia, a major proportion of females affected by this condition feel reluctant to open up and seek treatment which further results in complications and distress. Many treatment interventions are available for vulvar vestibulitis and can be effectively managed with appropriate treatment strategies.