Urethra

• Vestibular glands

PATHOGENESIS

In papers by Lotery et al. (2004) and Green et al. (2001) several causes for vestibulitis are debated. These include the absence or presence of inflammation in the vestibular tissue, and infections such as Candida and human papil-lomavirus, family history and contact dermatitis. They advise that there are no studies to substantiate these. An abnormal pain syndrome or an immunolog-ical role in the causation of vestibulitis are also discussed; but again Lotery et al. (2004) and Green et al. (2001) conclude that there is little evidence at present to sustain these causes.

Table 14 Management of vulval vestibulitis

Typical history

Physical findings

Suggested treatment

Usually premenopausal

Entry dyspareunia or pain with insertion of tampon or intercourse

Severe pain with pressure

Burning stinging irritation or raw sensation within vestibular area

Possible history of carbon dioxide laser therapy, cryotherapy, allergic drug reactions or recent use of chemical irritants

Positive swab test (vestibular point tenderness when touched with cotton swab)

Focal or diffuse vestibular erythema

5% lignocaine ointment

Tricyclic antidepressants

Gabapentin

Pelvic floor physiotherapy

  • consider local interferon injection
  • consider surgery (Lotery et al. 2004)

Counselling and support

Adapted from: Julius & Metts 1999 and Lotery et al. 2004.

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