Vulvar vestibulitis: a multi-factorial condition

Abstract

Objective To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non-symptomatic control group.Design A case±control study conducted in 1998.Setting Two clinics in northern Sweden. Sample Thirty-eight women, 18±25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls.Methods The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints.Results Regarding personality aspects the women with vulvar vestibulitis scored signi®cantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a signi®cantly higher number of somatic complaints in several areas. ConclusionsThe ®ndings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might in¯uence their experience and management of pain and stress. A multi-factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.

Enhancement of the perception of systemic pain in women with vulvar vestibulitis

“…Meana et al 8 , who failed to find a significant psychopathology in their patients, proposed a shift in conceptualisation of vulvar vestibulitis and dyspareunia from a sexual dysfunction involving pain to a pain syndrome resulting in sexual dysfunction. Danielsson et al 9 noted that women with VVS had more somatic symptoms than their controls. Bergeron et al…”

“…Danielsson et al 9 also noted that women with VVS were more anxious. Likewise, Russo et al 27 , who studied patients with various somatisation disorders, found that the number of current and past anxiety diagnoses increased with an increasing number of medically unexplained symptoms.…”

The Major Histopathologic Characteristics in the Vulvar Vestibulitis Syndrome

“…Although exact data regarding disease prevalence remain scarce, it is seen in as many as 15% of patients referred to tertiary care centers for evaluation of chronic vaginal symptoms [2]. The etiology of vulvar vestibulitis has still not been clarified, and is thought to be multifactorial [3,4]. Previous studies [5,6] have shown a nonspecific inflammatory infiltrate dominated by lymphocytes and plasma cells in the subepithelial part of the vestibular mucosa in patients with vulvar vestibulitis.…”

“…Several theories, for instance, concerning factors such as the existence of human papillomavirus infection [9,10], recurrent candidiasis [11], or the influence of irritant chemicals [12], have been discussed. Other proposed etiologies have included high levels of urinary oxalates [13], an increased number of intraepithelial nerve endings in the vulvar vestibulum [14,15], an increased number of mast cells [16] and even the existence of psychosomatic elements [3,17,18]. The aim of the present study was to analyze the histopathologic features of vulvar vestibulitis in vestibular mucosa specimens, obtained from women with vulvar vestibulitis syndrome, and to compare these histopathologic features with those found in women without symptoms or signs of vulvar vestibulitis.…”

New Developments in the Pathophysiology of Genital Pain: Role of Central Sensitization

“…In terms of the number of other pain conditions experienced, women with PVD report significantly more non-vulvar pain complaints (e.g., migraine), and they rate these pain issues as more severe and interfering with daily activity than control participants (e.g., [39,46,47]). Adding to this finding of selfreported pain is evidence of lowered thresholds in areas outside of the vulvar vestibule as measured by QST.…”