Vulvar vestibulitis syndrome: An overview

119

Women with vulvar vestibulitis syndrome (VVS) have a distinct burning pain provoked by almost any stimuli in the area around the vaginal introitus. In a previous study we observed an increased number of intraepithelial free nerve endings in women with VVS. The aim of the present study was to neurochemically characterize the superficial nerves in the vulvar vestibular mucosa of women with VVS. Immunohistochemical methods were used to detect neuropeptides normally found in various types of nerve fibers. Calcitonin gene-related peptide, which is known to exist in nociceptive afferent nerves, was the only neuropeptide detected in the superficial nerves of the vestibular mucosa. These findings confirm our previous theory that the free nerve endings within the epithelium are nociceptors.

Section: Discussionmentioning

confidence: 99%

Neurochemical Characterization of the Vestibular Nerves in Women with Vulvar Vestibulitis Syndrome

Bohm‐Starke

Hilliges

Falconer

et al. 1999

119

“…Several theories have been discussed, for instance concerning factors that cause a nonspecific inflammatory infiltrate with predominantly lymphocytes in the subepithelial part of the vestibular mucosa [5,6]. Conceivable factors are genital infections, immunological reactions, irritants or hormonal influence of the mucous membrane [7][8][9]. Psychosomatic disorders have also been considered [10,11].…”

Section: Introductionmentioning

confidence: 99%

Increased Intraepithelial Innervation in Women with Vulvar Vestibulitis Syndrome

Bohm‐Starke

Hilliges

Falconer

et al. 1998

193

112

Women with vulvar vestibulitis syndrome (VVS) suffer from severe pain and discomfort in the area around the introitus at almost any stimulus that causes pressure within the vestibule. In spite of the severe sensory symptoms present in these women, the influence of the peripheral nerves in the vulvar vestibulum has not been clarified before. In this study the nerve supply in the vestibular mucosa in women with VVS and in healthy women free from vulvar symptoms has been revealed by PGP 9.5 immunohistochemistry. The results show a significant increase in the number of intraepithelial nerve endings in women with VVS, indicating an alteration in the nerve supply in the afflicted area.

“…Two of the most disturbing lower female genital tract conditions are dyspareunia resulting from vulvar vestibulitis, and vulvar pruritus with vaginal discharge caused by vulvovaginal candidiasis (VVC) [1,2]. The concomitant occurrence of both diseases, i.e., vestibulitis complicated by VVC, is particularly disturbing.…”

Section: Introductionmentioning

confidence: 99%

“…The concomitant occurrence of both diseases, i.e., vestibulitis complicated by VVC, is particularly disturbing. Some women volunteer that a Candida infection was the initiating event of vestibulitis [1,3]. In several studies, 46-80% of women with vestibulitis report suffering from recurrent VVC [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Pure versus Complicated Vulvar Vestibulitis: A Randomized Trial of Fluconazole Treatment

Bornstein

Livnat²,

Stolar³

et al. 2000

Objective: To examine the effectiveness of a 6-month treatment consisting of a weekly oral dose of 150 mg fluconazole for women with vestibulitis, and to explore the causes of treatment failure. Methods: Forty women with vestibulitis were randomized to either of two treatment groups. One group received a 6-month low oxalate diet with calcium citrate complement, as a placebo, and the second group the same diet and calcium citrate with the addition of a weekly oral tablet of 150 mg fluconazole. The women were examined 3 months after completing treatment, for response to therapy. Results: The addition of intensive 6-month fluconazole treatment did not lead to an outcome better than that attained by maintaining a low oxalate diet with calcium citrate supplementation. The satisfactory response rate was 15 and 30%, respectively. The presence of ‘complicated vestibulitis’, candidiasis concomitant with vestibulitis, decreases the satisfactory response rate regardless of the type of treatment administered (odds ratio 19.9, 95% CI 1.6, 250). Conclusion: Prolonged oral fluconazole is an ineffective treatment of vestibulitis, whether pure or complicated by concomitant vulvovaginal candidiasis. The coexistence of candidiasis and vestibulitis – complicated vestibulitis – might represent a subset of vestibulitis that is resistant to the currently available medical therapy.