Vulvar vestibulitis is a chronic pain condition affecting the vulvar vestibule, the area surrounding the vaginal opening. It is characterized by localized pain and tenderness.
Defining Vulvar Vestibulitis
Vulvar vestibulitis is marked by pain and tenderness in the vulvar vestibule, a sensitive tissue located just inside the labia minora, encircling the vaginal opening, and including the openings of the urethra and certain glands. A burning or stinging sensation upon touch or pressure to this area is a main characteristic.
It is considered a subtype of localized, provoked vulvodynia. Discomfort is described as burning, stinging, or a raw feeling. While “vestibulitis” suggests inflammation, there is often little evidence of an inflammatory process, leading to the alternative term “vestibulodynia.”
Common Symptoms
Individuals with vulvar vestibulitis experience pain in the vulvar vestibule, often triggered by touch or pressure during sexual intercourse, tampon insertion, or from wearing tight clothing or prolonged sitting. The sensation is described as burning, stinging, rawness, or sharp pain.
Beyond the immediate pain, individuals may experience discomfort during gynecological examinations or difficulty using tampons. Painful intercourse, known as dyspareunia, can significantly impact sexual activity. The discomfort can linger for hours or days after any provoking activity.
Potential Contributing Factors
The exact cause of vulvar vestibulitis is often not fully understood; it can be idiopathic. Several factors are believed to contribute to its development. One theory involves nerve irritation or damage, suggesting hyperactivity or an increased density of nerve endings in the vestibular tissue, leading to heightened sensitivity and pain.
Chronic inflammation may also play a role, possibly stemming from recurrent infections like yeast infections or bacterial vaginosis, allergic reactions to products, or irritation from chemical exposures. Hormonal changes or deficiencies, such as those caused by oral contraceptive pills or menopause, can contribute by affecting vulvar tissue health and sensitivity.
Tightness or spasm of the pelvic floor muscles can lead to pain and tenderness. Some individuals might also have a genetic predisposition to chronic pain conditions or experience symptoms following prior trauma or injury.
Diagnosis and Treatment Approaches
Diagnosing vulvar vestibulitis begins with a detailed medical history and symptom assessment. A physical examination includes a visual inspection of the vulva. The “Q-tip test” is a key diagnostic tool, where a healthcare provider applies pressure with a cotton swab to pinpoint pain locations and severity in the vulvar vestibule.
Other conditions causing similar symptoms, such as yeast infections, bacterial vaginosis, sexually transmitted infections, or dermatological conditions, must be ruled out. Laboratory tests may be conducted to exclude infections or check hormone levels if an imbalance is suspected.
Treatment for vulvar vestibulitis is often multidisciplinary and tailored. Topical medications, such as lidocaine for temporary pain relief or estrogen creams for hormonal deficiencies, are used. Oral medications like neuropathic pain medications (e.g., gabapentin, pregablin) or tricyclic antidepressants (e.g., amitriptyline) can help manage nerve pain. Muscle relaxants may be prescribed if pelvic floor muscle tension is a factor.
Pelvic floor physical therapy is a common and effective treatment, aiming to release muscle tension, improve muscle function, and reduce pain. Nerve blocks, which involve injecting medication to interrupt nerve signals, can provide pain relief. Biofeedback therapy may help individuals learn to control and relax their pelvic floor muscles.
Lifestyle modifications are recommended, such as avoiding irritants in hygiene products, wearing loose-fitting clothing, and using gentle detergents. Psychological support, including counseling, can assist with pain management and address the emotional impact of chronic pain. In rare and severe cases, a vestibulectomy, a surgical procedure involving removing affected tissue, may be considered as a last resort if other treatments fail.