Operational Obstetrics & Gynecology

Vulvar Vestibulitis

Vulvar vestibulitis is a condition of uncertain cause, characterized by pain and burning in specific sites on the vulva.

Watch a 5-minute video showing how to perform a hymenotomy in a patient with vulvar vestibulitis.

The pain is most noticeable during intercourse and is very consistent, both in character and location.

The pain and tenderness is distributed in a U-shaped pattern around the introitus and includes the hymeneal remnants and up to 1 cm of skin exterior to the hymen. Visually, the tender areas are reddened and touching them gently with a cotton-tipped applicator will duplicate the pain they experience during intercourse (a positive "Q-Tip Test"). Biopsy of these tender areas will show a generalized inflammatory pattern of non-specific etiology.

Some women with vestibulitis indicate they have always felt this discomfort during intercourse. Others seem to have acquired the condition. They have painless intercourse initially, and later develop the painful intercourse so characteristic of this condition.

The diagnosis is based on the physical examination, with persistent areas of tenderness to touch, located in the U-shaped area surrounding the hymenal ring. Biopsy is neither necessary nor often done.

Treatment is problematic. Antibiotics, anti-fungals, anti-virals, estrogens, and steroids are often used and are often found to be ineffective. Antioxalates (used with the theory that oxalates provoke a skin reaction in this area) are promoted by some, but randomized studies demonstrate them to be no better than placebo.

Several studies have demonstrated the efficacy of surgical excision of the affected area (perineoplasty) in selected cases.

*This video is an added feature, provided by the Brookside Associates Medical Education Division. It was not present in the original edition.

Home  ·  Introduction  ·  Medical Support of Women in Field Environments  ·  The Prisoner of War Experience  ·  Routine Care  ·  Pap Smears  ·  Human Papilloma Virus  ·  Contraception  ·  Birth Control Pills  ·  Vulvar Disease  ·  Vaginal Discharge  ·  Abnormal Bleeding  ·  Menstrual Problems  ·  Abdominal Pain  ·  Urination Problems  ·  Menopause  ·  Breast Problems  ·  Sexual Assault  ·  Normal Pregnancy  ·  Abnormal Pregnancy  ·  Normal Labor and Delivery  ·  Problems During Labor and Delivery  ·  Care of the Newborn

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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