[Vulvar vestibulitis is a condition with diffuse etiology]

Vestibulum vulvae is covered by a sensitive mucosa of endodermal origin. The pain syndrome "vulvar vestibulitis", which is frequently occurring in young women, gives rise to intensive pain during sexual intercourse. The diagnosis requires at least six months duration of provoked pain and the presence of red areas in the vestibulum, which are intensely painful to the touch. There is an increased intraepithelial innervation but no active inflammation. The etiology of vulvar vestibulitis is probably multifactorial. Possible trigger mechanisms include repeated use of antibiotics and local treatment of Candida and HPV infections in combination with the use of hormonal contraceptives, frequent use of local substances that may be irritative, lack of arousal, vaginismus and tense pelvic floor muscles. Spontaneous recovery is possible if all treatment is suspended. Other regimens include biofeedback, psychotherapy, tricyclic antidepressants and surgery. There is a 80 per cent success rate after surgery in carefully selected patients.