[Vulvar vestibulitis]

In 1987 Friedrich defined the vulvar vestibulitis syndrome as "severe pain on vestibular touch or vaginal entry; tenderness to pressure localized within the vulvar vestibule; and physical findings confined to vestibular erythema of varying degrees". The vulvar vestibule extends laterally from the hymenal ring to a line of more keratinized skin on the labia minora (Hart's line). Anteriorly the vestibule reaches upwards to the frenulum of the clitoris and posteriorly downward to the fourchette. Characteristics of vestibulitis are the patient's complaint of entry dyspareunia, discomfort at the opening of the vagina and erythema and point tenderness discovered on palpation of the gland orifice with a cotton-tipped applicator (cotton swab is pressed gently in a circle around the base of the hymenal ring or at the posterior fourchette of the vagina). Women report severe pain at the vaginal introitus during intercourse, localized pain from tampon use. Pain developed in all patients during periods when they were sexually active, although there are a few reports of vulvar vestibulitis in celibate women. Vulvar vestibulitis may be acute or chronic. The cause of vulvar vestibulitis are most likely multifactorial. Vestibulitis may result from any infectious process that causes vulvovaginitis, irritants agents (soaps, sprays), antiseptics, creams, destructive treatments (cryosurgery, podophyllin, laser treatment), HPV, recurrent bacterial vaginosis, chronic candidiasis, altered vaginal acid-base balance. The candidal organism appears to play some role in this syndrome. Human papillomavirus appears to be an associated variable. An allergy-based etiology for vestibulitis has not been defined.(ABSTRACT TRUNCATED AT 250 WORDS)