Vulvar Vestibulitis

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Vulvar vestibulitis is a component of dysesthetic vulvodynia, a complex condition that requires careful assessment and individualized management.

A vestibule is "an entrance to," such as the entrance to your house, or in medical terms it may be the entrance to the ear (auricular vestibule), the mouth (oral vestibule), the nose (nasal vestibule), etc. The vulvar vestibule is that area of the female vulva (genitals) that is within the inner lips (labia minora) where the entrance to the urethra (the tube that leads to the bladder) and the vagina can be found.

Vulvar vestibulitis is defined as abnormal (dysesthesia) sensation in the vulvar vestibule. That sensation may be characterized as any or all of the following:

  • Tenderness
  • Sensation of burning, "hot", stinging, rawness, swelling, itching, dryness
  • Sensation of "being cut at the bottom"
  • Pain upon contact with clothes, especially tight fitting
  • Urinary frequency
  • Severe pain to touch / attempted vaginal penetration
  • Dyspareunia
  • Vaginismus – often disguised as vulvar vestibulitis.  Read Monica's story

There are many hypotheses as to the cause of vulvar vestibulitis, none firmly conclusive. Consequently, there are many venues of intervention, including topical medications (i.e. cromolyn, lidocaine, estrogen, capsaicin), anti-depressant medication (i.e. amitriptylin, amoxapine, clomipramine, imipramine), cognitive-behavioral therapy, biofeedback, vestibulectomy (surgery), laser surgery, Botox injections, etc.

Our extensive work with vulvar vestibulitis suggests that

  • It is a localized provocation with an associated stress response by the body
  • The dysesthesia (abnormal sensation) is the result, not the cause
  • The condition has many potential causes, each requiring careful investigation
  • The manifestations disrupt quality of life and lead to emotional crises
  • Once the cause is identified and intervention is implemented, there should be timely improvements
  • Prognosis and treatment duration are subjective - each woman will have her own "journey"

In our clinical experience, the primary causes for vulvar vestibulitis include:

  • Insufficient hydration
  • Insufficient lubrication
  • Emotional stress
  • Allergy/substance sensitivity
  • Sexual practice causes
  • Mechanical, chemical, hormonal, structural, environmental causes

However, not everyone can be helped by addressing these primary causes, supporting the recent hypothesis (the research is ongoing) that there may be physiological factors, such as increased neural density in the vulva and/or immunologic changes that cause the pain and discomfort of vulvar vestibulitis.

As with vulvodynia, the treatment process of vulvar vestibulitis must be that of a body-mind approach because both the body and the mind are affected!

Typically, there is a cure for vulvar vestibulitis -- it requires finding the right clinician who will be patient enough and knowledgeable enough to spend the time it may take to get to the root of the problem, and offer the intervention that will work best.

 

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