Some women have had pain since their first penetration (primary vulvar vestibulitis) while some have had it after a period of time with pain-free penetration (secondary vulvar vestibulitis). Relationship problems often occur as the result of chronic frustration, disappointment, and depression associated with the condition. Causes
Little is known about the cause of vestibulodynia. A number of causes may be involved, including subclinical human papillomavirus infection, chronic recurrent candidiasis, or chronic recurrent bacterial vaginosis.Muscular causes have been implicated as well, since chronic vulvar pain may be the result of chronic hypertonic perivaginal muscles, leading to vaginal tightening and subsequent pain. Some investigators have postulated the existence of neurological causes, such as vestibular neural hyperplasia. In vestibulodynia the nerves of the vulva transmit signals of pain when they normally should indicate touch, pressure, heat, or stretch. Normal sensations are processed by the brain as abnormal, which result in a heightened sensitivity, i.e. hyperalgesia. Finally, psychological factors may contribute to or exacerbate the problem, since the anticipation of pain often results in a conditioned spasmodic reflex along with sexual desire and arousal problems. Diagnosis
Diagnosis is readily made by the cotton-swab test, in which pressure is applied in a circular fashion around the vulvar vestibule to assess complaints of pain. Laboratory tests are used to exclude bacterial, viral or yeast infection, and a careful examination of the vulvovaginal area is conducted to assess whether any atrophy is present. Treatment
Treatment consists of general advice about hygiene and sexual behaviour, pelvic floor and desensitisation exercises, and psychological treatment by a multidisciplinary team.
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