Objective: This study aims to determine the pathophysiology of vulvar vestibulitis and to evaluate
currently used treatment options.
Methods: Two hundred twenty women with vulvar vestibulitis were seen between October 1987
and March 1995. Every patient had vulvar pain when they attempted intercourse, 75% had excessive
vaginal discharge, 36.4% had constant or recurring vulvar burning, and 10.9% had symptoms
suggestive of cystitis. All were cultured for the presence of Candida albicans. One hundred sixty-one
(73.2%) were also tested for vaginal IgE and prostaglandin E2 (PGE2); 72 (32.7%) had a vulvar biopsy performed as well.
Results: A wide range of variants were noted: 53 (24.1%) had a human papilloma virus (HPV)
infection, 25 (11.4%) had a Candida vulvovaginitis, 43 (19.5%) had a vaginal allergy, 15 (6.8%) had
vaginal PGE2 present, 14 (6.4%) had elevated urinary oxalate excretion, and 29 (13.2%) had a
variety of diagnosed variants. In 81 (36.8%) no underlying diagnosis was made. This understates
the numbers and varieties of vulvar vaginal diagnoses, for not all patients received a vaginal fluid
analysis, a vulvar biopsy, or a 24 h urine screen for oxalates. A variety of medical and operative
interventions was used. Symptoms were relieved in 65.9% of patients. The degree of sueeess varied.
Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate
supplementation, 16% with anti-Candida treatment, 48.1% with antihistamines, 77% with vulvar
injection of interferon, 83% with operative removal of inflamed vulvar tissue, and a posterior
colporrhaphy used to cover the cutaneous defect.
Conclusions: The diagnosis of vulvar vestibulitis is easy to make. An etiology for this chronic
condition will not be achieved in every patient. A majority of patients can get relief by a variety of
medical and operative interventions.