From the Research
Vulvar vestibulitis, now more commonly referred to as localized provoked vestibulodynia (LPV), is a chronic pain condition characterized by severe pain on vestibular touch or attempted vaginal entry, exquisite tenderness to palpation, and physical findings confined to vestibular erythema.
Definition and Characteristics
Vulvar vestibulitis is a chronic, persistent clinical syndrome that affects the vestibule area of the vulva, causing significant pain when pressure is applied to the area, such as during sexual intercourse, tampon insertion, gynecological examinations, or even when wearing tight clothing 1. The pain is typically described as burning, stinging, or rawness.
Etiology and Pathophysiology
The etiology of vulvar vestibulitis is unknown, but it is probably best considered as a chronic local inflammatory condition with a wide variety of etiologic causes, including nerve sensitization, inflammation, pelvic floor muscle dysfunction, and sometimes hormonal influences 2.
Treatment and Management
Treatment typically involves a multimodal approach, with the most recent and highest quality study suggesting that multimodal physical therapy is more effective than topical lidocaine for reducing pain intensity during intercourse and improving sexual function and distress 3. Some key components of treatment may include:
- Topical medications like lidocaine 2-5% ointment applied 15-30 minutes before intercourse or as needed for pain relief
- Physical therapy focusing on pelvic floor exercises to reduce muscle tension that may contribute to pain
- Low-dose tricyclic antidepressants like amitriptyline or anticonvulsants like gabapentin for pain management
- Avoidance of irritants like scented products, tight clothing, and harsh soaps
- Electromyographic biofeedback of pelvic floor musculature to help patients learn to control and relax their pelvic floor muscles 4
Importance of Personalized Care
Many patients benefit from working with healthcare providers specializing in vulvar pain conditions to develop a personalized treatment plan, as the condition likely results from a combination of factors and may require a tailored approach to management 3.