For about the last three years, it hurts whenever I have sex with my husband. Now it even hurts to put in a tampon, and the string really burns. My doctor says I have vestibulitis. Can you tell me more about this?
Vestibulitis is a chronic inflammation of the innermost region of the vulva, known as the vestibule. Vulvar pain is the hallmark of vestibulitis, other symptoms include: itching, burning, stinging or feeling raw. Most women with vestibulitis have had pain for more than six months. Many have seen several doctors and tried a variety of treatments, often making the symptoms no better or worse.
Vulvar pain may not always be present, but most women with vestibulitis notice pain during sexual activity. It generally occurs with entry, but some experience pain when touched during foreplay, or intense burning after intercourse. Sexual problems are common among women who have chronic pain with intercourse. Some have trouble getting aroused or reaching orgasm, others lose interest in sex, and some avoid it altogether.
The vulva can appear entirely normal during an examination, or there may be redness at the minor vestibular glands. In most cases the only abnormal finding is exquisite pinpoint tenderness when the area is touched with a cotton swab. Vulvar biopsy is usually not needed to make the diagnosis.
Some patients can pinpoint exactly when the problem started, such as after treatment for a yeast infection or other vulvar condition. Symptoms may be triggered by prolonged use of topical steroids or medications such as those used to treat genital warts. Vestibulitis has been linked to overwashing with irritating soaps or deodorants. Some cases are due to chronic infections, such as an ongoing yeast infection, and there may be an association between vestibulitis and human papillomavirus (HPV).
There are many causes of vestibulitis, and just as many approaches to treatment. Warm sitz baths with Burow’s solution may help. Topical treatment with corticosteroids, estrogen, or a local anesthetic may offer relief. Anti-yeast medication can help get rid of a chronic yeast infection. Some patients have had success with testosterone, low-dose antidepressants, vitamins or herbs. Biofeedback and graduated vaginal dilators can also be useful. Injections with Interferon, targeting viral causes, have produced mixed results. Even surgical treatment, with laser ablation or excision of the inflamed area (vestibulectomy), has been tried with limited success.
Unfortunately there is no real cure for vestibulitis. The goal is to relieve symptoms, and often it means trial and error. I’m glad that you’ve been able to discuss this with your doctor. Making the right diagnosis is the first step to proper treatment.
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