title: Psychosexual aspects of the evaluation and management of vulvar vestibulitis.
abstract: OBJECTIVE
  This article describes the structure and outcome of a collaboration between a gynecologist and a psychologist in evaluating and treating 45 consecutive women with vulvar vestibulitis.
  
  
  METHODS
  Women were interviewed by the psychologist in a structured format and also filled out questionnaires. Vulvar lesions were defined by clinical examination and colposcopy, and a conservative local excision was performed, without mobilization of the vagina. Postoperatively, women were offered sexual counseling including Kegel exercises, vaginal dilation, and couple therapy. Follow-up data were gathered a mean of 8 months after treatment.
  
  
  RESULTS
  Of the 32 women who had both surgical excision of vulvar lesions and contact with the psychologist, 50% were much improved in perceived pain, 41% were somewhate improved, and 9% were unimproved. Factors predictive of an improved outcome included willingness to have psychologic treatment, higher socioeconomic status, and self-report of specific, localized areas of vulvar pain rather than vague, diffuse pain. Parous women were more likely to improve. Those who reported increased pain intensity premenstrually had poorer outcomes.
  
  
  CONCLUSIONS
  Vulvar vestibulitis may be a syndrome that results from interacting pathophysiologic and psychologic factors, so that a comprehensive treatment approach is beneficial. Women who have diffuse genital pain or who refuse psychologic intervention may be poor candidates for surgery.
authors.affiliation: Center for Sexual Function, Cleveland Clinic Foundation, Ohio.
authors.forename: L R
authors.initials: LR
authors.lastname: Schover
authors.forename: D D
authors.initials: DD
authors.lastname: Youngs
authors.forename: R
authors.initials: R
authors.lastname: Cannata
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007249:Inflammation; D010146:Pain; D011581:Psychological Tests; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D014844:Vulva / Q000503:physiopathology; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy