Vulvar vestibulitis syndrome: an often unrecognized cause of dyspareunia.
Vulvar vestibulitis syndrome (VVS) is an easily identifiable cause of entry dyspareunia. The aetiology is unknown although there is a strong association with Candida infection. The condition represents a focal area of hyperaesthesia within the vulvar vestibule. A management protocol for patients with this condition is presented; 230 patients with VVS were managed and followed-up over a 5-year period. Spontaneous resolution or improvement occurred in 21% of patients following initial explanation and use of simple local measures. In 21%, there were positive Candida cultures and long-term antifungal therapy resulted in a 71% cure. In Candida-negative patients, low-dose amitriptyline was used (up to 75 mg daily) with a 60% positive response rate. Carbamazepine was of little benefit (13% response). Surgical vestibulectomy was offered when conservative measures failed and this was performed in 22 patients (10%) with a beneficial result in 20 patients (91%).
Pagano
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Vulvar Disorders Clinic, Royal Women's Hospital, Melbourne, Victoria.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000639:Amitriptyline / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D002220:Carbamazepine / Q000627:therapeutic use; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006941:Hyperesthesia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D007654:Ketoconazole / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome; D014847:Vulvitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
D018712:Analgesics, Non-Narcotic; D000929:Antidepressive Agents, Tricyclic; D000935:Antifungal Agents; D000639:Amitriptyline; D002220:Carbamazepine; D007654:Ketoconazole