Vulvar vestibulitis syndrome: a descriptive study and assessment of response to local steroid and topical clindamycin treatment.
Seventy-six women with insertional dyspareunia and clinical features of vulvar vestibulitis syndrome (VVS) were followed prospectively. The mean age was 26.4 years and the mean duration of symptoms prior to attending the department was 2.7 years. Twenty-nine per cent of women were considered by other clinicians to have no physical cause for their symptoms and had been initially referred for psychosexual counselling. Most women (53/76) had small, localised areas of intoital erythema and tenderness and 15 women revealed, in addition, erythema extending on to the posterior fourchette. Eight women had more extensive introital erythema associated with a distal vaginitis, some of whom exhibited microscopic features suggestive of a desquamative vaginitis in addition to VVS. Approximately 20% of women with localised areas of introital erythema and tenderness responded to a topical potent steroid or to intralesional injection of triamcinolone. Further controlled, long-term follow-up studies using objective methods of clinical assessment are urgently needed.
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Department of Genitourinary Medicine, Addenbrooke's NHS Trust Hospital, Cambridge, UK.