Vulvar vestibulitis syndrome: A critical review

Objective: Vulvar vestibulitis syndrome (VVS) is thought to be the most frequent cause of dyspareunia in premenopausal women and is one of the major subtypes of vulvodynia. Vulvar vestibulitis is a chronic, persistent clinical syndrome characterized by severe pain on vestibular touch or attempted vaginal entry, exquisite tenderness to a cotton-swab palpation of the vestibular area, and physical findings confined to vestibular erythema. The purpose of this paper is to critically review the descriptive, diagnostic, etiologic, and treatment studies on VVS. Methodological problems are highlighted, and future guidelines for research are proposed. Data Sources: References were obtained from a MEDLINE search covering the period from January 1984 until June 1995. The indexing term ''vulvar vestibulitis'' was used, and the search was constrained to English-language articles. References from other relevant sources, such as texts and bibliographies, were also included. Study Selection: All articles pertaining to VVS were reviewed. Data Extraction: All data relevant to the descriptive, diagnostic, etiologic, and treatment aspects of VVS were included. Data Synthesis: Pain symptomatology tends to be underemphasized in the current descriptive studies. The trend in etiological research is to focus on biomedical factors such as candidiasis and human papillomavirus (HPV). Only a few studies adopt a nonreductionnist approach. Surgery is the treatment option with the highest reported success rate. Medical management is underinvestigated, considering its widespread use. Pain management techniques such as biofeedback and behavior therapy show promising results. Conclusions: A pain syndrome conceptualization is suggested as the most useful approach for solving current empirical and clinical problems.