Elevated tissue levels of interleukin-1 beta and tumor necrosis factor-alpha in vulvar vestibulitis

Objective: To compare levels of two inflammatory cytokines, interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha), in selected regions of the vulva, vestibule, and vagina in women with vulvar vestibulitis and in asymptomatic controls. Methods: Selective samplings of surgical specimens from 12 women undergoing perineoplasty for vulvar vestibulitis and ten pain-free subjects undergoing posterior vaginal repair were prepared into tissue homogenates and analyzed for concentrations of IL-1 beta and TNF-alpha. Interleukin-1 beta and TNF-alpha concentrations were measured by sandwich enzyme-linked immunosorbent assay. The results were reported after adjustment for total tissue protein concentration. Results: Median tissue levels of IL-1 beta and TNF-alpha were elevated 2.3-fold and 1.8-fold, respectively, in women with vulvar vestibulitis relative to pain-free women. Median IL-beta tissue levels were increased significantly from 1.3 pg/mg to 3.0 pg/mg total protein in women with vulvar vestibulitis compared to pain-free women. Median TNF-alpha tissue levels were increased from 83 pg/mg to 148 pg/mg total protein in women with vulvar vestibulitis compared to pain-free women. Analysis by selected anatomic site of women with vulvar vestibulitis revealed a significant 2.2-fold higher median level of TNF-alpha at the vulvar site compared to the vestibule. Conclusion: Concentrations of IL-1 beta and TNF-alpha were elevated in women with vulvar vestibulitis relative to those in asymptomatic controls. This elevation in inflammatory cytokines with vulvar vestibulitis varied according to anatomic site and was, paradoxically, lowest in the area of highest hyperalgesia, the vulvar vestibule. Inflammatory cytokine elevation may contribute to the pathophysiology of mucocutaneous hyperalgesia. Copyright (C) 1997 by The American College of Obstetricians and Gynecologists.