VULVAR VESTIBULITIS SYNDROME - A CRITICAL-REVIEW

Objective: Vulvar vestibulitis syndrome (VVS) is thought to be the mos t frequent cause of dyspareunia in premenopausal women and is one of t he major subtypes of vulvodynia. Vulvar vestibulitis is a chronic, per sistent clinical syndrome characterized by severe pain on vestibular t ouch or attempted vaginal entry, exquisite tenderness to a cotton-swab palpation of the vestibular area, and physical findings confined to v estibular 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 res earch are proposed. Data Sources: References were obtained from a MEDL INE search covering the period from January 1984 until June 1995. The indexing term ''vulvar vestibulitis'' was used, and the search was con strained to English-language articles. References from other relevant sources, such as texts and bibliographies, were also included. Study S election: All articles pertaining to VVS were reviewed. Data Extractio n: All data relevant to the descriptive, diagnostic, etiologic, and tr eatment aspects of VVS were included. Data Synthesis: Pain symptomatol ogy tends to be underemphasized in the current descriptive studies. Th e trend in etiological research is to focus on biomedical factors such as candidiasis and human papillomavirus (HPV). Only a few studies ado pt a nonreductionnist approach. Surgery is the treatment option with t he highest reported success rate. Medical management is underinvestiga ted, considering its widespread use. Pain management techniques such a s biofeedback and behavior therapy show promising results. Conclusions : A pain syndrome conceptualization is suggested as the most useful ap proach for solving current empirical and clinical problems.