VULVAR VESTIBULITIS SUBJECTS UNDERGOING SURGICAL INTERVENTION - A DESCRIPTIVE ANALYSIS AND HISTOPATHOLOGICAL CORRELATES

Objective: We describe here a series of selected patients from an esta blished vaginitis research clinic diagnosed with vulvovestibulitis (VV ) who underwent surgical intervention for focal disease. Long-term res ults of surgical correction are reported and characteristic histopatho logy findings associated with vulvar vestibulitis are emphasized. Stud y Design: A retrospective chart review was carried out to extract rele vant clinical, histologic, and outcome data. Tissue blocks of resected specimens were reexamined for specific inflammatory response. Results : Complete data and long-term follow up were available in 16 patients who underwent surgical intervention. All were cared for by the same pr actitioner (CM). The mean (+/-S.D.) age and gravidity on presentation were 26.9+/-5.3 years and 0.9+/-1.5, respectively. All but one was cau casian, and 70% were nulliparous. Symptoms included entry dyspareunia (100%), discharge (70%), burning (66%), itching (20%) and other (30%). All patients had focal tenderness; other findings were erythema (50%) , acetowhite staining (80%), edema (20%), micropapules (20%) and condy loma (10%). After diagnosis, initial duration ofconservative managemen t was 9.4+/-6.9 months (1-26 months). No patients received interferon therapy. Because of persistent symptoms the 16 subjects underwent targ eted partial perineoplasties. Initial histopathology results revealed chronic. inflammation, parakeratosis, hyperkeratosis, edema, koilocyto sis and acanthosis. When tissue blocks were cut and stained with Giems a, large numbers of mast cells were identified. Mean postoperative fol low up was 42.0+/-22.4 months (10-70 months). Follow up after surgery showed an overall improvement in 15/16 patients (93.8%). Conclusion: W affects primarily white, nulliparous women. In the carefully selected subject, surgical intervention has a high success rate, even on long-t erm follow up. Although the exact etiology for this condition has yet to be elucidated, the presence of mast cells supports an association w ith other genitourinary inflammatory syndromes such as interstitial cy stitis; and allows for speculation about a possible role played by mas t cell activation in the etiology of VV.