FOCAL VULVITIS - A PSYCHOSEXUAL PROBLEM FOR WHICH SURGERY IS NOT THE ANSWER

In the last decade focal vulvitis has been identified as a distinct sy ndrome, characterized by unexplained burning vulvar pain and superfici al dyspareunia. A 'Woodruff perineoplasty' has been recommended as a t reatment method. A research project was conducted, investigating the l ongterm results of surgical treatment and the etiology of focal vulvit is. Results showed that the great majority of women continued to suffe r from focal vulvitis after the operation, which leads to the conclusi on that the procedure should be abandoned. Retrospective data revealed several immediate causes of mechanical and chemical irritation of the vulva. All women exhibited 'inadequate sexual behavior': having inter course without a sufficient amount of lubrication and/or in the presen ce of hypertonia of the pelvic floor. Psychosexual processes were furt her characterized by deterioration of sexual and general well-being, r esulting in lack of libido and depression, which contributed considera bly to the problem. An integrated approach to treatment is recommended , which incorporates protection of the vulvar skin, relaxation of pelv ic muscles and sexological treatment of the psychosexual and relationa l aspects.