VULVAR VESTIBULITIS SYNDROME - AN EXPLORATORY CASE-CONTROL STUDY

Objective: To assess the prevalence of genital bacterial infection amo ng women with vulvar vestibulitis syndrome and to evaluate the associa tion of several potential risk factors with the occurrence of the synd rome. Methods: Fifty-seven women referred for dyspareunia who satisfie d Friedrich's criteria and had symptoms for at least 6 months were rec ruited as cases. Controls included 173 patients without dyspareunia se en at a private clinic. Cases and controls were aged 18-35 years and w ere not pregnant. Results: Among cases, the prevalences were low for g enital infection with gonorrhea (O%), Chlamydia (O%), Trichomonas (O%) , Mycoplasma (O%), Gardnerella (14%), and Candida (8.8%). Ureaplasma w as detected in the Bartholin glands of ten affected women (17.5%). Hum an papillomavirus DNA was detected in only three cases (5.3%) based on polymerase chain reaction assays on vestibular biopsies. The relative risk (RR) of the syndrome was related to some aspects of sexual and r eproductive history. In particular, the RR in women who had used oral contraceptives (OCs) early (before age 17) reached 11.0 (95% confidenc e interval [CI] 1.3-97.1) relative to those who had never used OCs. Wo men who had first intercourse at age 15 or earlier had a 3.3-fold incr ease in RR (95% CI 1.4-8.0) compared to those who had first intercours e at age 16 or later. Conclusion: Our data provide little support for the idea that infection causes the vulvar vestibulitis syndrome. Hormo nal factors such as early OC use may be involved in the etiology of th is condition. (Obstet Gynecol 1994;83:47-50)