VESTIBULODYNIA - A SUBSET OF VULVAR VESTIBULITIS OR A NOVEL SYNDROME

OBJECTIVE: Our purpose was to recognize special features of women with both vestibulitis and constant vulvar pain (vestibulodynia) and to de termine whether vestibulodynia is a separate disease entity or a subse t of vestibulitis. STUDY DESIGN: Ninety-one women with severe vulvar v estibulitis underwent perineoplasty by a single surgeon during 1992 to 1995. Twenty-five (27%) of them who had vestibulodynia were compared with 66 (73%) who had dyspareunia alone. With univariate and then mult ivariate analysis, the two groups were compared with regard to demogra phic, social, and medical variables, the presence of human papillomavi rus deoxyribonucleic acid, physical findings in the vestibule, and sur gical outcome. RESULTS: The vestibulodynia and vestibulitis groups dif fered in age (30.5 +/- 10.6 years vs 24.7 +/- 6.2 years respectively), as well as in marital status (married, 44% vs 18%, respectively), non use of contraception (20% vs 1%, respectively), presence of human papi llomavirus deoxyribonucleic acid in the vestibule (80% vs 48%, respect ively), and failure of surgical treatment (incomplete response rate, 6 4% vs 2%, respectively). With multivariate analysis, patients with hum an papillomavirus deoxyribonucleic acid present in the vestibule have an odds ratio of 5.44 (95% confidence interval, 1.45 to 20.33) of belo nging to the group with vestibulodynia, whereas dysuria and age have o dds ratios of 3.70 (95% confidence interval 1.09 to 12.55) and 1.14 (9 5% confidence interval 1.04 to 1.24), respectively. CONCLUSIONS: Vesti bulodynia is a unique syndrome in that it affects women who are older than those who have vestibulitis alone and it is associated with human papillamavirus deoxyribonucleic acid, dysuria, and a higher surgical failure rate than that for vestibulitis.