HISTOPATHOLOGIC FEATURES OF VULVAR VESTIBULITIS

Vulvar vestibulitis, a subset of vulvodynia, is present in 15% of pati ents in a general gynecologic practice. Only a few studies have focuse d on pathologic features of vulvar vestibulitis and none have included a control group. Punch biopsies from the vulvar vestibule of 12 patie nts with an age range of 22 to 51 years (mean 28 years) and 12 age-mat ched controls were analyzed for histopathologic features and investiga ted for the role of probable etiologic factors including human papillo mavirus (HPV). A chronic inflammatory infiltrate was present in all sp ecimens from patients with vestibulitis, and was composed predominantl y of T-lymphocytes with a small number of B cells and an admixture of plasma cells, mast cells, and occasional monocytes. T-helper suppresso r ratio was normal. The infiltrate was mild in 5 patients, moderate in 1, and severe in 6. Minor vestibular glands were observed in 8 (66%) patients and were associated with a periglandular inflammatory infiltr ate. Squamous metaplasia was observed in 4 (44%) patients. Epithelial hyperplasia was present in 10 (83%) patients with mild dysplasia in 2 (16%). Immunohistochemistry for immunoglobulins IgG, IgA, and IgM show ed the presence of IgG-positive plasma cells in 75% of patients, sugge sting chronic irritation, but an autoimmune etiology cannot be exclude d or confirmed. Biopsies of control cases did not show any inflammator y infiltrate. In situ hybridization for HPV 6, 11, 16, and 18 was nega tive in the patient group as well as in the control group. We conclude that histopathologic abnormalities in patients with vulvar vestibulit is are the result of a chronic inflammatory reaction of the mucosa of the vulvar vestibule, for which the cause remains unclear.