"Primary" versus "secondary" vulvar vestibulitis: One disease, two variants

OBJECTIVE: Our aim was to determine whether women with primary vestibulitis -since the first episode of sexual intercourse-differ in disease characteri stics and outcome of operative treatment from women with secondary vestibul itis. STUDY DESIGN: A total of 111 patients with severe vulvar vestibulitis under went perineoplasty from 1991 to 1995. Thirty-nine (35%) of them had primary vestibulitis tie, dyspareunia from the first attempt at sexual intercourse ). They were compared with 72 (65%) who had secondary vestibulitis with reg ard to demographic, social, and medical variables, the presence of human pa pillomavirus deoxyribonucleic acid, physical and histopathologic findings i n the vestibule, and surgical outcome. RESULTS: Women with primary vestibulitis were 5 years younger than those wh o had secondary vestibulitis (22.9 +/- 2.9 years vs 27.7 +/- 8.6 years, res pectively; P < .0001) and differed in their marital status (unmarried, 84% vs 56%, respectively; P < .008), parity (nulliparous, 97% vs 67%, respectiv ely; P < .0002), and involvement of the whole vestibule (74% vs 93%, respec tively; P < .006). The 2 groups were similar in all other variables, includ ing use of oral contraception, smoking, presence of human papillomavirus, d ysuria, success of perineoplasty (average, 83%), and histopathologic findin gs. CONCLUSIONS: Women with primary vestibulitis were younger than women with s econdary vestibulitis. Most other differences were dependent on the differe nt ages of the 2 groups. Primary and secondary vestibulitis may therefore b e two presentations of the same disease.