The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis

Background. Although women with vulvar vestibulitis syndrome have principal symptoms of inflammation such as local erythema and pain in the mucosa aro und the vaginal introitus, it is not clear if vestibulitis is an inflammato ry condition. Cyclooxygenase 2 and inducible nitric oxide synthase are know n to be upregulated during inflammation. The aim of the present study was t o analyze the expression of these enzymes in the vestibular mucosa in order to evaluate the inflammatory activity in the tissue. Methods. Ten women fulfilling Friedrich's criteria of vulvar vestibulitis s yndrome and ten control subjects were included in the study. Punch biopsies were obtained from the vestibular mucose for analysis of cyclooxygenas 2 a nd inducible nitric oxide synthase, using indirect immunohistochemistry and Western dot-blot analyses. Results. Both methods used showed low expression of cyclooxygenas 2 and ind ucible nitric oxide synthase in the vestibular mucose of all women. There w as no difference observed between the groups. Conclusions. There is a low expression of the inflammatory markers cyclooxy genas 2 and inducible nitric oxide synthase in the vestibular mucosa of wom en with vulvar vestibulitis syndrome as well as in healthy control subjects . The results indicate no active inflammation present and imply that topica l corticosteroids in the treatment of vulvar vestibulitis: are unfounded.