The treatment of vulvar vestibulitis syndrome: Towards a multimodal approach

Abstract
Vulvar vestibulitis syndrome (VVS) is currently thought to be the main cause of dyspareunia in pre-menopausal women (Friedrich, 1988; Meana et al., in press a), with reported prevalence rates of up to 15% in general gynecological practice (Goetsch, 1991). This syndrome is characterized by severe pain on vestibular touch or attempted vaginal entry, point tenderness to cotton-tip palpation of the vulvar vestibule, and physical findings confined to vestibular erythema and non-specific inflammation (Friedrich, 1987). Irritation and burning can persist for hours or days after sexual activity, and many patients also report localized pain from tampon use, finger insertion, gynecological examinations, wearing tight clothing and exercise. VVS is usually classified as one of the most common subsets of vulvodynia, a general condition of chronic, unexplained vulvar pain. Although it was probably described over a century ago (Skene, 1889), VVS has only recently been recognized as worthy of serious clinical and empirical consideration (e.g. Basson, 1994).

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