The symptoms often have an acute onset after some trigger such as surgery, childbirth, or an infection. The patients complain of pain on attempted vaginal entry, that is, with intercourse or using tampons, and demonstrate acute tenderness in the vestibule on pressure with a cotton-wool tip, together with variable erythema. The tenderness is The histology shows nonspecific inflammatory changes, but it has now been shown that such changes occur also in normal vestibular tissue. Management begins with a careful explanation to the patient, and an assurance that the condition is well recognized. For those with a short history and a stable personality this may suffice.
Some patients have pelvic floor hypertonia and can be helped by biofeedback.
Low-oxalate diets have been advocated but with little evidence of benefit. In severe cases, it is worth introducing amitriptyline. Surgical treatment should be used, if at all, only in those who have failed to respond to other measures. The surgical procedure should be very fully explained to achieve the best outcome. The recognition of some overlap between dysesthetic vulvodynia and vulval vestibulitis, in that in the latter, the pain may be helped by amitriptyline and in some cases may change into a constant, unprovoked affair, has gradually led to the concept that both may be pain syndromes.