In some cases, inappropriate therapy may even make the symptoms worse. Since physical findings are few and cultures and biopsies are frequently negative, patients may be told that the problem is primarily psychologic, thus invalidating their pain and adding to Diagnostic and Management Challenges Subsets of Vulvodynia Several subsets of vulvodynia have been identified. 4,8 Since vulvodynia is a multifactorial condition, certain subsets may also coexist with Vulvar Vestibulitis Syndrome Vulvar vestibulitis syndrome is also known as adenitis or focal vulvitis. It is characterized by entry dyspareunia, discomfort at the opening of the vagina, a positive swab test, tenderness localized within the vulvar vestibulum, and Chronic vestibulitis lasts for months to years, and patients may experience entry dyspareunia and pain when attempting to insert a tampon. The etiology of vulvar vestibulitis syndrome is unknown.
Some cases seem to be provoked by yeast vaginitis.
Other suspected causes include recent use of chemical irritants, a history of destructive therapy such as carbon dioxide laser or cryotherapy, or allergic drug reactions. When surgical specimens were evaluated by polymerase chain reaction, human papillomavirus was present in many women with vulvar vestibulitis syndrome Histologic examination of symptomatic vestibular tissue has confirmed the presence of mixed chronic inflammatory infiltrates in the superficial stroma, but inflammatory cells have not been found to Cyclic Vulvovaginitis Cyclic vulvovaginitis is probably the most common cause of vulvodynia and is believed to be caused by a hypersensitivity reaction to Candida. While vaginal smears and cultures are not consistently positive, microbiologic proof should be sought by obtaining candidal or fungal cultures during an asymptomatic phase. Pain is typically worse just before or during menstrual bleeding. It also may be exacerbated after intercourse, especially on the following day.