vestibulitis

Vestibulitis, also known as vulvar vestibulitis syndrome, is a pain or inflammation of the vulvar vestibule, the area around the vaginal opening. It is considered a form of vulvodynia, characterized by pain that is provoked by touch or penetration. The pain is commonly described as burning, stinging, or raw sensation and may affect sexual activity, voiding, or insertion of tampons.

Signs and symptoms are typically provoked by contact with clothing or objects, during sexual activity, tampon use, or attempted penetration. A cotton-swab test or gentle vestibular palpation reproduces pain. Inflammation may be localized to the vestibule with normal surrounding skin; infections are absent.

Causes and risk factors: The underlying cause is not well understood. The condition may involve inflammatory or neuropathic processes, hormonal factors, irritants or allergies, minor infections, and pelvic floor muscle hypertonicity. It often coexists with other vulvar pain disorders such as provoked vestibulodynia.

Diagnosis is clinical, based on history and pelvic examination; cultures and dermatologic screening are used to exclude infection or dermatitis. The cotton-swab test helps identify localization of pain to the vestibule. Imaging is not routinely required.

Management is typically multidisciplinary and starts with conservative measures: avoidance of irritants (perfumed products), wearing breathable cotton underwear, vaginal moisturizers, and analgesic lidocaine during flares. Pelvic floor physical therapy, oral neuropathic medications (e.g., amitriptyline, gabapentin), and cognitive-behavioral therapy can improve pain and function. Topical corticosteroids may be used selectively for dermatitis. In refractory cases, surgical options such as vestibulectomy or vestibuloplasty may be considered, with risks including altered sensation and persistent pain; surgical outcomes vary.

Prognosis and epidemiology: Many affected individuals respond to multidisciplinary care, though some experience chronic symptoms. The condition is relatively common among vulvar pain disorders, with estimates varying due to diagnostic criteria.