Vulvar vestibulitis syndrome: an often unrecognized cause of dyspareunia.

Vulvar vestibulitis syndrome (VVS) is an easily identifiable cause of entry dyspareunia. The aetiology is unknown although there is a strong association with Candida infection. The condition represents a focal area of hyperaesthesia within the vulvar vestibule. A management protocol for patients with this condition is presented; 230 patients with VVS were managed and followed-up over a 5-year period. Spontaneous resolution or improvement occurred in 21% of patients following initial explanation and use of simple local measures. In 21%, there were positive Candida cultures and long-term antifungal therapy resulted in a 71% cure. In Candida-negative patients, low-dose amitriptyline was used (up to 75 mg daily) with a 60% positive response rate. Carbamazepine was of little benefit (13% response). Surgical vestibulectomy was offered when conservative measures failed and this was performed in 22 patients (10%) with a beneficial result in 20 patients (91%).