Vestibulodynia

Question 1

Definition of vestibulodynia

Answer 1

Likely to be multifactorial, a history of vulvovaginal
candidiasis, usually recurrent, is the most commonly
reported feature

Question 2

Symptoms of vestibulodynia

Answer 2

. Vulval pain – frequently felt at the introitus at penetration during sexual intercourse or on insertion of
tampons. There is usually a long history

Question 3

Signs of vestibulodynia

Answer 3

. Focal tenderness elicited by gentle application of a
cotton wool tip bud at the introitus or around the
clitoris

Question 4

Investigations for vestibulodynia

Answer 4

. After exclusion of other treatable causes no further
investigation is required.
. Biopsy should be performed if there is any suspicion
of an underlying dermatosis

Question 5

Treatment of vestibulodynia

Answer 5

. Avoidance of irritating factors.
. Use of emollient soap substitute.
. Topical local anaesthetics, e.g. 5% lidocaine ointment
or 2% lidocaine gel should be used with caution
as irritation may be caused. The application
should be made 15–20 min prior to penetrative sex
and washing off the lidocaine just before sex or the
use of condom by the partner can reduce the risk of
transfer resulting in penile numbness. Oral contact
should be avoided.
. Physical therapies
. Pelvic floor muscle biofeedback.
. Vaginal transcutaneous electrical nerve stimulation
. Vaginal trainers
. Cognitive behaviour therapy
. Psychosexual counselling.
- amytriptiline
- vestibulectomy