Vulvar vestibulitis
Introduction
Introduction to vulvar vestibulitis Vulvar vestibulitis, also known as vulvar vestibular syndrome, is a chronic persistent clinical syndrome. Vulvar pain during sexual intercourse, more common in women with active sexual life. Most patients have a history of several months or even years with repeated bacterial infections or a history of genital warts. The cause may be related to infections, especially human papillomavirus infection, urate stimulation, long-term topical medication, local neuromuscular dysfunction, and psychological factors. basic knowledge Sickness ratio: 0.05%-0.08% Susceptible people: women Mode of infection: non-infectious Complications: vaginal fistula
Cause
Causes of vulvar vestibulitis
Human papillomavirus infection (40%):
The infection may be related to the subclinical infection of the human papillary bacterium (HPV) in the vulva vestibule. In addition, it may be related to Gardnerella vaginalis, Candida and Ureaplasma urealyticum infection.
Vaginal fistula (15%):
Vaginal fistula refers to the intense and continuous contraction of the involuntary vaginal and pelvic floor muscle system during sexual intercourse, making the erect penis unable to be inserted, or although it can be inserted, but during the sexual intercourse or after sexual intercourse, the vaginal opening or deep pain and discomfort . The cause of vaginal fistula is related to psychological factors.
Pathogenesis:
Pathological examination showed non-specific inflammation in the lamina propria and peri-gland tissues, but these changes were also seen in the vestibular tissue of the normal control group; other lesions were squamous metaplasia, parakeratosis and non-specific complement and fibrin deposition, morphology Evidence suggests that the innervation of the vulvar vestibular mucosa has undergone structural changes, epithelial nerve fibers sprout, and free nerve endings proliferate. The detection of neuropeptides in these nerve endings confirms that calcitonin gene-related peptide (GCRP) immunity Positive reaction, some scholars use the peripheral sensitization theory of injury sensory to explain the pathogenesis of vulvar vestibulitis, that is, the sensory abnormality of vulvar vestibulitis patients is due to different types of C nociceptive fiber terminal sensitization and / or hyperplasia To the sensation of mechanically and thermally stimulating polymorphic C fibers, C fibers that are only sensitive to noxious stimuli, and even "silent" fibers that are not normally sensitive to any stimuli. The sum of impulses increases and the time is summed. At the same time, the increase in the number of nociceptive fiber ends can cause the space of the impulse to occur. The sum ultimately leads to a decrease in the pain threshold. In addition, paresthesia is also present in the anterior vestibular mucosa of the vulvar vestibular patient. Although there is no erythema in this part of the mucosa, it is speculated that this area may be associated with peripheral hypersensitivity of the injury sensory sensor.
Prevention
Vulvar vestibular inflammation prevention
Explain to patients that vestibulitis is a disease that has been recognized, not a primary psychological problem. There is no effective treatment. It is recommended to use soap substitutes to avoid soap baths or soaking baths. Most people who follow the doctor's advice The effect is very good and the symptoms will diminish or disappear over time.
Complication
Vulvar vestibulitis complications Complications, vaginal fistula
Be cautious when diagnosing patients who do not follow the doctor's advice or treatment, and look for potential mental problems.
Symptom
Vulvar vestibular inflammation symptoms Common symptoms Urinary pain urinary frequency vulva burning irritating painful dysparid difficulty postpartum drips feeling allergic vaginal mouth local redness heat pain congestion
Mainly manifested as severe pain in the vaginal opening during sexual intercourse, can last for 1 ~ 24h, or a burning sensation in the long-term vaginal opening, may be accompanied by dysuria, frequent urination, drip after urine, which often leads to sexual fear, pain can be after the first sexual intercourse Occurrence or after the occurrence of normal sexual activity, can also be triggered by the placement of a sanitary tampon, vulvar vestibulitis usually under the influence of some stimulating factors (such as surgery, childbirth, infection), the vestibular congestion, swelling, use Cotton swabs can induce pain, usually in the vicinity of the vestibular gland opening. The erythema is confined to the edge of the hymen or around the vaginal opening, or erythema is induced by palpation. The erythema range will also expand in the vestibular area. The allergic area is located in the entire vestibular area, and is limited to the vestibular gland opening or the labial ligament. It can also be expressed as the opening of the paraurethral gland. Sometimes, multiple papillomas can be seen, which are usually misdiagnosed as genital warts. These papillomas are confined to the medial labyrinth and the vestibule, and the base is solid, but they do not fuse like genital warts. Their distribution is uniform and symmetrical, and virological examination is performed. HPV is isolated and considered to be a normal human anatomical variation. Therefore, this type of papilloma-like manifestation in patients with vestibular inflammation is only a coincidence. Some patients also have a history of skin allergies in other parts of the body, most commonly in Facial and facial allergies are associated with triple syndrome: difficulty in sexual intercourse, vestibular erythema and tenderness during gynecological examination, but not due to previous vestibular parotid gland inflammation.
Examine
Examination of vulvar vestibulitis
No specific laboratory tests, negative patch test.
The cotton swab test is an effective way to check the tenderness of the vestibule: use the tip of the cotton swab to gently touch the normal skin as a control, then check the different parts of the external genitalia, and touch the vestibular area to cause the pain to be positive.
The patch test is an auxiliary diagnostic method for determining the body's allergic reaction. According to the nature of the test substance, prepare an appropriate concentration of the infusion solution, solution, ointment or directly use the original as a reagent, soak the test solution with 4 layers of 1 cm2 gauze, or place the test object on the gauze, and place the forearm flexion side. Covered with slightly larger transparent cellophane, surrounded by adhesive plaster, removed after 48 hours, can induce local skin reaction, and the results were judged according to local skin performance at 72 hours.
Diagnosis
Diagnosis and diagnosis of vulvar vestibulitis
diagnosis
According to long-term sexual intercourse vaginal pain and vestibular redness and tenderness can make a preliminary diagnosis, Friedrich in 1987 proposed the diagnostic criteria for vestibulitis.
1. Contact with the vestibule or attempt to insert into the vagina causes severe pain.
2. The tenderness is limited to the vestibular area.
3. The erythema is confined to the vestibular area.
Differential diagnosis
It should be differentiated from the following diseases:
1. Vulvar inflammatory diseases, such as Candida vaginitis, trichomonas vaginitis, sclerosing atrophic moss, eczema.
2. Nervous labial ligament and brittle vulvar syndrome.
3. Symptomatic skin scratch marks.
4. Palsy cysts.
5. Vulvar aphthous ulcers, erosive lichen planus, bullous disease and herpes simplex virus infection.
