Clinical Presentation

Typically, patients will present with a history of vaginal pain or burning and dyspareunia. Upon further questioning, the pain is localized to the introitus and usually described as a burning or cutting that initiates with entry. Often tampon insertion or other activities increasing pressure in the vestibule will elicit similar symptoms. Many patients will present with "recurrent cystitis," caused by episodic burning with urination. Upon detailed questioning, it is determined that the burning is external, typically after voiding and frequently with negative urine cultures, and it resolves whether or not antibiotics are taken.

Other vulvar dysesthesias can be difficult to distinguish from vestibulitis. The key difference is that vulvar vestibu-litis has provoked symptoms, with pain initiated by direct physical contact. Women with vestibulitis will often have great apprehension about sexual intercourse and largely cease activity secondary to the degree of pain.

Distinctions have been made between women with primary vestibulitis, dyspareunia at the initiation of their sexual experience, and secondary vestibulitis (dyspareunia after a time of asymptomatic intercourse) because patients with primary vestibulitis do not tend to respond as well to treatment.4

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