Historic terms for vulvar vestibulitis (vulvar adenitis, ery-thematous vulvitis, burning vulva syndrome) all implicate inflammatory changes, but it was not until the late 1970s and 1980s that the histologic changes associated with vestibulitis were better characterized.

A 1988 study analyzed 41 surgical specimens from patients diagnosed with vulvar vestibulitis. Chronic interstitial inflammation was seen in all cases and the glands were not involved. The etiology of this inflammation was undetermined.7 More recently, controlled studies have produced more mixed results with similar patterns of inflammation but often no differences from control specimens.6,11,12

When investigating hypotheses that vascular injury, immunologic alterations, or changes in nociception may be contributing factors, additional histologic findings have been noted. Inflammatory cytokines interleukin-1 and tumor necrosis factor were elevated in vestibulitis specimens compared with perineoplasty specimens from asymptomatic women.13 Increased levels of perivascular immunoglobulin M, complement, and fibrinogen, as well as heightened angiogenesis have been noted in vestibulitis specimens compared with controls.14 Studies have noted increased neural hyperplasia in vestibulitis subjects and found the degree of vestibular nerve formation significantly correlated with the degree of inflamma-tion.15,16 Whether these changes are causative or secondary remains unclear.

Immune dysfunction has also been postulated as an underlying factor in vulvar vestibulitis with decreased natural killer cell activity in the vestibular tissues of symptomatic women. It has also been observed that natural killer cell activity increases after application of interferon.17

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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