In the past ten years, the problem of vestibulitis has been increasingly recognized as a cause of painful sexual intercourse. Women with this disorder report "burning" pain that is right at the opening (vestibule) of the vagina. In more severe cases, the pain is present during normal daily activities, as well as during sex. Careful examination reveals redness and unusual sensitivity of the tissue at the opening of the vagina. It seems to be what is called a "neuro-inflammatory" condition. This means that inflammation starts (for any one of a long list of reasons, such as vaginal infection) which causes pain; the nerves involved in sensing the pain then release chemicals that promote inflammation, and this inflammation causes further pain. Thus, a "vicious cycle" gets started that can last for years
Although this problem is not caused by any single factor, it can be aggravated by acid foods in the diet, by low levels of estrogen hormone, and by any infections that happen to occur while it is there. At the same time, it seems that many treatments bring about at least some relief in some women.
The regimen we use now is one we have arrived at as the result of over 10 years of experience in treating this disorder, having tried many different treatment methods. Our most successful treatment has been a combination of estradiol (estrogen hormone) and lidocaine (local anesthetic) compounded in a special preparation. Applied three times daily over 6 to 8 weeks, many women note considerable improvement.
In some cases, we add medications that seem to interrupt the abnormal sensitivity of the nerves, such as tricyclic antidepressants and anti-epileptic drugs, medications that have been shown to be effective for "neuropathic" (abnormal nerve function) pain. When pelvic muscles have become abnormally tight as a result of the pain, we find pelvic muscle exercises helpful, sometimes assisted by pelvic floor biofeedback done by a physical therapist. Medical measures bring about sufficient relief in about 8 of 10 women.
For those still having pain after medical measures have been used for a number of months, we offer a surgery (vulvar vestibuloplasty) that has proven successful in over 90% of cases. We try medical measures first, however, because they are so often successful, and the surgery involves 10 days of rest at home afterward, following by several months of further treatments to the sensitive vaginal tissue before comfortable sexual relations can resume.
We have performed approximately 150 of the vestibuloplasty surgeries, and have made a number of improvements in the procedure over the years.We've tried a number of treatments that have been popular for short periods of time and found them unhelpful in the long run. These include laser treatment, interferon injections, low oxalate diet, and pelvic floor biofeedback as a primary treatment method.
Finally, we recognize that long years of unhappy sexual life can cause great strains on a relationship. We have developed a list of counselors skilled in dealing with marital and sexual issues, and often encourage counseling as part of recovery.