Bornstein J, MD, MPA, Professor and Chairman. Department of Obstetrics and Gynecology, Western Galilee Hospital and Rappaport Faculty of Medicine
Vestibulitis, recently renamed Vestibulodynia, or localized provoked vulvodynia, is a common cause of dyspareunia. Until 1981, dyspareunia was considered a result of vaginismus. Since then it was discovered that dyspareunia can be caused by Vestibulodynia, a physical condition characterized by hyperesthesia of the vestibule. In a population-based study, 16% of women aged 18-64 reported histories of chronic vestibular burning, knifelike pain, or pain on contact that lasted three months or longer. This highly prevalent condition causes many women to abstain from intercourse. Using immunostaining by C-kit, Mast cell Tryptase and Heparanase, S-100 and PGP-5,9, we detected increased local heparanse expression, as well as subepithelial and intraepithelial hyperinnervation, and a significant increase in sub-epithelial inflammatory infiltrate, number of mast cells and degranulated mast cells, in cases of Vestibulodynia, compared to normal controls. A search for the local presence of H. Pylori proved negative.
As a result of our finding, anti-heparanse therapy is under clinical study. So far, the most effective therapy for Vestibulodynia is surgical excision of the vulvar vestibule (Vestibulectomy, Perineoplasty). Other treatments are rehabilitation of pelvic musculature using biofeedback techniques, topical oils or anesthetic creams, behavioral therapy, low dose tri-cyclic antidepressants, certain anti-convulsants, such as Gabapentin and Pregabalin, low oxalate diet, and local interferon injections.