Vulvar vestibulitis syndrome: a form of reflex sympathetic dystrophy?

Abstract

Our purpose was to determine whether vulvar vestibulitis syndrome is a form of reflex sympathetic dystrophy syndrome. Between October 1, 1998, and February 16, 1999, 20 subjects attending a gynecology clinic at a tertiary care center received diagnoses of vulvar vestibulitis syndrome. A history was recorded, and a gynecological examination was performed for each, including a detailed description of the vulva, vaginal Gram's stain, vaginal culture, pH, and wet preparation of any discharge. Vulvar examination included assessing each subject's response to touch, pressure, pinprick, vibration, and cold. Subjects completed the short form of the McGill Pain Questionnaire. Twenty subjects with vulvar vestibulitis syndrome (average age, 30.6 years; range, 20-71 years) had pain present an average of 4 years and 8 months (range, 6 months-33 years). Pain occurred with entry dyspareunia, tampon insertion, or touching of the vestibule. Vulvar vestibular erythema was present in 13 subjects. None of the 20 subjects felt pain to light touch on the vulvar vestibule. Light pressure produced allodynia in all 20. Nine subjects had hyperalgesia to pinprick; five subjects had allodynia in response to vibration; and three subjects experienced allodynia to cold. Summation and aftersensation to test modalities were uncommon. Though both vulvar vestibulitis and reflex sympathetic dystrophy seem to be neuropathic pain syndromes, they do not share enough physical characteristics to be considered the same pathological processes.