As a Private Gynaecologist working in Harley Street, London. I am now seeing many more patients, who cannot access NHS GPs or are referred for NHS Gynaecology appointments. Vestibulitis is treatable but a difficult condition to manage, and I am struck by how much women with this condition suffer.
These conditions require a face-to-face consultation with a Consultant Gynaecologist. This will allow me to advise you on a specific treatment plan. The diagnosis is made from the history, and also the characteristic findings at examination. Most patients tell me about a feeling of ground glass on the vulva. They go on to explain that even using a tampon is the most painful experience.
When I carry out the examination, I always find a characteristic flare on the labia caused by touch, normally with a cotton wool bud. The pain remains and I will always treat this, but result by the end of the examination.
The medical treatments for Vestibulitis are both effective and transformative. I include in my treatment regime, the use of low dose imipramine, which is a tricyclic anti-depressant. This treatment is now successfully helping many women who have this condition. Vestibulitis is a chronic pain syndrome, and imipramine after a three month course is highly effective.
I also offer the MonaLisa touch laser as an effective laser treatment for Vestibulitis. These results using the MonaLisa Touch are very exciting, and some patients only need one treatment.
I ensure that all my patients have a thorough pelvic evaluation to rule out other pathology. If I am concerned about a candidal vaginitis or bacterial vaginosis is considered during the examination, I will send swabs for analysis. There can be more than one cause.
Biopsies are only be performed only if there is a vulvar abnormality or lesion. The diagnosis is that the only only pathology that should be noted on pelvic examination is erythema of vulvar tissue. If vulvodynia is the diagnosis, pain mapping—with either a Q-tip test is vital.
Below is the classic appearance of vulval vestibulitis which causes extreme pain.