As a Private Gynaecologist working in Harley Street, London. I am now seeing many more patients, who cannot access NHS GPs NHS Gynaecology appointments, and many of these women cannot access treatment for the pain associated with Vestibulitis and vulvodynia. Vestibulitis is now a treatable but a difficult condition to manage, and I am disappointed by how many women suffer from this condition, and do not have adequate treatment.
It is a characteristic pain around the vulva or the vestibule-just outside the vagina. This pain can cause redness and irritation of the vulval labial and perineal skin. VVS will require a face-to-face consultation with a Consultant Gynaecologist. This will allow the specialist to advise on a specific treatment plan.
The diagnosis is based on 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.
I ensure that all my patients have a thorough pelvic evaluation to rule out other pathology. If I am concerned about either a candidal vaginitis or bacterial vaginosis, I will assess this during the examination, and I will send swabs for analysis. There can be more than one cause for symptoms.
Biopsies are only be performed only if there is a vulvar abnormality or a lesion. The diagnosis is that the only finding found on examination is erythema of the vulvar tissue. If vulvodynia is the diagnosis, pain mapping-with either a Q-tip test is vital.
The most successful treatment is a 5 month course of a tricyclic antidepressant.
70% of patients are cured, some will also benefit from psychosexual support.
Topical local anaesthetic. C02 laser treatments.
Like all chronic conditions, it is vital to start treatment early to prevent recurrence.