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When Love Hurts: Vulvar Vestibulitis

Learn about this condition that can make intercourse painful and how it can be treated.

“Maybe you’d better see a sex therapist.” That’s what Karisa was told by her gynecologist after he had run some tests and found nothing wrong. “In other words, he thought it was all in my head,” said the twenty-nine-year-old middle-school teacher. But Karisa knew that the burning sensation and the painful intercourse she was experiencing were real and that something definitely was not right.

Fortunately, Karisa didn’t let her (former) doctor’s words stop her. She did some research on her own and found information about what appeared to be the answer: vulvar vestibulitis. She then went to a new gynecologist for another opinion and had her suspicions confirmed.


Vulvar vestibulitis is a type of vulvodynia, a syndrome characterized by stinging, irritation, burning, and a raw feeling in the external female genitalia, or vulva, and inflammation of the vaginal opening and the surrounding tissues. These symptoms make sexual intercourse extremely painful and impossible for many women.

In fact, the Vulvar Pain Foundation estimates that 100,000 to 150,000 Women in the Untied States suffer with this syndrome. (This could be greatly underestimated, however, as many doctors don’t recognize this syndrome.) Most affected are white women ages 20 to 60. Not only is sexual intercourse painful for these women, but for many it is difficult to sit or walk because of the pain.

Symptoms of Vulvar Vestibulitis

* Severe pain in the genital area with pressure; for example, when exercising, biking, wearing tight clothing, using tampons, during

sexual intercourse

* Burning, stinging, feelings of rawness and irritation within the

vestibular area (below the urethra opening and above the hymen)

* Redness and inflammation in the vestibular area

* Difficulty walking or sitting

* · Sudden and frequent urge to urinate


Researchers at Weill Medical College of Cornell University in New York City discovered a gene which they believe may be responsible for about 50 percent of cases of vulvar vestibulitis. In the study, 52.9 percent of women with vulvar vestibulitis had the rare gene, an interleukin-1 receptor antagonist (IL-1 gene). Less than 10 percent of women in the general population have this gene.

The IL-1 gene regulates inflammation in other conditions, such as rheumatoid arthritis and inflammatory bowel disease. This is the first time it has been associated with vulvar vestibulitis.

Stephen S. Witkin, PhD, a member of the study, says that simply having the rare gene doesn’t guarantee women will get the syndrome. Something must trigger the inflammation process.

That something could be several different things. Some studies indicate that the human papilloma virus (HPV) could be a trigger. One problem with this idea is that in most women who have the virus, their immune system destroys the virus, which makes it impossible for doctors to isolate and identify whether it was the culprit.

Other researchers suggest that yeast infections, bacterial vaginosis, a history of cryotherapy and carbon dioxide laser therapy, and the use of

irritants such as spermicides, lubricants, soaps, and bath oils could trigger vulvar vestibulitis. Further research is needed to identify any

and all causative factors.


For now, women who have vulvar vestibulitis can only treat symptoms rather than address the cause. Some of those effective treatments include:

· Tricholoroacetic acid, which destroys the affected skin and allows healthy skin to grow in its place

· Interferon injections, which enhance the immune system

· Steroid ointments, which relieve itching and burning

· Applying witch hazel, or taking a bath with baking soda to relieve itching

· Limiting intake of foods that contain high amounts of oxalate (e.g., spinach, peanuts, beets, chocolate, tea, wheat bran). Oxalates are an irritant that causes burning. By reducing oxalates in the diet you decrease the amount of oxalate crystals in the urine.

· Taking 1,200 to 1,800 mg calcium daily to reduce crystals in the urine

Dr. Witkin believes that with the discovery of the rare IL-1 gene, new treatment options may be around the corner. Already, several compounds that reduce inflammation are being tested.

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