The etiology of vulvar vestibulitis is unknown. It includes acute and chronic inflammation of the vestibular glands, which are located in the vestibule of the vagina near the hymen. Affected glands can be located on the circumference of the vestibule and capture the urethra area, but more often involved are the posterolateral glands in the position between 4 and 8 hours. Vestibulitis should be presumed in all patients with the first emerging dyspareunia of administration. Such patients often complain of progressive dyspareunia up to the total impossibility of sexual intercourse.
This condition can develop in a few weeks, but more often the progressive deterioration takes place within 3-4 months. Patients also complain of pain when swabs are inserted, as well as during washing or irrigation of the perineum.
The basis of diagnosis is a physical examination. Since the vestibular glands are located in the fold between the hymen and the medial margin of the vestibule, this area is often not examined, which leads to incorrect diagnosis. After introduction into the vagina of the mirror, the area of the vestibular glands becomes inaccessible for examination. After a careful examination of the area of the vestibular glands, with a light touch to it with a stick with a wet gauze swab at the end, the pain occurs precisely in those patients who have vulvar vestibulitis.
In addition, in the affected areas are often visible reddish spots of small dimensions. Since the cause is unknown vestibulitis, its treatment is highly diverse and vary from temporary interruption of sexual activity, application of ointments and cortisone ksilokainovogo gel to a drastic methods, such as surgical removal of the vestibular glands. No monotherapy was not efficient enough, and every treatment should be individualized and based on the severity of symptoms and the degree of sexual dysfunction.
In a small number of recent reports, there have been suggestions of the effectiveness of small doses of tricyclic antidepressants (amitriptyline and imipramine) in some patients that eliminate pain syndrome. Other reports suggested using calcium citrate to change the composition of urine and prevent the formation of oxalic acid crystals. The authors suggest changing the chemical composition of urine, justify this with a special irritating effect of oxalic acid crystals, which are formed with a high content of oxalic acid in the urine. The effectiveness of the use of calcium citrate requires a further, long-term, randomized study, but the preliminary data look promising.
Benign neoplasms of external genital organs.
Fat or inclusive cysts result from inflammation and subsequent blockage of the excretory ducts of the sebaceous glands and are small, smooth formations, usually protruding from the inner surfaces of small and large labia, filled with curdled grease. They can easily be removed if their size or position causes inconvenience.
A round ligament reaches the large labia, accompanied by a process of peritoneum. Sometimes peritoneal fluid can accumulate in this process, forming the cyst of the inguinal canal or the hydrocele of the large labia. When such cysts reach symptomatic dimensions, they usually need to be removed.
Fibromas arise from the connective tissue of the vulva and are usually small in size. Large fibroids may have a leg. The almost incredible case of fibroids of the vulva on a leg weighing more than 100 kg, described by Buckner in 1851, is of purely historical interest. The method of treatment, of course, is surgical removal. Lipomas are similar to fibroids, they are very rare and are also treated by surgical removal.
Hydroadenoma is a rare formation that arises from the sweat glands of the vulva. It is almost always benign and usually located on the inner surface of large lips. The method of treatment is surgical removal.
Nevuses are benign. usually asymptomatic, pigmented foci, which need to be differentiated from malignant melanoma, since 3 to 4% of melanomas in women are localized on the external genitalia. For this reason, a biopsy of the pigment lesions of the vulva is important.