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Abstract
This review is based on a MEDLINE/PSYCHINFO search for all papers on psychological aspects of vulvar vestibulitis syndrome (VVS) published 1995-2002. VVS is a condition in which painful patches appear on the vulva which make intercourse painful. Causation, natural history and prevalence of VVS are unknown. Attempts to identify psychological characteristics typical of women with VVS have not yielded consistent results with some studies suggesting high levels of psychopathology and others not. It is suggested that inconsistencies in findings reflect not only decisions by women about whether and how to access health care but also the health care system acting to actively filter those reaching specialist services and selecting those with particular psychological characteristics. There is no compelling evidence that VVS per se is associated with any particular psychological or behavioural characteristics other than the sort of difficulties in sexual functioning which might be expected with chronic vulval pain. However there is evidence for high levels of psychological distress in some samples of women with VVS being seen in secondary care.
Keywords: Vulvar vestibulitis, sexual dysfunction, vulvodynia, vulva
Introduction
Vulvar vestibulitis syndrome (WS) is a puzzling condition in which women develop painful patches on the vestibule [I]3 the area of the vulva around the entrance to the vagina. The main problem caused by the patches is that they make intercourse painful, sometimes intensely so. They can also make the insertion of items into the vagina, such as tampons, traumatic. The pain is only present when the painful patches are touched, this differs from other vulval pain conditions (vulvodynias) of unknown origin, of which the most common is probably essential vulvodynia, where pain is present in the absence of touch. However, since it is impossible to have intercourse without the vestibule being pressed on, WS can cause major disruption to the sex lives of the women who have it. In some women tight jeans or other mechanical pressure on the vulval area can also cause pain.
The cause of WS is unknown. It has been suggested that it is the result of an infection with a sexually transmitted disease such as wart virus [1-7] associated with recurrent Candida [5,8-12] or the result of an allergic reaction [13-15]. There is no convincing evidence for...