VESTIBULITIS

Report #7226

Gynecologists often are unable to find a cause for vaginal pain, burning and itching. Recent papers show exciting new treatments for at least two common conditions.

The most common cause of vaginal itching and burning is infection. Allergy to something touching that area is rarely a cause of the long-term symptoms (1). Doctors test for sexually transmitted diseases such as chlamydia, gonorrhea, gardnerella and other bacteria, a virus called herpes, a parasite called trichomonas, and yeast. Since yeast is a normal inhabitant of the vagina, it is often diagnosed as the cause of vaginal problems when it is often an innocent bystander. Often the cultures fail to reveal a cause, but it is still good practice for doctors to prescribe antibiotics, such as metronidazole and azithromycin. If symptoms continue, doctors often apply vinegar pads to look for warts or they may recommend stopping bubble baths that cause irritations. A biopsy can lead to diagnoses of vestibulitis or lichen sclerosis, which until recently had no effective treatments. A recent paper shows that lichen sclerosis can be treated with decadron injections (2). (8 mg dexamethasone, 4 mg into each side of lesion, three injections in a week.) Another shows that it may be caused by Lyme disease and therefore, could respond to antibiotics (3). Another recent paper shows that some cases of vestibulitis are caused by venereal warts (4), which can be treated with thrice weekly injections of interferon into the warts, or injections of a cancer drug called 5-FU (5). Non wart vestibulitis can also be cured with an antifungal cream called ketoconazole (6) or a combination of a fungal cream with the antibiotic, metronidazole (7). Yet, many women continue to have itching and burning and doctors can find neither a cause nor an effective treatment.

By Gabe Mirkin, M.D., for CBS Radio News
Checked 8/9/05

1) D Nunns, J Ferguson, M Beck, D Mandal. Is patch testing necessary in vulval vestibulitis? Contact Dermatitis 37: 2 (AUG 1997):87-89.

2) MS Baggish, EHM Sze. Subdermal decadron and bupivacaine to treat symptomatic lichen sclerosus. Journal of Gynecologic Surgery 11:4(WIN 1995):245-249.

3) H Fujiwara, K Fujiwara, K Hashimoto, AH Mehregan, G Schaumburglever, R Lange, C Schempp, H Gollnick. Detection of Borrelia burgdorferi DNA (B-garinii or B-afzelii) in morphea and lichen sclerosus et atrophicus tissues of German and Japanese but not of US patients. Archives of Dermatology 133: 1 (JAN 1997):41-44.

4) J Bornstein, S Shapiro, M Rahat, N Goldshmid, Z Goldik, H Abramovici, N Lahat. Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome. American Journal of Obstetrics and Gynecology 175: 1(JUL 1996):139-144.

5) JM Swinehart, M Sperling, S Phillips, S Kraus, S Gordon, JM Mccarty, GF Webster, R Skinner, A Korey, EK Orenberg. Intralesional fluorouracil/epinephrine injectable gel for treatment of condylomata acuminata: A phase 3 clinical study. Archives of Dermatology 133: 1 (JAN 1997):67-73. The fluorouracil/epinephrine gel was significantly more effective (P<.002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with cure rate was 58%. No clinically significant drug-related systemic reactions occurred.

6) GD Morrison, SJ Adams, JS Curnow, RJ Parsons, P Sargeant, TAA Frost. A preliminary study of topical ketoconazole in vulvar vestibulitis syndrome. Journal of Dermatological Treatment 7: 4 (DEC 1996):219-221. Improvement 44% in 8 months.

7) S Kukner, T Ergin, N Cicek, M Ugur, H Yesilyurt, O Gokmen. Treatment of vaginitis. International Journal of Gynecology & Obstetrics 52: 1(JAN 1996):43-47. Metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran(R), Embil Pharmacy Company, Istanbul, Turkey) insert twice daily for 14 days.

Checked 9/5/05