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 What Doctors Don't Tell You: Vestibulitis and labyrinthitis 
What Doctors Don't Tell You © (Volume 12, Issue 7)
Q I have been diagnosed with vestibulitis, which I have been suffering from for the past two years. During that time, I have been receiving treatment from a dermatologist. I’ve tried steroid creams, local anaesthetic gels and antidepressants. None of these has worked. The next suggested treatment is antispasmodic drugs which, I believe, are more of the same thing.

This week at the hospital, I saw a gynaecologist, who suggested surgery for removing the affected area of skin and remodelling. I understand this is a painful operation and the gynaecologist had no figures to hand regarding success rates. I have since looked on the Internet and at information sent me by Women’s Health in South Tyneside, but have found no details on success rates. In fact, I read that some women are in worse pain afterwards.- D.D., via e-mail

A Vestibulitis refers to an inflammation of the entrance - called the ‘vestibule’ - to the vagina, the moist pink part immediately inside. These little hot spots of inflammation can occur near the urethra, the canal through which urine passes, or at the back or sides of the vagina. Often, those areas most inflamed are the four glands which provide lubrication to the vaginal entrance.

Doctors can’t always pinpoint any problem and any medical tests often turn out negative. The pain can be so acute that even just touching the affected area with a cottonbud can cause the patient to cry out in sometimes severe pain.

Nevertheless, vestibulitis can often be missed on a general medical examination because the pain only occurs when the areas are touched or pressure is applied. There are no obvious signs of infection such as a discharge, bleeding or a visible lesion.

At best, even with a biopsy, a doctor may only see a slight increase in blood supply - not much on which to determine that anything significant is wrong. In one study, two-thirds of patients required more than six visits to various doctors before a diagnosis was finally made (J Reprod Med, 2001; 46: 227-31).

One theory is that this condition could be the result of a rare gene, and that symptoms are caused by an immune imbalance in the regulation of inflammation. In one recent study, the researchers found the presence of increased numbers of nerve fibres in vestibulitis sufferers (Obstet Gynecol, 1998; 91: 572-6), a situation that is similar to that seen in other diseases of chronic inflammation, such as Crohn’s disease and interstitial cystitis.

The fact that, initially, doctors usually can’t find anything wrong with a patient who complains of pain during sexual intercourse presents them with a golden opportunity for labelling the condition as all in the patient’s pretty little head. Nevertheless, more and more doctors are acknowledging this condition to be a very real problem, even if their only solutions are crude, solely suppressive or, in your case, the drastic offer to remodel your vagina.

As you mentioned, the typical treatment involves an assortment of pills and creams, including oral antibiotics, which are thought to reduce inflammation in general; the antidepressant amitriptyline, which supposedly can reduce pain when taken in small doses at night; steroid creams, to be applied to the affected areas; or even steroid injections.

In one study, researchers were experimenting with a steroid/anaesthetic combination administered in such a way as to provide a slow drip-feed of the drug (J Reprod Med, 2001; 46; 713-6). Nevertheless, even with this double-whammy, nearly a third of the study patients failed to respond. One of the latest attempts at finding the magic bullet employed cromolyn, usually administered for asthma, in a cream, but this drug did no better than a placebo in reducing symptoms (Sex Transm Infect, 2001; 77: 53-7).

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What Doctors Don't Tell You What Doctors Don’t Tell You is one of the few publications in the world that can justifiably claim to solve people's health problems - and even save lives. Our monthly newsletter gives you the facts you won't......more
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