Vulval Vestibulitis Syndrome
Objective: This project investigates ways of assessing Vulval Vestibulitis Syndrome (VVS), possible aetiological factors, and response to a range of treatments. Materials and Methods: 1. Data were collected and analysed to identify possible epidemiological characteristics and compared to existing evidence. 2. Technology (an algesiometer) was used to reliably assess patients, and quantify response to treatment. 3. Immunohistochemistry was used to determine whether VVS is an inflammatory condition. 4. Immunohistochemistry was also used to investigate the expression of oestrogen and progesterone receptors in the vulval tissue of women with VVS and biochemical techniques were used to investigate any relationship with serum oestradiol. Results: The cohort of women fulfilling the criteria for VVS were aged 22 to 53 (mean age 34.6) and for some there appeared to be an association with use of the combined oral contraceptive pill (cOCP). The algesiometer allowed quantification of pain, and improvement with treatment. There appears to be an overall decreased expression of inflammatory markers in women with VVS. There appears to be no correlation between serum oestradiol and VVS, however vulval tissue from women with VVS appears to express less oestrogen receptors, although there is no difference in the expression of progesterone receptors. Discussion: VVS is a condition which appears to have well defined epidemiological characteristics, although subgroups may exist. There is evidence that it is not an inflammatory condition, as previously thought, giving weight to the current argument that it is not an "itis" and the condition should be defined as localised provoked vulvodynia, as proposed by the International Society for the Study of Vulvovaginal Disease (ISSVD) at their congress in 2003. The nomenclature and classification of vulval pain forever appears to be evolving. Since late 2003 the term Vulval Vestibulitis Syndrome is no longer recommended by the ISSVD, although it was the term in use at the time this work was performed. The patients were selected for the studies by fulfilling Friedrich's criteria for WS, and therefore this term is used throughout this thesis.