Vulvar vestibulitis

　　1. Etiology

　　The etiology is unclear and may be related to infection, especially human papillomavirus (HPV) infection, abnormal nerve fiber hyperplasia, vaginismus, candidal vulvovaginitis, uric acid stimulation in urine, changes in vaginal pH, reactions after vulvar disease treatment, urethral pressure and variation, long-term local medication, oral contraceptives, and psychological factors.

　　2. Pathogenesis

　　Pathological examination shows non-specific inflammation in the lamina propria and periglandular tissue, but these changes are also seen in the vestibular tissue of the normal control group; other lesions include squamous metaplasia, incomplete keratinization, and non-specific complement and fibrin deposition. Morphological evidence indicates that there has been a structural change in the nerve supply of the vulvar vestibular mucosa, with the sprouting of nerve fibers in the epithelial layer and the hyperplasia of free nerve endings. Detection of the content of neuropeptides in these nerve endings confirms a positive GCRP immune reaction. Some scholars use the theory of peripheral sensitization of nociceptors to explain the pathogenesis of vulvar vestibulitis, that is, the sensory abnormalities in patients with vulvar vestibulitis are caused by the sensitization and (or) hyperplasia of different types of C nociceptive fibers, including poly-modal C fibers that sense mechanical and thermal stimuli, C fibers that are only sensitive to noxious stimuli, and even 'silent' fibers that are insensitive to any stimulation in normal times. After these fibers become sensitized, their传入 impulses increase and occur in temporal summation. At the same time, the increase in the number of nociceptive fiber endings can also cause spatial summation of传入 impulses, ultimately leading to a decrease in the pain threshold. In addition, sensory abnormalities also exist in the anterior mucosa of the vulvar vestibulitis patients, although this part of the mucosa has no erythema. It is speculated that the sensory abnormalities in this area may also be related to peripheral sensitization of nociceptors.

　　Vulvar vestibulitis complications: Caution is required when diagnosing patients who do not follow medical advice or whose treatment is ineffective, and potential mental health issues should be sought. When there are mental health issues, patients should be explained that vestibulitis is a recognized disease rather than a primary psychological problem. There is no effective treatment. Patients can be advised to use soap substitutes to avoid soap baths or sitting baths. Most patients who follow medical advice have a good effect, and symptoms will subside or disappear over time.

　　The main manifestation is severe pain at the vaginal orifice during sexual intercourse, which can last from 1 to 24 hours, or there may be a long-term burning sensation at the vaginal orifice, accompanied by dysuria, frequent urination, and dripping after urination, which often leads to fear of sexual intercourse. Pain can occur after the first sexual intercourse or after normal sexual activity, or can be triggered by inserting a sanitary pad. Vulvar vestibulitis usually acute onset under the influence of some triggering factors (such as surgery, childbirth, infection). Examination shows congestion and swelling of the vestibule, and gentle touch with a cotton swab can induce pain, which is most pronounced near the opening of the vestibular gland. Erythema is limited to the edge of the hymen or around the vaginal orifice, or erythema can be induced by palpation, and the erythema range can also expand within the vestibule. The area of hyperesthesia is located throughout the vestibule, some are limited to the opening of the vestibular gland or the labial frenulum, and can also be manifested as the opening of the paraurethral glands. Sometimes multiple papillomas can be seen, usually misdiagnosed as genital warts. These papillomas are limited to the inner side of the small labia and the vestibule, with a firm base, but unlike genital warts, they do not fuse together. Their distribution is uniform and symmetrical. Virus testing did not isolate HPV, and it is considered a normal anatomical variation in the human body. Therefore, the appearance of this papilloma-like manifestation in patients with vestibulitis is coincidental. Some patients also have a history of skin allergies in other parts of the body, most commonly on the face. Facial allergies often occur with the 'triad': sexual difficulty, vulvar erythema, and tenderness during gynecological examination, but not due to the previously thought vulvar glanditis.

　　I. Epidemiology

　　It is more common in women with active sex lives, especially white women with red hair aged 20 to 40, accounting for 15% to 21.3% of gynecological clinic visits. Most have a history of recurrent bacterial or condyloma acuminatum infection. The history lasts for several months to several years. About 30% can self-resolve, half of which occur within one year. Vulvar vestibulitis syndrome is prevalent in active women, most of whom have a history of recurrent bacterial or infection. In 1987, Friedrich defined this syndrome as:

　　1. The patient feels severe pain when touching the vulvar vestibule, or inserting into the vagina, or inserting a suppository into the vagina.

　　2. There is tenderness upon pressing the vulvar vestibule.

　　3. The prepuce presents with varying degrees of erythema. The characteristic is that the patient reports pain and discomfort upon vaginal opening, with insertion pain, local erythema palpable during examination, and pinpoint pain upon gentle pressure with a cotton swab on the gland openings or the posterior vaginal frenulum. Pain during sexual intercourse is abnormal, and even within 24 hours after sexual intercourse, there may be burning pain in the vulva. Severe cases may not be able to have normal sexual life. Generally speaking, lesions within 3 months are considered acute; those beyond 3 months are chronic.

　　Second, prognosis

　　No adverse prognosis has been reported.

　　1. There is no specific laboratory examination, and the patch test is negative.

　　2. Cotton swab test is an effective method to check for vestibular tenderness: that is, use the tip of a cotton swab to gently touch normal skin as a control, and then check different parts of the external genitalia, and gentle touching the vestibular area can cause pain, which is positive.

　　3. Patch test is an auxiliary diagnostic method for determining the body's变态反应. Prepare appropriate concentrations of solutions, ointments, or directly use the original substance as reagents according to the nature of the test substance, moisten 4 layers of 1 cm2 gauze with the test solution, or place the test substance on the gauze, place it on the flexor side of the forearm, cover it with a slightly larger transparent glass paper, and fix it with rubber膏. After 48 hours, remove it to induce local skin reactions, and read the results according to the local skin manifestations at 72 hours.

　　First, dietary therapy for vulvar vestibulitis

　　1. Black fungus and rock sugar as needed. Dry the black fungus, grind it into powder, take 2 grams twice a day with sugar water. Suitable for red and white leukorrhea.

　　2. Winter melon seeds 90 grams, rock sugar 90 grams. Crush the winter melon seeds and add rock sugar, boil with water, take one dose in the morning and one dose in the evening. Suitable for excessive leukorrhea.

　　3. Fresh portulaca oleracea 200 grams, raw eggs 2. Crush the portulaca oleracea and filter the juice, remove the yolks from the raw eggs, mix the egg whites with the portulaca oleracea juice, stir well, and drink with boiling water. Take once a day. Suitable for excessive leukorrhea.

　　4. Cuttlefish 100 grams, lean pork 200 grams, Chinese yam 10 grams, lotus seeds 4 grams. Cut the cuttlefish and pork into pieces, boil with Chinese yam and lotus seeds. Eat the meat and drink the soup. Suitable for excessive leukorrhea.

　　5. White bean 250 grams. Roast the white bean, grind it into powder, take 6 grams twice a day, with congee as a medicine. Suitable for excessive leukorrhea.

　　6.韭菜根适量，鸡蛋1个，红糖10克。将韭菜根洗净，水煎，调红糖煮熟后共食用。每日1剂，连服7天。适用于白带过多。

　　Second, what foods are good for vulvar vestibulitis

　　1. Eat more foods rich in protein and sugars. For example: milk, soy milk, eggs, meats, etc.

　　2. Drink more water and eat more fresh fruits and vegetables. Such as apples, pears, bananas, strawberries, kiwi, cabbage, green vegetables, rapeseed, mushrooms, seaweed, kelp, etc.

　　3. Prefer cool blood and detoxifying foods. Such as mung beans, glutinous rice, cucumbers, bitter melon, portulaca oleracea, green tea, etc.

　　Three, it is best not to eat certain foods with vulvar vestibulitis

　　1. Avoid foods that may cause allergic reactions. Such as fish, shrimp, crab, chicken heads, pork heads, goose meat, chicken wings, chicken feet, etc., which may worsen the itching and inflammation in the private parts.

　　2. Try to eat less spicy and stimulating foods. For example: onions, pepper, chili, Sichuan pepper, mustard greens, fennel.

　　3、避免吃油炸、油腻的食物。如油条、奶油、黄油、巧克力等，这些食物有助湿增热的作用，会增加白带的分泌量，不利于病情的治疗。

　　4、戒烟戒酒。烟酒刺激性很强，会加重炎症。

　　一、外阴前庭炎中医治疗方法偏方：

　　1、金银花、蒲公英、野菊花、地丁、天葵子各15克，赤芍、丹皮各12克，制乳香、制没药各10克，生甘草6克。

　　2、金银花、连翘、赤芍、丹皮各15克，当归、皂刺、制乳香、制没药、贝母、白芷各10克，生甘草6克。

　　3. Each 10 grams of Cornu Cervi, Raw Rehmannia, Bupleurum chinense, Cinnamon, Pinellia ternata. Each 6 grams of Ephedra, Prepared ginger, Licorice.

　　Secondly, Western medical treatment methods for vulvovaginitis

　　1. Drug Treatment

　　Topical application of 1% hydrocortisone ointment, while applying 2% to 5% lidocaine solution locally to relieve sexual discomfort. When the above treatments are ineffective or the lesion is severe, high-efficiency corticosteroids such as 0.025% fluocinolone or 0.1% triamcinolone acetonide ointment can be used topically. Other treatments such as warm water sitting bath, applying liquid paraffin for lubrication before sexual intercourse. In recent years, reports have shown that local or intramuscular injection of interferon alpha has some efficacy, with a success rate of 50%. Some patients may find antihistamines effective. Due to the central analgesic effect of tricyclic antidepressants and their effectiveness in secondary depression, they can be used. The efficacy of antibiotics is not certain, such as oral imidazole antifungal drugs, metronidazole, which are ineffective.

　　2. Surgical Treatment

　　Treatment methods include vestibular plastic surgery and vestibular resection (modified perineal plastic surgery), the latter has better efficacy, with a success rate of 60% to 90%. Vestibular plastic surgery involves a longitudinal incision of the vaginal wall at the vaginal orifice, especially the posterior mucosa, followed by horizontal suturing of the vaginal mucosa and perineal skin, thereby enlarging the vaginal orifice. Vestibular resection involves the removal of the mucosa at the painful vestibular site, followed by subperiosteal separation of part of the vaginal mucosa for coverage. Partial or total vestibular resection can be chosen according to the condition. There are reports that laser or surgical removal of the vestibular gland distribution area is helpful to improve symptoms in some patients, but there is a lack of long-term follow-up study data.