His and Her Health

Dr. Goldstein- I am a physician assistant, and also a patient with new vulvar vestibilitis for less than a year. I was wondering if you have heard of this problem before:<P>In addition to my external vulvar symptoms, I have also been having what feels like pain just inside the vagina and a feeling of painful stretching, like I might tear. On self-exam, I discovered a small band of thickened hymenal ring on one side which does not stretch well and which is very painful when stretched. I have been sexually active for 10 years and have never had this problem before. <P>In doing Internet searches, I found one passing mention of "hymenal fibrosis" as a consequence of vulvodynia/vulvar vestibulitis. I have never heard of this before, and have not been able to find anything else about it anywhere, but this seems like it could be consistent with what I am experiencing. I'm not asking for your diagnosis, of course, but is this something that you have heard of, and do you know whether manual stretching or dilators may help such a condition? Thank you.

The underlying pathology of vestibulitis is that there are too many nerve endings in the vestibular mucosa (skin). These nerve endings are nociceptors- a special type of nerve ending that are responsibel for the sensation of pain and stretch. That is why women with vestibulitis feel like they are tearing or ripping with penetration. To my knowledge, vestibulitis does not cause fibrosis but there are other dermatologist disorders of the vulva that can. These disorders can be confused with vestibulitis and I suggest that you see a vulavr specialist to try to determine the cause of your pain. <P>------------------<BR>Andrew T. Goldstein<BR>Director, The Center For Vulvovaginal Disorders