Vulvar vestibulitis syndrome: a clinical approach.

Vulvar vestibulitis syndrome (VVS) is a heterogeneous, multisystemic, and multifactorial disease and is one of the leading causes of dyspareunia in fertile women. As a multisystemic disease, it involves the mucous structure of the vulvar vestibule and the immune, muscular, vascular, and nervous systems, including pain fibers and centers. As a multifactorial disease, its etiology is complex, involving biological, psychosexual, and relational factors. In this article, we discuss the progression of the disease and the impact of an often lengthy delay between the onset of symptoms and a correct diagnosis. Moreover, despite documented improvements from available treatments, VVS becomes a chronic disease unless it is diagnosed early and an integrated, pathophysiologically oriented treatment is offered in an experienced center. Health care providers would therefore benefit from approaching the condition within a pain management framework focused on the woman's chronic pain, the impact on the couple's relationship, and any associated psychological sequelae.