“Primary” versus “secondary” vulvar vestibulitis: One disease, two variants

Objective: Our aim was to determine whether women with primary vestibulitis—since the first episode of sexual intercourse—differ in disease characteristics and outcome of operative treatment from women with secondary vestibulitis. Study Design: A total of 111 patients with severe vulvar vestibulitis underwent perineoplasty from 1991 to 1995. Thirty-nine (35%) of them had primary vestibulitis (ie, dyspareunia from the first attempt at sexual intercourse). They were compared with 72 (65%) who had secondary vestibulitis with regard to demographic, social, and medical variables, the presence of human papillomavirus deoxyribonucleic acid, physical and histopathologic findings in the vestibule, and surgical outcome. Results: Women with primary vestibulitis were 5 years younger than those who had secondary vestibulitis (22.9 ± 2.9 years vs 27.7 ± 8.6 years, respectively; P< .0001) and differed in their marital status (unmarried, 84% vs 56%, respectively; P< .008), parity (nulliparous, 97% vs 67%, respectively; P< .0002), and involvement of the whole vestibule (74% vs 93%, respectively; P< .006). The 2 groups were similar in all other variables, including use of oral contraception, smoking, presence of human papillomavirus, dysuria, success of perineoplasty (average, 83%), and histopathologic findings. Conclusions: Women with primary vestibulitis were younger than women with secondary vestibulitis. Most other differences were dependent on the different ages of the 2 groups. Primary and secondary vestibulitis may therefore be two presentations of the same disease. (Am J Obstet Gynecol 2001;184:28-31.)