"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 inter-course). 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.