Bergeron S, Binik Y M, Khalifé S, Pagidas K
Department of Psychology, McGill University, Montréal, Québec, Canada.
Clin J Pain. 1997 Mar;13(1):27-42. doi: 10.1097/00002508-199703000-00006.
Vulvar vestibulitis syndrome (VVS) is thought to be the most frequent cause of dyspareunia in premenopausal women and is one of the major subtypes of vulvodynia. Vulvar vestibulitis is a chronic, persistent clinical syndrome characterized by severe pain on vestibular touch or attempted vaginal entry, exquisite tenderness to a cotton-swab palpation of the vestibular area, and physical findings confined to vestibular erythema. The purpose of this paper is to critically review the descriptive, diagnostic, etiologic, and treatment studies on VVS. Methodological problems are highlighted, and future guidelines for research are proposed.
References were obtained from a MEDLINE search covering the period from January 1984 until June 1995. The indexing term "vulvar vestibulitis" was used, and the search was constrained to English-language articles. References from other relevant sources, such as texts and bibliographies, were also included.
All articles pertaining to VVS were reviewed.
All data relevant to the descriptive, diagnostic, etiologic, and treatment aspects of VVS were included.
Pain symptomatology tends to be underemphasized in the current descriptive studies. The trend in etiological research is to focus on biomedical factors such as candidiasis and human papillomavirus (HPV). Only a few studies adopt a nonreductionnist approach. Surgery is the treatment option with the highest reported success rate. Medical management is underinvestigated, considering its widespread use. Pain management techniques such as biofeedback and behavior therapy show promising results.
A pain syndrome conceptualization is suggested as the most useful approach for solving current empirical and clinical problems.
外阴前庭炎综合征（VVS）被认为是绝经前女性性交困难最常见的原因，也是外阴痛的主要亚型之一。外阴前庭炎是一种慢性、持续性临床综合征，其特征为前庭触诊或试图插入阴道时剧痛、前庭区棉拭子触诊时极度压痛，且体格检查结果仅限于前庭红斑。本文旨在对VVS的描述性、诊断性、病因学及治疗性研究进行批判性综述。突出方法学问题，并提出未来的研究指南。
参考文献来自MEDLINE搜索，涵盖1984年1月至1995年6月期间。使用索引词“外阴前庭炎”，搜索限于英文文章。还纳入了其他相关来源的参考文献，如教科书和书目。
对所有与VVS相关的文章进行了综述。
纳入了所有与VVS的描述性、诊断性、病因学及治疗方面相关的数据。
在当前的描述性研究中，疼痛症状往往未得到充分重视。病因学研究的趋势是关注生物医学因素，如念珠菌病和人乳头瘤病毒（HPV）。只有少数研究采用非还原论方法。手术是报道成功率最高的治疗选择。考虑到药物治疗的广泛应用，对其研究不足。生物反馈和行为疗法等疼痛管理技术显示出有前景的结果。
建议采用疼痛综合征概念化作为解决当前实证和临床问题的最有用方法。
