Human papillomavirus in vulvar vestibulitis syndrome.

OBJECTIVE: To investigate the prevalence of human papillomavirus (HPV) in patients with vulvar vestibulitis syndrome by using a recently developed polymerase chain reaction (PCR) primer set that detects known papillomavirus types. STUDY DESIGN: We retrospectively identified 38 patients with vulvar vestibulitis who underwent therapeutic surgical excision of the vestibule. Eleven controls without vestibulitis who underwent vestibular excision for conditions unrelated to HPV infection were identified prospectively. Surgical specimens were examined for the presence of HPV DNA by PCR amplification. DNA sequencing was used to determine HPV type. RESULTS: The prevalence of HPV among patients with vestibulitis was 21% vs. 36% among controls. Group B HPV types accounted for 4 of the 10 (40%) HPV types found in patients with vestibulitis. Overall, in both patient and control samples, a spectrum of HPV types was identified, encompassing many branches of the HPV phylogenetic tree. No etiologic association was apparent. CONCLUSION: This study did not support an association of HPV with vulvar vestibulitis. The low rate of observed infection in women with and without vestibulitis and the diversity of HPV types identified suggest incidental virus carriage rather than direct cause and effect. The underlying cause of this debilitating condition remains unknown.

Vestibulectomy for vulvar vestibulitis.

OBJECTIVE: To determine if surgery is an effective therapy for vulvar vestibulitis. STUDY DESIGN: A retrospective chart review of all patients having vestibulectomy at the Mayo Clinic, Rochester, Minnesota, from 1992 to 2001 was performed. A scoring system measuring objective and subjective findings was used both preoperatively and postoperatively to assess the effects of surgery. A paired t test was used to analyze the difference between preoperative and postoperative symptom scores. The Wilcoxon signed-rank test evaluated changes in symptom scores. RESULTS: Thirty-eight of 42 patients (90%) with "pure" vulvar vestibulitis, as determined by physical findings and pathologic confirmation, had a significant improvement (P < .01) in their symptoms. The remaining 4 patients had confounding factors that may explain their lack of improvement. CONCLUSION: Vestibulectomy is a simple and very effective treatment for vulvar vestibulitis.

Pelvic Castleman disease presenting as vaginal occlusion.

BACKGROUND: Castleman disease is a lymphoreticular disorder, which may be clinically silent. However, systemic manifestations can occur, which include generalized adenopathy and life-threatening bronchiolitis obliterans. CASE: A woman presented with vaginal mucosal lesions recalcitrant to initial treatment efforts. Progression of the disease required hospitalization for pulmonary involvement. Castleman disease was diagnosed after extensive multidisciplinary evaluation and excision of a pelvic mass. The patient's symptoms dramatically improved postoperatively. CONCLUSION: Castleman disease should be included in the differential diagnosis in patients with paraneoplastic symptoms and a pelvic mass.