Professor Jacob Bornstein
Western Galilee Hospital, Nahariya, Israel

Test for Vestibulitis

Vulvar Vestibulitis:
Friedrich’s criteria of diagnosis
1. Severe pain with vestibular touch
2. Sensitivity is limited to the vestibule
3. Erythema of various degrees (may be absent)

Outcome of surgery for Vulvar Vestibulitis
Age
17-80
Follow-up in years
CR
0.2-10
PR
371
(57%)
103
(16%)
Outcome
NR CR+
PR
104
(16%)
68
(11%)
Total
646
(100%)
Bornstein et al. Obstet Gynecol 1999;93:876-880

• Lichen Sclerosus
• How to do a vulvar biopsy
• Approach to chronic vulvar pruritus

Clinical characteristics of
Lichen Sclerosus:
1. Lichenification and vulvar + perianal pruritus
5. Lichenification, including thickening of the skin, a thick keratin layer and emphasizing the skin fissures
6. Fissure
2. Second stage – Thinning of the labia minora mucosa, rendering it easy to become lacerated
7. Involvement of the vulvar and perianal area in the figure of “8”
3. The anterior parts of the labia minora adhere to each other and produce Phymosis covering the clitoris
4. Ecchimoses – sign of scrathing the skin
8. Stenosis of introitus –
“Kraurosis”
9. Rare prior to adolescence.
Spontaneously resolve after puberty in 50%
10. Rarely extra-genital –
Forearm and breasts

Keye’s dermal punch
Vulvar biopsy

•Sterilization
•Topical anesthetic – Esracaine,
Emla
•Local anesthetic
•Sample the ulcer’s margin
•Take several biopsies from a large lesion
•Do not compress the specimen
•Immerse in Formalin immediately

•Dizziness
•Tinnitus
•Peri-oral itch
•Metal taste
•Tremor
•Convulsions
•Myocardial depression

Lichen Sclerosus
Histopathologic diagnostic criteria:
1. Thin hyperkeratotic layer
2. Thinning of the epithelial layer
3. Flatenning of the papillae
(Rete pegs)
4. Homogenization of the stroma
5. Deep lymphocitic infiltration

Lichen Sclerosus histopathologic diagnostic criteria (Repeat):
1. Thin hyperkeratotic layer
2. Thinning of the epithelial layer
3. Flatenning of the papillae (Rete pegs)
4. Homogenization of the stroma
5. Deep lymphocytic infiltration

• chronic inflammation / atrophy
• autoimmune disease
• deficiency in dehydro-Testosterone

Local steroids Genital care
Symptomatic treatment
Clobetasol propionate 0.05%
Sitz baths avoid strong soaps -
Anti-histamine (Otarex)
Emla 5%; Eurax 10%
-Avoid tight synthetic underwear

Dermovate (Clobetasol
Propionate 0.05%)
Cream or Ointment
Instruction for the use of Dermovate:
•Twice a day for two weeks
•Once a day for one month
•Twice a week for two months
•As needed

• 3 month assesment
• 6 month follow-up
• 1 yearly follow-up
• Every persistent ulceration or new growth must be examined – risk of malignant transformation: 3%-5%