Association of human papillomavirus with vulvodynia and the vulvar vestibulitis syndrome.

Seven women presenting with longstanding introital dyspareunia and burning in the vulvar area were demonstrated, with DNA hybridization techniques, to harbor human papillomavirus (HPV). Three of the seven had intermittent, culture-negative dysuria coincident with the vulvar complaints. All the patients had mild to marked erythema of the openings of the minor vestibular glands, with exquisite tenderness on palpation with a cotton-tipped applicator. A regular histologic examination was equivocal for evidence of HPV infection in four of the seven cases. The clinical picture prior to acetic acid application exhibited three variations: (1) smooth epithelial surfaces devoid of papillations; (2) patchy papillations of the vestibular and adjacent structures; and (3) florid, fine papillomatosis of the vestibule and adjacent structures. We propose that HPV infection is one of the causes of vulvodynia and the vulvar vestibulitis syndrome.