Pain on vestibular touch or vaginal entry (dyspareunia) by intercourse, tampon, etc. is characteristic. Erythema may be variable. Brightly erythematous patches which are exquisitely tender upon Q-tip palpation may be seen as the openings of the minor vestibular glands. It has been reportedly associated with subclinical HPV infection, recurrent candidiasis or persistent alteration of the vaginal mucosal pH. Most cases, however, are idiopathic.
A thorough examination with culture for Candida should be done. The patient should be educated about the disease as much as possible, e.g. not a sign of a serious disease, not contagious, that therapy is somewhat of a trial and error procedure. Initially, amitriptyline at a low dose (e.g. 5 mg QHS) may be started and increased. A mid-potency steroid may be given is pruritus is significant. Intralesional interferon alfa may also be tried. If all these fail, surgical excision of the affected areas may give relief.