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Comment and Controversy

Surgery is not the only effective treatment for vestibulitis

September 2009 · Vol. 21, No. 09
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I thought Dr. Soper’s article represented the typical, surgically oriented approach to vulvar vestibulitis with its emphasis on vestibulectomy and its assumption that interferon provides only moderate relief.

I’ve treated vulvar vestibulitis for 15 years and have used alpha-interferon (Alferon-N) with excellent results. When I first began managing this disorder, it was poorly understood, and it took me a year or two to determine the best approach. I eventually concluded that vestibulitis is caused by the human papillomavirus (HPV), though that link has not been proved definitively. However, it seems likely to me that a nonpathologic subspecies of HPV causes this condition. Accordingly, I began prescribing alpha-interferon, following the regimen for condyloma. I noticed that each patient began to improve after 5 or 6 weeks of treatment, and was symptom-free by the end of 8 weeks.

Most specialists treat the vestibulitis patient with interferon for 4 weeks. I have always treated the patient for 8 weeks, as it is only after 5 or 6 weeks that her symptoms begin to resolve. This improvement is not dependent on the dosage of interferon, though I prescribe a dosage that is markedly lower than the one that is prescribed for 4 weeks of treatment. Over 15 years, I have treated and essentially cured 55 patients, though I have only followed them for as long as 5 years. It is possible that symptoms may recur after 10 years or longer.

My concern now is that the company that has produced Alferon-N no longer does so. I’m looking into a similar interferon known as Intron, which is also used for condyloma, as well as for various types of cancer and hepatitis. I’m not sure whether I want to try a new medication, especially at dosages that may not be equivalent, but I would like to continue treating this problem. Why? Because it is rewarding to offer the patient a pain-free life, with complete resolution of her symptoms.

Richard G. Hofmann, MD
Carthage, NY

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