The Vulvar Vestibule, a Small Tissue with a Central Position: Anatomy, Embryology, Pain Mechanisms, and Hormonal Associations

  • Ahinoam Lev-SagieEmail author
  • Ronit Gilad
  • Diana Prus
Urology, Gynecology, and Endocrinology (J Simon and M Luria, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Urology, Gynecology, and Endocrinology
  2. Topical Collection on Urology, Gynecology, and Endocrinology


The vulvar vestibule is the tissue located between the vagina and the vulva, comprising the vaginal introitus. It is mainly considered in the context of localized provoked vestibulodynia, a pain condition causing dyspareunia in 8–16% of women.

Purpose of Review

To describe the vulvar vestibule’s unique properties, which may have a role in the development of vestibular tenderness and dyspareunia.

Recent Findings

The vestibule displays different neural features when compared with neighboring organs. It is an immunologically diverse tissue that exhibits highly localized and tissue-specific pro-inflammatory responses. Systemic, as well as local hormonal-associated processes regarding estrogen, androgens, and usage of hormonal contraception apear to influence the pain threshold in the vestibule.


The vestibule, emerging from the embryonic endoderm, exhibits unique features regarding innervation, inflammation, and hormonal stimuli. A better understanding of these mechanisms is required in order to advance our understanding of introital dyspareunia.


Vulvar vestibule Provoked vestibulodynia Dyspareunia 


Compliance with Ethical Standards

Conflict of Interest

Ahinoam Lev-Sagie, Ronit Gilad, and Diana Prus each declares that they have no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Hadassah Medical Center, The Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
  2. 2.Department of Pathology, Hadassah Medical Center, The Faculty of MedicineHebrew University of JerusalemJerusalemIsrael

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