Friedrich proposed criteria to identify women with the vulvar vestibulitis syndrome. This has been modified based on clinical experience.


Original criteria:

(1) Severe pain on touching the vestibule or attempting vaginal entry. In addition to sexual intercourse, the pain may be produced by any action that places pressure on the vulvar vestibule, including wearing pants, riding a bicycle or horse, or inserting a tampon.

(2) Tenderness to pressure localized to within the vulvar vestibule. Testing is often performed using a cotton swab (positive swab test).

(3) Physical findings confined to vestibular erythema of various degrees.



(1) The duration of symptoms should be at least 6 months.

(2) The presence or degree of erythema has limited diagnostic significance for many patients. (I read the original criteria as meaning that no other physical findings are present other than possibly erythema. Friedrich states that the erythema may be limited to a small area and that it may be so slight as to be easily overlooked.)

(3) Some researchers include the presence of nonspecific inflammation on histology as supportive evidence of the diagnosis.



• Techniques for applying the cotton swab to elicit tenderness vary between clinicians, and the amount of pressure can differ.


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