Surgical Treatment for the Vulvar Vestibulitis Syndrome

Abstract

This study is an evaluation of surgical treatment for vulvar vestibulitis, a major cause of superficial dyspareunia in premenopausal women. Its estimated prevalence in a general gynecologic population is 15%. Those affected have severe vestibular pain on touch or vaginal entry as well as tenderness to pressure within the vulvar vestibule. It is not uncommon for symptoms to last longer than 6 months with no apparent cause. The investigators reviewed the records of 155 women 40 years of age or younger who were operated on for this condition in the years 1998 through 2001. Just over 80% of these women (n = 126) were interviewed by telephone 1 to 4 years postoperatively. A single gynecologist performed all operations in a uniform manner under general anesthesia on an outpatient or short-admission setting. Vestibulectomy and advancement plasty are carried out. The procedure entails total removal of the hymen and the full thickness of skin on the adjacent vestibulum (Hart's line and the fourchette are boundaries). The remaining defect is covered by vaginal wall after it has been undermined and advanced. Vaginal dilation exercises with a mold begin 6 weeks postoperatively if wound healing is satisfactory; at the same time, women are encouraged to begin or resume intercourse. The phone interview, carried out a median of 37 months after surgery, revealed that 93% of women were able to have intercourse and that 62% had no pain in doing do. Just over 60% of women had no postoperative complications. The most common problem, affecting approximately one fourth of patients, was decreased lubrication during sexual arousal. Eight patients (6%) developed a Bartholin's cyst. The odds ratio (OR) for being able to have intercourse only after surgery was 3.43 (95% confidence interval [CI], 1.48-7.96). For women 30 years of age or younger, the OR was 8.20 (95% CI, 1.54-43.73). Younger women were especially disposed to suggest the procedure to other patients. The results were basically the same after adjusting ORs for the follow-up interval. The outcome of surgery could not be related to parity, the ability to have intercourse before surgery, or previous nonsurgical treatment. Surgery has a role in the management of vulvar vestibulitis syndrome; and, because there is a low risk of surgical complications, it can be presented as a potentially helpful option when medical measures have proved not to be effective.