Vestibulectomy for Vulvar Vestibulitis

Abstract

At the Mayo Clinic, vulvar vestibulitis is treated with vestibulectomy consisting of simple excision of the vulvar vestibule as described by Bomstein and Kaufman. The authors conducted a review of the medical records of their patients who underwent vestibulectomy between 1986 and 2002, and identified 45 who met the definition of vestibulitis described by Friedrich: 1) focal, reproducible points in the vestibule exquisitely tender to light touch; 2) coincident focal area of erythema; and 3) a history of superficial dyspareunia or severe pain on attempted vaginal entry. In addition, a pathologic diagnosis of chronic inflammation only was required. Participants were interviewed by phone at least 6 months after surgery and asked to rate their pre- and postoperative symptoms on a scale from none (0) to 15. Forty-two patients were available for inclusion in the analysis. Their median age was 29 years. On average, women had experienced symptoms of vulvar vestibulitis for 40.7 months (range, 6-240 months) before surgery. There were no diagnoses of psychiatric problems or major medical problems at the time of treatment. Thirty-eight women reported at least a substantial improvement in their symptoms of vulvar vestibulitis. These patients had an average preoperative score of 8.9 (range, 3-13) and an average postoperative score of 1.3 (range, 0-8) (P <0.01). Four women had no improvement in symptoms. Their average pre- and postoperative scores were 7.0 (range, 3-10) and 7.3 (range, 6-10), respectively.