Vulvar Vestibulectomy for Neuroproliferative-Associated Provoked Vestibulodynia: A Retrospective Analysis

Abstract

Objective: This study was conducted to determine if women with neuroproliferative-associated vestibulodynia who had vulvar vestibulectomy had less vulvar pain and sexual distress than women with neuroproliferative-associated vestibulodynia who chose not to have this surgery. Materials and Methods: This was a retrospective analysis study of a vulvar disorders clinic database. A database review was used to identify 227 women diagnosed with neuroproliferative-associated vestibulodynia for whom conservative treatment failed and who were advised to have vulvar vestibulectomy. Of the 227 women, 101 elected to undergo vestibulectomy and 126 declined the procedure. Ninety-eight of the 101 women who had surgery and 40 of the 126 who declined surgery answered an online questionnaire. Results: Compared to women who had vestibulectomy, women who declined this surgery were more likely to report significant persistent vulvar burning (29.58% versus 80%; p < 0.001), vulvar rawness (23.450% versus 67.5%; p < 0.0001), vulvar cutting (9.18% versus 30%; p < 0.002), and sexual distress, as measured by the Female Sexual Distress Scale (18.88 versus 25.925; p = 0.005). In addition, 97% of surgical pathology specimens met the histopathologic criteria for neuroproliferative-associated vestibulodynia. Conclusions: This study demonstrated the importance of the 2015 International Society for the Study of Vulvovaginal Disease/International Society for the Study of Women's Sexual Health/International Pelvic Pain Society vulvodynia nomenclature emphasizing that treatment should be chosen according to possible associated factors rather than using a “shotgun” approach. The correlation between the presumptive preoperative diagnoses and the confirmatory postoperative histology validates the vulvar-pain diagnostic algorithm previously published by King and colleagues. Finally, this study provides further evidence that vulvar vestibulectomy can be an appropriate first-line treatment for women with neuroproliferative-associated vestibulodynia. (J GYNECOL SURG 34:58)