Abstract Introduction There is no standardization for pathology reporting of vestibulectomy specimens. Our current understanding of neuroproliferative vestibulodynia is limited, but it is understood to be mediated by the accumulation c-afferent nociceptors and mast cells. Histopathology is fundamental to our understanding of disease mechanism and treatment. Given how much remains unknown about the histology, physiology, and neuroplasticity of the vestibule, it is imperative that we take every opportunity to fully examine this tissue and its complex role in pain. Objective Describe current pathology reporting practices for vestibulectomy specimens Methods Data was collected using Epic and Cerner report tools to identify any patients between 1/2017 to 10/2023 with a surgical history of vestibulectomy. Forty-five patients were identified & confirmed to have a history of vestibulectomy. Charts were reviewed to locate surgical pathology reports (available through hospital EMR, CRISP, or Care Everywhere). Results Pathology reports were available for 37 patients. Thirty-one of these reports (84%) were from our own institution; six reports were from outside hospitals. Marked variability in pathology reporting was noted between pathologists and institutions. All but one pathology report notes inflammation. The one report that does not include language about inflammation only notes “negative for dysplasia or malignancy”. Twenty-nine reports comment on the absence of dysplasia, including two reports from other institutions. All pathology reports from our institution (100%), note lymphoid infiltrate; however, this is not noted on any of the 6 pathology reports from other hospitals. Nineteen of the 31 specimens (61%) examined at our institution included specific stains to test for mast cells and nerve fibers. Nineteen specimens were evaluated with Giemsa staining and 8 specimens were evaluated with CD117 staining to assess for mast cell density (measured in mast cells/hpf). The range of mast cell density was 1/hpf to 25/hpf, and the average mast cell density was 8.1/hpf. All 19 specimens stained with S100 noted a relative increase in nerve fibers in the superficial dermis. Conclusions Histopathology is a window of opportunity to better understand the pathophysiology of neuroproliferative vestibulodynia. There is no standard when it comes to examining and reporting on vestibulectomy specimens. This results in reporting inconsistencies, which limits our ability to compile data and draw clinical conclusions. As surgeons we can collaborate to advance our understanding of the pathophysiology of vestibulodynia. This starts with communicating with our pathology colleagues, requesting appropriate stains, and setting a standard for reporting. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Patty Brisben Foundation.