Original Article
Evaluation of the surgical treatment of vulvar vestibulitis

https://doi.org/10.1016/S0301-2115(99)00061-5Get rights and content

Abstract

Objective: To assess the efficacy of perineoplasty in the management of vulvar vestibulitis. Study design: Forty-two women who had undergone operative perineoplasty for the treatment of vulvar vestibulitis completed a questionnaire, a mean of 4.8 years postoperatively. Results: Vulvodynia was constant or daily in 29 (69%) before surgery and in eight (19%) of respondents after surgery. In all, 27 (80%) of 34 women who had preoperative vulvar discomfort reported that the discomfort was much better or absent following surgery. Before surgery, 26 (70%) of 37 women who were not celibate for reasons other than vulvar vestibulitis, were celibate because of vulvar vestibulitis or always had pain during coitus and sometimes had to discontinue coitus because of pain. In contrast, only two (5.7%) of 35 women had this degree of dyspareunia following surgery. Similarly, 28 (85%) of 33 sexually active women who had dyspareunia before surgery reported that intercourse was much less painful or pain-free following surgery. Conclusion: Perineoplasty has a role in the management of vulvar vestibulitis for women who do not achieve satisfactory relief of vulvodynia and/or dyspareunia with nonoperative treatments.

Introduction

Although a reference to vulvar vestibulitis can be found in the medical literature over 100 years ago [1], the disease did not enter current medical awareness until the landmark paper by Woodruff and Parmley [2] in 1983. Subsequent publications [3], [4], [5] have categorized vulvar vestibulitis (also known as focal vulvitis and inflammation of the lesser vestibular glands), as an idiopathic disorder of reproductive-age women. The average age of onset is 25 years. Most patients are Caucasian. Symptoms include vulvar discomfort and dyspareunia. Examination is notable for focal areas of erythema and tenderness in vaginal vestibule adjacent to the hymen, compression of which reproduces the discomfort experienced during intercourse.

As with most disorders of unknown cause, a plethora of treatments have been recommended. Most of the suggested treatments initially provided favorable outcomes in a few patients, and fell into disfavor as wider application of the treatment was associated with disappointing results. Currently recommended treatments include diet and medication aimed at reducing urinary oxalate excretion [6] and biofeedback [7].

In their original paper, Woodruff and Parmley [2] described a surgical treatment for vulvar vestibulitis which, in their hands, was curative in most patients. Subsequent publications [8], [9], [10], including a randomized trial by Bornstein and associates [8], have confirmed the utility of the Woodruff procedure. The operation includes resection of the hymen and vestibule with mobilization of the lower vagina to cover the resulting defect.

In order to further assess the utility of perineoplasty for vulvar vestibulitis, we conducted this questionnaire survey of our patients who had undergone the procedure.

Section snippets

Materials and methods

The diagnosis of vulvar vestibulitis was made using the criteria outlined by Friedrich [4]. Briefly, women were considered to have vulvar vestibulitis if they presented with unprovoked vulvar discomfort (vulvodynia) and/or introital dyspareunia, had focal vestibular erythematous lesions palpation of which reproduced the dyspareunia, and had no evidence of an infectious (vulvovaginal candidiasis, herpes simplex virus infection, etc) or dermatologic (lichen planus, lichen sclerous, etc) cause of

Results

The level of vulvar discomfort before and after surgery and the patients’ retrospective opinion as to whether this had improved or not are shown in Table 1, Table 2. Similarly, self-reported degrees of dyspareunia before and after surgery are shown in Table 3, Table 4.

We also asked the participants if they had to do it over again, would they undergo surgery for vulvar vestibulitis. Thirty one (74%) responded yes, three (7.1%) responded no, while eight (19%) indicate that they were not sure. Ten

Comment

The 42 patients described in this report primarily include women with severe vulvar vestibulitis who had failed to respond to conservative management. They had been symptomatic for an average of 3.5 years before surgery. Most (29; 69%) reported daily or constant vulvodynia and 33 (79%) of them always had pain during intercourse or were celibate because of dyspareunia.

Few of the patients included in this survey had received currently popular noninvasive treatments such as a low oxalate diet with

Condensation

Perineoplasty improved vulvar discomfort and dyspareunia in about 80% of women with vulvar vestibulitis unresponsive to conservative management.

References (11)

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