European Journal of Obstetrics & Gynecology and Reproductive Biology
Original ArticleEvaluation of the surgical treatment of vulvar vestibulitis
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.
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