Vulvar vestibulitis syndrome (VVS), or vestibulodynia, is a complex pain syndrome which is increasingly recognised, and has a major impact on the quality of life of many women.
Multiple treatment modalities have been used with relatively poor success.
Vestibulectomy can be used in refractory cases of severe VVS if conservative therapies have failed.
Modified posterior vestibulectomy by day surgery will be described.
The vestibulectomy case series consisted of 117 women with severe VVS and no response to conservative therapy.
Both short-term and long-term outcomes are reported among 92 of the 117 women.
Of the vestibulectomy cases, 18 developed minor postoperative problems, mean duration of wound pain was 14 days, mean duration of sick leave was 13 days, and a mean of 6 weeks was needed for full recovery.
Long-term outcome after a mean of 4 year follow-up showed that 76% were sexually active, Beck deppression score was 4 (mean), general health score (EQ-5D) was 8 (mean), and 24 women had had delivery postoperatively.
Preoperative VAS was 9.0 (mean) and postoperative VAS was 2.0 (mean).
Overall rate of satisfactory response was 90%, and 89% of the women would have choosed the operation again.
Day surgery by posterior vestibulectomy is strikingly effective in refractory cases of vulvar vetibulitis syndrome.