Vulvar vestibulitis syndrome (VVS), also called vestibulodynia and localised provoked vulvodynia (LPV), a subset of vulvodynia, is a complex vulvar pain syndrome (VPS) characterised by altered pain sensation. VVS causes severe dyspareunia and affects mainly young women. Recent studies on VVS have demonstrated activation of vestibule-associated lymphoid tissue (VALT) which may emerge as a response to localised inflammation. Immune activation enhances epithelial nerve growth in the vestibular mucosa causing allodynia. No uniformly effective treatment exists. Clinical algorithms have been developed to augment the management of VVS.
Methods and results: Surgical treatment is usually offered to the most severe cases refractory to conservative treatment modalities, including discontinuation of oral contraceptives, physical therapy for pelvic floor dysfunction, and antimycotic maintenance therapy. Vestibulectomy operation is strikingly effective is severe cases, and has high patient satisfaction. Vestibulectomy is a day surgery operation with low risk for postoperative complications. Recurrence rate is low. In the operation, vestibular mucosa is removed, and replaced by properly liberated vaginal mucosa.
One problem is the lack of randomised controlled trials of vestibulectomy. This is not surprising, since vestibulectomy is generally offered as the last resort in the most severe refractory cases. Long-term follow-up studies have demonstrated that this operation has favorable outcome and significantly improves the quality of life of women with severe VPS.