If you have persistent vulvar pain that hasn’t responded to treatment and is severe and interfering with your enjoyment of life, you may be a candidate for surgery.
Surgery is usually only available if you have a condition called vestibulodynia or provoked vulvodynia (formerly known as vulvar vestibulitis).
Vestibulodynia was first described in 1988 by an American gynaecologist named Edward Freidrich after he had observed a number of women who had severe pain and burning of the vestibule of the vagina.
The vestibule is the external area of skin where the vulva meets the vagina. It was originally thought that this area was inflamed, hence the term "itis". The medical profession later changed the name of the disorder because they now think that the problem originates from changes in nerve fibers rather than inflammation.
Symptoms include:
• Pain when touched, even if lightly
• Pain when trying to insert tampons (some women can’t)
• Pain when attempting intercourse
• Pain after intercourse
• Pain when wearing tight clothing or when sitting on hard chairs
• Sore genital skin
The pain is often described as a burning sensation in the vulva. Vestibulodynia differs from vulvodynia because it only occurs when the area is touched and is localized to the vestibule.
Vulvodynia is constant pain with no trigger, sometimes in multiple areas of the genitals (for instance, the labia and clitoris may hurt too).
When the pain is localized in vestibulodynia, an operation may be possible to remove the affected area of skin. This is called a vestibulectomy.
About Vestibulectomy
The skin at the vestibule is removed. It depends how severe your symptoms are as to how much the surgeon will remove. In moderate cases, only a small amount of tissue is removed.
In more extreme cases, radical surgery can be done to remove much of the external genitalia (the labia and skin near the anus). You will then be given dissolvable stitches to cover over where the skin was removed.
The procedure is done with a general anaesthetic. After surgery, antibiotic ointment is placed on the incision area and covered over with gauze to help prevent you getting an infection and you will be given painkillers afterwards to ensure you are comfortable.
You may need to stay in hospital for a couple of days. If a minor amount of skin was removed and you aren’t having any complications, it can be done as a day case surgery.
Recovery takes around 6 to 12 weeks.
You should have regular baths to keep the area clean and reduce post-operative pain. You may also be advised to use steroid cream to ease inflammation and a vaginal dilator. This gently stretches the skin to prevent scar tissue becoming problematic.
Does it Work?
Surgery is usually only given as a last resort, however, a review of the technique found it to be effective. One hundred and thirty-four women who had had vestibulectomies at one of three different surgeons were contacted by telephone between 12 and 72 months after surgery.
Of this group, 97 women (93 percent) were satisfied with the outcome of their surgery. Seven women (7 percent) reported a recurrence of their symptoms after surgery and only three women (3 percent) reported that their vestibulodynia was worse.
Before surgery, 72 percent of the women had such severe symptoms that they were unable to have intercourse. After surgery, only 11 percent of the women could not have intercourse so if your symptoms are very severe and you have tried other treatments without success, you may want to consider surgery as an option. (J Sex Med)
In the United States, contact the National Vulvodynia Association for more information and resources to find a specialist who treats women with this condition at http://www.nva.org/ . In the UK, contact The Vulvar Pain Society at http://www.vulvalpainsociety.org/vps/ .
Sources:
Surgery for vulval pain, The Vulval Pain Society. Web. 29 February 2012. http://www.vulvalpainsociety.org/vps/index.php/treatments/surgery-for-vulval-pain
Vestibulectomy, Sexual Med. Web. 29 February 2012. http://www.sexualmed.org/index.cfm/sexual-health-treatments/for-women/vestibulectomy
Vulvar vestibulitis treated by modified vestibulectomy, Int J Gynaecol Obstet. 1999 Feb;64(2):147-52.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10189023
Surgical treatment of vulvar vestibulitis syndrome: outcome assessment derived from a postoperative questionnaire, J Sex Med. 2006 Sep;3(5):923-31.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/16942537
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
Reviewed February 29, 2012
by Michele Blacksberg RN
Edited by Jody Smith