Presentation Authors: Rachel Rubin*, Elizabeth Malphrus, Washington, DC, Christine Mayuga, Washington , DC, Lucy Treene, James Simon, Washington, DC
Introduction: Vestibulectomy is a surgical procedure performed for the treatment of superficial dyspareunia caused by vestibulodynia and is typically done when conservative management has failed. Surgery is performed in an outpatient setting and results in the removal of the entire vulvar vestibule, including all underlying endodermally derived tissue, and advancing a vaginal flap onto the perineum. Relatively few vestibulodynia patients ultimately require surgical intervention, and as a result, data on their experiences and outcomes is limited. We set out to elucidate the post-operative experiences of patients who have undergone this procedure in single center.
Methods: We conducted a retrospective chart review of vestibulodynia and dyspareunia patients in a private practice in Washington, DC focused on Women&[prime]s Health and Sexual Medicine. Additionally, an internet-based survey was sent to patients who underwent vestibulectomy to assess post-operative experience and satisfaction.
Results: From 2013-2017 there were 676 new patients with vulvodynia. Of those, 39 underwent vestibulectomy surgery (5.8%). Age at time of surgery averaged 28 (ranging 18-50). The average length of time from diagnosis to surgery was 520 days. An Internet survey was sent to all 39 surgical patients with 29 responses (74.3%). 26 of 29 (89.7%) reported being able to have comfortable intercourse after surgery (13 reporting this was not 100% of the time), with the remaining 3 patients reporting they had not yet attempted penetration. Time to comfortable intercourse averaged 4-6 months in more than half of responders. When asked &[Prime]if you could go back in time, knowing what you now know about the effects of your vestibulectomy, would you choose to have this surgery?&[Prime] 100% responded &[Prime]yes&[Prime]. Additionally, patients reported improvements in desire (n=13), arousal (n=8), orgasm (n=6), and enjoyment (n=19). The average recovery time (back to work/school) was reported as 5 weeks (ranging 2 weeks-3 months). Complications included Bartholin cysts (n=8), and pelvic floor tightness (n=14), with 16 out of 29 patients reporting no complications (55.2%).
Conclusions: Vestibulectomy is a last-resort treatment for dyspareunia due to vestibulodynia that nonetheless has a very high rate of success with relatively minor complications. Patients typically attempt multiple medical and behavioral interventions before pursuing surgery. For patients who fail conservative therapy, vestibulectomy is a viable option that, based on our experience, has a high likelihood of improving symptoms and quality of life.