BEHAVIORAL-APPROACH WITH OR WITHOUT SURGICAL INTERVENTION TO THE VULVAR VESTIBULITIS SYNDROME - A PROSPECTIVE RANDOMIZED AND NON RANDOMIZEDSTUDY

This article describes the outcome of a behavioral approach with or wi thout preceding surgical intervention in 48 women with the vulvar vest ibulitis syndrome. In the first part of the study, 14 women with the v ulvar vestibulitis syndrome were randomly assigned to one of two treat ment programs: either a behavioral approach or a behavioral approach p receded by surgery In the second part of the study, 34 women and their partners were given a choice of treatment. Follow-lip data were gathe red a mean of 3 and 2 1/2 years after treatment, respectively In the r andomized patient population, the intervention had a positive effect o n all of them: the complaints disappeared diminished or did not change but formed less of a problem. The difference in outcome between the t wo different treatments, a behavioral approach with or without precedi ng surgery, war not statistically significant. In the second non-rando mized part of the study, 28 out of the 34 women (82%) chose the behavi oral approach without preceding surgery. The difference in outcome bet ween the two treatments was not statistically significant. Two out of the 28 women who chose behavioral treatment without preceding surgery had to be referred for psychiatry consultation because of serious psyc hosexual problems. In one woman, psychiatric treatment was successful. Three other women, whose behavioral treatment failed underwent additi onal surgery, which clearly helped them to overcome the deadlock in th e behavioral approach. The behavioral approach should be the first cho ice of treatment for the vulvar vestibulitis syndrome. Surgical interv ention should be considered as an additional form of treatment in some cases with the vulvar vestibulitis syndrome to facilitate breaking th e vicious circle of irritation, pelvic floor muscle hypertonia and sex ual maladaptive behavior.