MEMBRANOUS HYPERTROPHY OF THE POSTERIOR FOURCHETTE AS A CAUSE OF DYSPAREUNIA AND VULVODYNIA

Twenty-one women were treated surgically for entry dyspareunia and vul vodynia. The ages of the patients ranged from 18 to 39 years (mean, 24 .5). Physical examination showed the presence of membranous hypertroph y of the posterior fourchette with consequent stricture of the vaginal introitus in all the patients. Eighty percent of the patients had ery thema and tenderness of the vestibule, particularly in the posterior p art. The histologic findings were somewhat enigmatic and quite unimpre ssive, frequently suggestive of chronic nonspecific inflammation; in o nly two cases were histologic changes suggestive of human papillomavir us infection observed. All the patients underwent excision of the post erior part of the vestibule with vaginal advancement under general ane sthesia. Follow-up showed elimination of the symptoms in 19 patients a nd an improvement in the symptoms in the remaining 2.